International Journal of Infectious Diseases (Feb 2023)
Outcomes of laboratory-confirmed SARS-CoV-2 infection during resurgence driven by Omicron lineages BA.4 and BA.5 compared with previous waves in the Western Cape Province, South Africa
- Mary-Ann Davies,
- Erna Morden,
- Petro Rousseau,
- Juanita Arendse,
- Jamy-Lee Bam,
- Linda Boloko,
- Keith Cloete,
- Cheryl Cohen,
- Nicole Chetty,
- Pierre Dane,
- Alexa Heekes,
- Nei-Yuan Hsiao,
- Mehreen Hunter,
- Hannah Hussey,
- Theuns Jacobs,
- Waasila Jassat,
- Saadiq Kariem,
- Reshma Kassanjee,
- Inneke Laenen,
- Sue Le Roux,
- Richard Lessells,
- Hassan Mahomed,
- Deborah Maughan,
- Graeme Meintjes,
- Marc Mendelson,
- Ayanda Mnguni,
- Melvin Moodley,
- Katy Murie,
- Jonathan Naude,
- Ntobeko A.B. Ntusi,
- Masudah Paleker,
- Arifa Parker,
- David Pienaar,
- Wolfgang Preiser,
- Hans Prozesky,
- Peter Raubenheimer,
- Liezel Rossouw,
- Neshaad Schrueder,
- Barry Smith,
- Mariette Smith,
- Wesley Solomon,
- Greg Symons,
- Jantjie Taljaard,
- Sean Wasserman,
- Robert J. Wilkinson,
- Milani Wolmarans,
- Nicole Wolter,
- Andrew Boulle
Affiliations
- Mary-Ann Davies
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Corresponding author: Mary-Ann Davies University of Cape Town, Faculty of Health Sciences, Anzio Road, Observatory, 7925, Cape Town, South Africa
- Erna Morden
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa; Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Petro Rousseau
- National Department of Health, Pretoria, South Africa
- Juanita Arendse
- Western Cape Government: Health, Cape Town, South Africa
- Jamy-Lee Bam
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa
- Linda Boloko
- Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa; Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Keith Cloete
- Western Cape Government: Health, Cape Town, South Africa
- Cheryl Cohen
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Nicole Chetty
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Pierre Dane
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Alexa Heekes
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Nei-Yuan Hsiao
- Division of Medical Virology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, South Africa
- Mehreen Hunter
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa; Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Hannah Hussey
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa; Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Metro Health Services, Western Cape Government: Health, Cape Town, South Africa
- Theuns Jacobs
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa
- Waasila Jassat
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Saadiq Kariem
- Western Cape Government: Health, Cape Town, South Africa
- Reshma Kassanjee
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Inneke Laenen
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa; Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Sue Le Roux
- Western Cape Government: Health, Cape Town, South Africa; Karl Bremer Hospital, Western Cape Government: Health, Cape Town, South Africa
- Richard Lessells
- KwaZulu-Natal Research, Innovation & Sequencing Platform, University of KwaZulu-Natal, Durban, South Africa
- Hassan Mahomed
- Metro Health Services, Western Cape Government: Health, Cape Town, South Africa; Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Deborah Maughan
- Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
- Graeme Meintjes
- Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
- Marc Mendelson
- Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa; Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Ayanda Mnguni
- Khayelitsha District Hospital, Western Cape Government: Health, Cape Town, South Africa
- Melvin Moodley
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa
- Katy Murie
- Western Cape Government: Health, Cape Town, South Africa; Metro Health Services, Western Cape Government: Health, Cape Town, South Africa
- Jonathan Naude
- Mitchells Plain Hospital, Western Cape Government: Health, Cape Town, South Africa
- Ntobeko A.B. Ntusi
- Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa; South African Medical Research Council Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa
- Masudah Paleker
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa; Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Arifa Parker
- Tygerberg Hospital, Western Cape Government: Health, Cape Town, South Africa; Division of Infectious Diseases, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa; Division of General Medicine, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
- David Pienaar
- Rural Health Services, Western Cape Government: Health, Cape Town, South Africa
- Wolfgang Preiser
- National Health Laboratory Service, South Africa; Division of Medical Virology, University of Stellenbosch, Stellenbosch, South Africa
- Hans Prozesky
- Tygerberg Hospital, Western Cape Government: Health, Cape Town, South Africa; Division of Infectious Diseases, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
- Peter Raubenheimer
- Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
- Liezel Rossouw
- Western Cape Government: Health, Cape Town, South Africa
- Neshaad Schrueder
- Tygerberg Hospital, Western Cape Government: Health, Cape Town, South Africa; Division of General Medicine, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
- Barry Smith
- Western Cape Government: Health, Cape Town, South Africa; Karl Bremer Hospital, Western Cape Government: Health, Cape Town, South Africa
- Mariette Smith
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Wesley Solomon
- National Department of Health, Pretoria, South Africa
- Greg Symons
- Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
- Jantjie Taljaard
- Tygerberg Hospital, Western Cape Government: Health, Cape Town, South Africa; Division of Infectious Diseases, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
- Sean Wasserman
- Groote Schuur Hospital, Western Cape Government: Health, Cape Town, South Africa; Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Robert J. Wilkinson
- The Francis Crick Institute, London, UK; Department of Infectious Diseases, Imperial College London, London, UK; Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Milani Wolmarans
- National Department of Health, Pretoria, South Africa
- Nicole Wolter
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Andrew Boulle
- Health Intelligence, Western Cape Government: Health, Cape Town, South Africa; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Journal volume & issue
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Vol. 127
pp. 63 – 68
Abstract
Objectives: We aimed to compare the clinical severity of Omicron BA.4/BA.5 infection with BA.1 and earlier variant infections among laboratory-confirmed SARS-CoV-2 cases in the Western Cape, South Africa, using timing of infection to infer the lineage/variant causing infection. Methods: We included public sector patients aged ≥20 years with laboratory-confirmed COVID-19 between May 01-May 21, 2022 (BA.4/BA.5 wave) and equivalent previous wave periods. We compared the risk between waves of (i) death and (ii) severe hospitalization/death (all within 21 days of diagnosis) using Cox regression adjusted for demographics, comorbidities, admission pressure, vaccination, and previous infection. Results: Among 3793 patients from the BA.4/BA.5 wave and 190,836 patients from previous waves, the risk of severe hospitalization/death was similar in the BA.4/BA.5 and BA.1 waves (adjusted hazard ratio [aHR] 1.12; 95% confidence interval [CI] 0.93; 1.34). Both Omicron waves had a lower risk of severe outcomes than previous waves. Previous infection (aHR 0.29, 95% CI 0.24; 0.36) and vaccination (aHR 0.17; 95% CI 0.07; 0.40 for at least three doses vs no vaccine) were protective. Conclusion: Disease severity was similar among diagnosed COVID-19 cases in the BA.4/BA.5 and BA.1 periods in the context of growing immunity against SARS-CoV-2 due to previous infection and vaccination, both of which were strongly protective.
