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1Laboratory of Immunopathology, René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
2Department of Computing, Federal University of Ouro Preto, Ouro Preto, Brazil
© 2023, Korean Society of Epidemiology
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
The authors have no conflicts of interest to declare for this study.
FUNDING
This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil - CAPES (grants 88887.506931/2020-00), National Council for Scientific and Technological Development − CNPq (grants 441016/2020-0), Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG (grants APQ-00582-21) and the Federal University of Ouro Preto – UFOP.
AUTHOR CONTRIBUTIONS
Conceptualization: de Souza FSH, Hojo-Souza NS, Guidoni DL. Data curation: de Souza FSH, Guidoni DL. Formal analysis: de Souza FSH, Freitas VLS. Funding acquisition: de Souza FSH. Methodology: de Souza FSH, Freitas VLS, Hojo-Souza NS, Guidoni DL. Project administration: de Souza FSH. Writing - original draft: de Souza FSH, Hojo-Souza NS, Freitas VLS. Writing - review & editing: de Souza FSH, Hojo-Souza NS, Freitas VLS, Guidoni DL.
Symptoms |
W1 (n=193,391) |
W2 (n=339,234) |
W3 (n=71,218) |
W4 (n=29,977) |
aRR (95% CI)*** |
||
---|---|---|---|---|---|---|---|
Wuhan strain | Gamma/P.1 | Omicron | BA.4/BA.5 | W2 vs. W1 | W3 vs. W1 | W4 vs. W1 | |
Fever | 171,144 | 287,315 | 55,978 | 23,155 | - | - | - |
118,271 (69.11) | 191,091 (66.51) | 32,324 (57.74) | 11,710 (50.57) | 0.95 (0.95, 0.96) | 0.89 (0.88, 0.90) | 0.81 (0.80, 0.83) | |
Cough | 175,016 | 298,573 | 59,731 | 25,464 | - | - | - |
137,419 (78.52) | 235,838 (78.99) | 44,448 (74.41) | 19,315 (75.85) | 1.00 (1.00, 1.00) | 0.97(0.96, 0.97) | 0.99 (0.98, 1.00) | |
Sore throat | 147,800 | 243,637 | 48,488 | 20,805 | - | - | - |
31,629 (21.40) | 61,549 (25.26) | 12,019 (24.79) | 4,957 (23.83) | 1.14 (1.13, 1.15) | 1.24 (1.21, 1.27) | 1.23 (1.18, 1.27) | |
Dyspnea | 175,462 | 305,632 | 58,904 | 24,335 | - | - | - |
137,721 (78.49) | 254,278 (83.20) | 43,433 (73.74) | 17,002 (69.87) | 1.06 (1.06, 1.07) | 0.96 (0.95, 0.97) | 0.91 (0.90, 0.92) | |
Respiratory distress | 164,908 | 281,955 | 54,104 | 22,708 | - | - | - |
111,010 (67.32) | 203,361 (72.13) | 33,443 (61.81) | 13,184 (58.06) | 1.08 (1.07, 1.08) | 0.94 (0.93, 0.95) | 0.89 (0.87, 0.90) | |
SpO2 <95% | 166,874 | 296,577 | 57,561 | 23,854 | - | - | - |
115,903 (69.46) | 240,804 (81.19) | 40,919 (71.09) | 15,814 (66.29) | 1.18 (1.18, 1.19) | 1.02 (1.01, 1.03) | 0.94 (0.92, 0.95) | |
Diarrhea | 147,189 | 241,100 | 46,952 | 19,965 | - | - | - |
26,930 (18.30) | 48,610 (20.16) | 6,300 (13.42) | 2,160 (10.82) | 1.08 (1.07, 1.10) | 0.78 (0.76, 0.81) | 0.64 (0.60, 0.67) | |
Vomiting | 144,477 | 235,551 | 46,560 | 20,075 | - | - | - |
15,580 (10.78) | 28,062 (11.91) | 5,421 (11.64) | 2,381 (11.86) | 1.08 (1.06, 1.10) | 1.13 (1.09, 1.18) | 1.18 (1.11, 1.25) | |
Abdominal pain | 78,074 | 230,880 | 45,977 | 19,827 | - | - | - |
4,886 (6.26) | 20,654 (8.95) | 4,296 (9.34) | 1,802 (9.09) | 1.39 (1.35, 1.43) | 1.59 (1.51, 1.67) | 1.57 (1.46, 1.69) | |
Fatigue | 79,958 | 247,403 | 48,493 | 20,691 | - | - | - |
18,650 (23.32) | 101,233 (40.92) | 15,575 (32.12) | 6,031 (29.15) | 1.74 (1.72, 1.77) | 1.36 (1.33, 1.40) | 1.24 (1.19, 1.28) | |
Loss of smell | 78,548 | 234,501 | 45,252 | 19,479 | - | - | - |
10,332 (13.15) | 35,742 (15.24) | 1,916 (4.23) | 633 (3.25) | 1.09 (1.07, 1.11) | 0.37 (0.35, 0.39) | 0.31 (0.28, 0.35) | |
Loss of taste | 78,324 | 234,184 | 45,228 | 19,473 | - | - | - |
10,261 (13.10) | 36,512 (15.59) | 2,145 (4.74) | 649 (3.33) | 1.13 (1.10, 1.15) | 0.42 (0.40, 0.45) | 0.33 (0.30, 0.36) |
Values are presented as number or number (%).
aRR, adjusted relative risk; CI, confidence interval; SpO2, oxygen saturation.
