Descriptive comparison of admission characteristics between pandemic waves and multivariable analysis of the association of the Alpha variant (B.1.1.7 lineage) of SARS-CoV-2 with disease severity in inner London.
epidemiology
public health
virology
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
08 02 2022
08 02 2022
Historique:
entrez:
9
2
2022
pubmed:
10
2
2022
medline:
15
2
2022
Statut:
epublish
Résumé
The Alpha variant (B.1.1.7 lineage) of SARS-CoV-2 emerged and became the dominant circulating variant in the UK in late 2020. Current literature is unclear on whether the Alpha variant is associated with increased severity. We linked clinical data with viral genome sequence data to compare admitted cases between SARS-CoV-2 waves in London and to investigate the association between the Alpha variant and the severity of disease. Clinical, demographic, laboratory and viral sequence data from electronic health record systems were collected for all cases with a positive SARS-CoV-2 RNA test between 13 March 2020 and 17 February 2021 in a multisite London healthcare institution. Multivariate analysis using logistic regression assessed risk factors for severity as defined by hypoxia at admission. There were 5810 SARS-CoV-2 RNA-positive cases of which 2341 were admitted (838 in wave 1 and 1503 in wave 2). Both waves had a temporally aligned rise in nosocomial cases (96 in wave 1 and 137 in wave 2). The Alpha variant was first identified on 15 November 2020 and increased rapidly to comprise 400/472 (85%) of sequenced isolates from admitted cases in wave 2. A multivariate analysis identified risk factors for severity on admission, such as age (OR 1.02, 95% CI 1.01 to 1.03, for every year older; p<0.001), obesity (OR 1.70, 95% CI 1.28 to 2.26; p<0.001) and infection with the Alpha variant (OR 1.68, 95% CI 1.26 to 2.24; p<0.001). Our analysis is the first in hospitalised cohorts to show increased severity of disease associated with the Alpha variant. The number of nosocomial cases was similar in both waves despite the introduction of many infection control interventions before wave 2.
Sections du résumé
BACKGROUND
The Alpha variant (B.1.1.7 lineage) of SARS-CoV-2 emerged and became the dominant circulating variant in the UK in late 2020. Current literature is unclear on whether the Alpha variant is associated with increased severity. We linked clinical data with viral genome sequence data to compare admitted cases between SARS-CoV-2 waves in London and to investigate the association between the Alpha variant and the severity of disease.
METHODS
Clinical, demographic, laboratory and viral sequence data from electronic health record systems were collected for all cases with a positive SARS-CoV-2 RNA test between 13 March 2020 and 17 February 2021 in a multisite London healthcare institution. Multivariate analysis using logistic regression assessed risk factors for severity as defined by hypoxia at admission.
RESULTS
There were 5810 SARS-CoV-2 RNA-positive cases of which 2341 were admitted (838 in wave 1 and 1503 in wave 2). Both waves had a temporally aligned rise in nosocomial cases (96 in wave 1 and 137 in wave 2). The Alpha variant was first identified on 15 November 2020 and increased rapidly to comprise 400/472 (85%) of sequenced isolates from admitted cases in wave 2. A multivariate analysis identified risk factors for severity on admission, such as age (OR 1.02, 95% CI 1.01 to 1.03, for every year older; p<0.001), obesity (OR 1.70, 95% CI 1.28 to 2.26; p<0.001) and infection with the Alpha variant (OR 1.68, 95% CI 1.26 to 2.24; p<0.001).
CONCLUSIONS
Our analysis is the first in hospitalised cohorts to show increased severity of disease associated with the Alpha variant. The number of nosocomial cases was similar in both waves despite the introduction of many infection control interventions before wave 2.
Identifiants
pubmed: 35135773
pii: bmjopen-2021-055474
doi: 10.1136/bmjopen-2021-055474
pmc: PMC8829842
doi:
Substances chimiques
RNA, Viral
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e055474Subventions
