Protective effect of COVID-19 vaccination against long COVID syndrome: A systematic review and meta-analysis

Atsuyuki Watanabe; Masao Iwagami; Jun Yasuhara; Hisato Takagi; Toshiki Kuno

doi:10.1016/j.vaccine.2023.02.008

Protective effect of COVID-19 vaccination against long COVID syndrome: A systematic review and meta-analysis

Vaccine. 2023 Mar 10;41(11):1783-1790. doi: 10.1016/j.vaccine.2023.02.008. Epub 2023 Feb 8.

Authors

Atsuyuki Watanabe¹, Masao Iwagami², Jun Yasuhara³, Hisato Takagi⁴, Toshiki Kuno⁵

Affiliations

¹ Division of Hospital Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.
² Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
³ Center for Cardiovascular Research, The Abigail Wexner Research Institute and The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
⁴ Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
⁵ Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA. Electronic address: tkuno@montefiore.org.

Abstract

Background: The relationship between coronavirus disease 2019 (COVID-19) vaccination and long COVID has not been firmly established. We conducted a systematic review and meta-analysis to evaluate the association between COVID-19 vaccination and long COVID.

Methods: PubMed and EMBASE databases were searched on September 2022 without language restrictions (CRD42022360399) to identify prospective trials and observational studies comparing patients with and without vaccination before severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We also included studies reporting symptomatic changes of ongoing long COVID following vaccination among those with a history of SARS-CoV-2 infection. Odds ratios (ORs) for each outcome were synthesized using a random-effects model. Symptomatic changes after vaccination were synthesized by a one-group meta-analysis.

Results: Six observational studies involving 536,291 unvaccinated and 84,603 vaccinated (before SARS-CoV-2 infection) patients (mean age, 41.2-66.6; female, 9.0-67.3%) and six observational studies involving 8,199 long COVID patients (mean age, 40.0 to 53.5; female, 22.2-85.9%) who received vaccination after SARS-CoV-2 infection were included. Two-dose vaccination was associated with a lower risk of long COVID compared to no vaccination (OR, 0.64; 95% confidence interval [CI], 0.45-0.92) and one-dose vaccination (OR, 0.60; 95% CI, 0.43-0.83). Two-dose vaccination compared to no vaccination was associated with a lower risk of persistent fatigue (OR, 0.62; 95% CI, 0.41-0.93) and pulmonary disorder (OR, 0.50; 95% CI, 0.47-0.52). Among those with ongoing long COVID symptoms, 54.4% (95% CI, 34.3-73.1%) did not report symptomatic changes following vaccination, while 20.3% (95% CI, 8.1-42.4%) experienced symptomatic improvement after two weeks to six months of COVID-19 vaccination.

Conclusions: COVID-19 vaccination before SARS-CoV-2 infection was associated with a lower risk of long COVID, while most of those with ongoing long COVID did not experience symptomatic changes following vaccination.

Keywords: COVID-19; Long COVID; Post-acute sequelae of COVID-19; SARS-CoV-2; Vaccine.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Adult
Aged
COVID-19 Vaccines
COVID-19* / prevention & control
Female
Humans
Middle Aged
Post-Acute COVID-19 Syndrome*
Prospective Studies
SARS-CoV-2

Substances

COVID-19 Vaccines