1 W1, ancestral strain/B.1 lineage (2020/05/31 to 2020/09/12); W2, Gamma/P.1 variant (2021/01/31 to 2021/05/15); W3, Omicron variant (2021/12/05 to 2022/03/19); W4, Omicron BA.4/BA.5 subvariants (2022/05/22 to 2022/09/03).
*** p<0.001.
Variables | W1 (n=193,391) | W2 (n=339,234) | W3 (n=71,218) | W4 (n=29,977) | |
---|---|---|---|---|---|
In-hospital death | 65,148 (33.69) | 125,231 (36.92) | 25,634 (35.99) | 8,527 (28.45) | |
Age, median (IQR), yr | 62 (36-88) | 58 (37-79) | 71 (37-105) | 74 (38-110) | |
Age (yr) | |||||
18-39 | 24,365 (12.60) | 49,312 (14.54) | 7,816 (10.97) | 2,663 (8.88) | |
40-59 | 62,846 (32.50) | 133,280 (39.29) | 13,528 (19.00) | 4,449 (14.84) | |
60-79 | 76,635 (39.63) | 126,891 (37.41) | 28,662 (40.25) | 11,854 (39.54) | |
≥80 | 29,545 (15.28) | 29,751 (8.77) | 21,212 (29.78) | 11,011 (36.73) | |
Sex | |||||
Female | 85,217 (44.06) | 151,835 (44.76) | 34,739 (48.78) | 15,606 (52.06) | |
Male | 108,174 (55.94) | 187,399 (55.24) | 36,479 (51.22) | 14,371 (47.94) | |
Vaccine status | |||||
Booster | 0 (0.00) | 0 (0.00) | 9,141 (12.84) | 18,393 (61.36) | |
Full | 0 (0.00) | 3,432 (1.01) | 35,978 (50.52) | 7,518 (25.08) | |
Partial | 0 (0.00) | 24,248 (7.15) | 3,580 (5.03) | 1,049 (3.50) | |
Unvaccinated | 193,391 (100) | 311,554 (91.84) | 22,519 (31.62) | 3,017 (10.06) |
Symptoms | W1 (n=193,391) |
W2 (n=339,234) |
W3 (n=71,218) |
W4 (n=29,977) |
aRR (95% CI) |
||
---|---|---|---|---|---|---|---|
Wuhan strain | Gamma/P.1 | Omicron | BA.4/BA.5 | W2 vs. W1 | W3 vs. W1 | W4 vs. W1 | |
Fever | 171,144 | 287,315 | 55,978 | 23,155 | - | - | - |
118,271 (69.11) | 191,091 (66.51) | 32,324 (57.74) | 11,710 (50.57) | 0.95 (0.95, 0.96) | 0.89 (0.88, 0.90) | 0.81 (0.80, 0.83) | |
Cough | 175,016 | 298,573 | 59,731 | 25,464 | - | - | - |
137,419 (78.52) | 235,838 (78.99) | 44,448 (74.41) | 19,315 (75.85) | 1.00 (1.00, 1.00) | 0.97(0.96, 0.97) | 0.99 (0.98, 1.00) | |
Sore throat | 147,800 | 243,637 | 48,488 | 20,805 | - | - | - |
31,629 (21.40) | 61,549 (25.26) | 12,019 (24.79) | 4,957 (23.83) | 1.14 (1.13, 1.15) | 1.24 (1.21, 1.27) | 1.23 (1.18, 1.27) | |
Dyspnea | 175,462 | 305,632 | 58,904 | 24,335 | - | - | - |
137,721 (78.49) | 254,278 (83.20) | 43,433 (73.74) | 17,002 (69.87) | 1.06 (1.06, 1.07) | 0.96 (0.95, 0.97) | 0.91 (0.90, 0.92) | |
Respiratory distress | 164,908 | 281,955 | 54,104 | 22,708 | - | - | - |
111,010 (67.32) | 203,361 (72.13) | 33,443 (61.81) | 13,184 (58.06) | 1.08 (1.07, 1.08) | 0.94 (0.93, 0.95) | 0.89 (0.87, 0.90) | |
SpO2 <95% | 166,874 | 296,577 | 57,561 | 23,854 | - | - | - |
115,903 (69.46) | 240,804 (81.19) | 40,919 (71.09) | 15,814 (66.29) | 1.18 (1.18, 1.19) | 1.02 (1.01, 1.03) | 0.94 (0.92, 0.95) | |
Diarrhea | 147,189 | 241,100 | 46,952 | 19,965 | - | - | - |
26,930 (18.30) | 48,610 (20.16) | 6,300 (13.42) | 2,160 (10.82) | 1.08 (1.07, 1.10) | 0.78 (0.76, 0.81) | 0.64 (0.60, 0.67) | |
Vomiting | 144,477 | 235,551 | 46,560 | 20,075 | - | - | - |
15,580 (10.78) | 28,062 (11.91) | 5,421 (11.64) | 2,381 (11.86) | 1.08 (1.06, 1.10) | 1.13 (1.09, 1.18) | 1.18 (1.11, 1.25) | |