Organisme : Medical Research Council
ID : MC_PC_19027
Pays : United Kingdom
Investigateurs
Teresa Cutino-Moguel
(T)
Tabassum Khan
(T)
Beatrix Kele
(B)
Raghavendran Kulasegaran-Shylini
(R)
Claire E Broad
(CE)
Dola Owoyemi
(D)
David Harrington
(D)
Clare Coffey
(C)
Martina Cummins
(M)
Anna Riddell
(A)
Tyrra D'Souza
(T)
Guy Mollett
(G)
Emma Thomson
(E)
Christine Peters
(C)
Aleks Marek
(A)
Rory Gunson
(R)
Emily Goldstein
(E)
Emilie Shepherd
(E)
James Shepherd
(J)
David Robertson
(D)
Katherine Smollett
(K)
Ana da Silva Filipe
(ADS)
Alice Broos
(A)
Stephen Carmichael
(S)
Nicholas Suarez
(N)
Chris Davis
(C)
Sreenu Vattipally
(S)
Joseph Hughes
(J)
Ioulia Tsatsani
(I)
Jacqueline McTaggart
(J)
Stephanie McEnhill
(S)
Adela Medina
(A)
Themoula Charalampous
(T)
Bindi Patel
(B)
Flavia Flaviani
(F)
Jörg Saßmannshausen
(J)
May Rabuya
(M)
Sulekha Gurung
(S)
Anu Augustine
(A)
Rahul Batra
(R)
Luke Snell
(L)
Gaia Nebbia
(G)
Alison Holmes
(A)
Sid Mookerjee
(S)
James Price
(J)
Paul Randell
(P)
Krystal Johnson
(K)
Thilipan Thaventhiran
(T)
Damien Mine
(D)
Sophie Hunter
(S)
Isa Ahmad
(I)
Anitha Ramanathan
(A)
Anu Chawla
(A)
Alistair Derby
(A)
Sam Haldenby
(S)
Becky Taylor
(B)
Keith Morris
(K)
Charles Numbere
(C)
Mark Hopkins
(M)
Jenifer Mason
(J)
Alexandra Bailey
(A)
Nicholas Machin
(N)
Shazaad Ahmad
(S)
Julie Cawthorne
(J)
Ryan George
(R)
James Montgomery
(J)
Deborah McKew
(D)
Yusri Taha
(Y)
Angela Cobb
(A)
Michelle Ramsay
(M)
Maria Leader
(M)
Shirelle Burton-Fanning
(S)
Julie Samuel
(J)
Sarah Francis
(S)
Lydia Taylor
(L)
Darren Smith
(D)
Matthew Bashton
(M)
Matthew Crown
(M)
Nikunj Mahida
(N)
Matthew Loose
(M)
Patrick McClure
(P)
Mitch Clarke
(M)
Elaine Baxter
(E)
Carl Yates
(C)
Irfan Aslam
(I)
Vicki Fleming
(V)
Michelle Lister
(M)
Johnny Debebe
(J)
Nadine Holmes
(N)
Christopher Moore
(C)
Matt Carlile
(M)
Tabitha Mahungu
(T)
Sophie Weller
(S)
Tanzina Haque
(T)
Jennifer Hart
(J)
Dianne Irish-Tavares
(D)
Eric Witele
(E)
Mia De Mesa
(M)
Vicky Pang
(V)
Jelena Heaphy
(J)
Wendy Chatterton
(W)
Monika Pusok
(M)
Tranprit Saluja
(T)
Zahira Maqsood
(Z)
Angie Williams
(A)
Debbie Devonport
(D)
Lucy Palinkas
(L)
Diane Thomlinson
(D)
Julie Booth
(J)
Ashok Dadrah
(A)
Amanda Symonds
(A)
Cassandra Craig
(C)
Abhinav Kumar
(A)
Thushan de Silva
(T)
Matthew D Parker
(MD)
Peijun Zhang
(P)
Max Whiteley
(M)
Benjamin B Lindsey
(BB)
Paige Wolverson
(P)
Benjamin H Foulkes
(BH)
Luke Green
(L)
Marta Gallis Ramalho
(MG)
Stavroula F Louka
(SF)
Adrienn Angyal
(A)
Nikki Smith
(N)
David G Partridge
(DG)
Cariad Evans
(C)
Mohammad Raza
(M)
Hayley Colton
(H)
Rebecca Gregory
(R)
Phillip Ravencroft
(P)
Katie Johnson
(K)
Sharon Hsu
(S)
Alexander J Keeley
(AJ)
Alison Cope
(A)
Amy State
(A)
Nasar Ali
(N)
Rasha Raghei
(R)
Joe Heffer
(J)
Stella Christou
(S)
Samantha E Hansford
(SE)
Hailey R Hornsby
(HR)
Phil Wade
(P)
Kay Cawthron
(K)
Maqsood Khan
(M)
Amber Ford
(A)
Imogen Wilson
(I)
Kate Harrington
(K)
Nic Tinker
(N)
Sally Nyinza
(S)
Kordo Saeed
(K)
Jacqui Prieto
(J)
Adhyana Mahanama
(A)
Buddhini Samaraweera
(B)
Siona Silviera
(S)
Emanuela Pelosi
(E)
Eleri Wilson-Davies
(E)
Sarah Jeremiah
(S)
Helen Wheeler
(H)
Matthew Harvey
(M)
Thea Sass
(T)
Helen Umpleby
(H)
Stephen Aplin
(S)
Samuel Robson
(S)
Sharon Glaysher
(S)
Scott Elliott
(S)
Kate Cook
(K)
Christopher Fearn
(C)
Salman Goudarzi
(S)
Katie Loveson
(K)
Kenneth Laing
(K)
Irene Monahan
(I)
Adam Witney
(A)
Joshua Taylor
(J)
NgeeKeong Tan
(N)
Cassie Pope
(C)
Claudia Cardosa Pereira
(CC)
Vaz Malik
(V)
Gee Yen Shin
(GY)
Eleni Nastouli
(E)
Catherine Houlihan
(C)
Judith Heaney
(J)
Matt Byott
(M)
Dan Frampton
(D)
Gema Martinez-Garcia
(G)
Leila Hail
(L)
Ndifreke Atang
(N)
Helen Francis
(H)
Milica Rajkov
(M)
Judith Breuer
(J)
Rachel Williams
(R)
Sunando Roy
(S)
Charlotte Williams
(C)
Nadua Bayzid
(N)
Marius Cotic
(M)
James Blackstone
(J)
Leanne Hockey
(L)
Rachel McComish
(R)
Alyson MacNeil
(A)
Monica Panca
(M)
Georgia Marley
(G)
Andrew Copas
(A)
Oliver Stirrup
(O)
Fiona Mapp
(F)
Alif Tamuri
(A)
Stefan Piatek
(S)
Paul Flowers
(P)
Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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