Abdominal pain | 78,074 | 230,880 | 45,977 | 19,827 | - | - | - |
4,886 (6.26) | 20,654 (8.95) | 4,296 (9.34) | 1,802 (9.09) | 1.39 (1.35, 1.43) | 1.59 (1.51, 1.67) | 1.57 (1.46, 1.69) | |
Fatigue | 79,958 | 247,403 | 48,493 | 20,691 | - | - | - |
18,650 (23.32) | 101,233 (40.92) | 15,575 (32.12) | 6,031 (29.15) | 1.74 (1.72, 1.77) | 1.36 (1.33, 1.40) | 1.24 (1.19, 1.28) | |
Loss of smell | 78,548 | 234,501 | 45,252 | 19,479 | - | - | - |
10,332 (13.15) | 35,742 (15.24) | 1,916 (4.23) | 633 (3.25) | 1.09 (1.07, 1.11) | 0.37 (0.35, 0.39) | 0.31 (0.28, 0.35) | |
Loss of taste | 78,324 | 234,184 | 45,228 | 19,473 | - | - | - |
10,261 (13.10) | 36,512 (15.59) | 2,145 (4.74) | 649 (3.33) | 1.13 (1.10, 1.15) | 0.42 (0.40, 0.45) | 0.33 (0.30, 0.36) |
Symptom | W3 |
W4 |
||||
---|---|---|---|---|---|---|
Vaccinated | Unvaccinated | p-value | Vaccinated | Unvaccinated | p-value | |
Fever | 56.19 (20,298/36,122) | 60.57 (12,026/19,856) | <0.001 | 50.12 (10,014/19,982) | 53.45 (1,696/3,173) | <0.001 |
Cough | 73.92 (28,454/38,495) | 75.32 (15,994/21,236) | <0.001 | 76.04 (16,747/22,024) | 74.65 (2,568/3,440) | 0.080 |
Sore throat | 24.35 (7,738/31,780) | 25.62 (4,281/16,708) | 0.002 | 23.98 (4,322/18,026) | 22.85 (635/2,779) | 0.203 |
Dyspnea | 72.89 (27,695/37,998) | 75.28 (15,738/20,906) | <0.001 | 69.59 (14,623/21,014) | 71.64 (2,379/3,321) | 0.018 |
Respiratory distress | 61.12 (21,489/35,160) | 63.10 (11,954/18,944) | <0.001 | 57.49 (11,290/19,639) | 61.71 (1,894/3,069) | <0.001 |
SpO2 < 95% | 71.02 (26,446/37,235) | 71.20 (14,473/20,326) | 0.649 | 66.18 (13,663/20,646) | 67.05 (2,151/3,208) | 0.340 |
Diarrhea | 13.18 (4,067/30,867) | 13.88 (2,233/16,085) | 0.034 | 10.64 (1,840/17,294) | 11.98 (320/2,671) | 0.041 |
Vomiting | 11.23 (3,432/30,574) | 12.44 (1,989/15,986) | <0.001 | 11.84 (2,060/17,404) | 12.02 (321/2,671) | 0.812 |
Abdominal pain | 9.04 (2,741/30,307) | 9.92 (1,555/15,670) | 0.002 | 8.96 (1,540/17,189) | 9.93 (262/2,638) | 0.114 |
Fatigue | 32.67 (10,439/31,949) | 31.04 (5,136/16,544) | <0.001 | 29.01 (5,197/17,916) | 30.05 (834/2,775) | 0.269 |
Loss of smell | 4.13 (1,231/29,838) | 4.44 (685/15,414) | 0.116 | 3.23 (545/16,890) | 3.40 (88/2,589) | 0.689 |
Loss of taste | 4.59 (1,367/29,813) | 5.05 (778/15,415) | 0.030 | 3.21 (542/16,884) | 4.13 (107/2,589) | 0.017 |
Values are presented as number (%). IQR, interquartile range. W1, ancestral strain/B.1 lineage (2020/05/31 to 2020/09/12); W2, Gamma/P.1 variant (2021/01/31 to 2021/05/15); W3, Omicron variant (2021/12/05 to 2022/03/19); W4, Omicron BA.4/BA.5 subvariants (2022/05/22 to 2022/09/03).
Values are presented as number or number (%). aRR, adjusted relative risk; CI, confidence interval; SpO2, oxygen saturation. W1, ancestral strain/B.1 lineage (2020/05/31 to 2020/09/12); W2, Gamma/P.1 variant (2021/01/31 to 2021/05/15); W3, Omicron variant (2021/12/05 to 2022/03/19); W4, Omicron BA.4/BA.5 subvariants (2022/05/22 to 2022/09/03). p<0.001.
SpO2, oxygen saturation.