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      SARS-CoV-2 Variants Infection in Relationship to Imaging-based Pneumonia and Clinical Outcomes

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      Author(s): , MD 1 , , MD 2 , , MD, PhD 1 , , MD, PhD 3 , , MD 4 , , MD 1 , , MD, PhD 5 ,
      Publication date (Electronic):
      Journal: Radiology
      Publisher: Radiological Society of North America

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          Abstract

          Background

          Few reports have evaluated the effect of the SARS-CoV-2 variant and vaccination on the clinical and imaging features of COVID-19.

          Purpose

          To evaluate and compare the effect of vaccination and variant prevalence on the clinical and imaging features of infections by the SARS-CoV-2.

          Materials and Methods

          Consecutive adults hospitalized for confirmed COVID-19 at three centers (two academic medical centers and one community hospital) and registered in a nationwide open data repository for COVID-19 between August 2021 and March 2022 were retrospectively included. All patients had available chest radiographs or CT. Patients were divided into two groups according to predominant variant type over the study period. Differences between clinical and imaging features were analyzed using Pearson χ 2 test, Fisher exact test, or the independent t-test. Multivariable logistic regression analyses were used to evaluate the effect of variant predominance and vaccination status on imaging features of pneumonia and clinical severity.

          Results

          Of the 2180 patients (mean age, 57 years ± 21, 1171 women), 1022 patients (46%) were treated during the Delta variant predominant period and 1158 (54%) during the Omicron period. The Omicron variant prevalence was associated with lower pneumonia severity based on CT scores (OR, 0.71 [95% CI: 0.51, 0.99; P = .04]) and lower clinical severity based on ICU admission or in-hospital death (OR 0.43, 95% CI: 0.24, 0.77, P = .004) than the Delta variant prevalence. Vaccination was associated with the lowest odds of severe pneumonia based on CT scores (OR 0.05, 95% CI:0.03, 0.13, P < .001) and clinical severity based on ICU admission or in-hospital death (OR 0.15, 95% CI: 0.07, 0.31, P < .001) relative to no vaccination.

          Conclusion

          The SARS-CoV-2 Omicron variant prevalence and vaccination were associated with better clinical outcomes and lower severe pneumonia risk relative to Delta variant prevalence.

          Abstract

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          Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant

          Jamie Lopez Bernal, Nick Andrews, Charlotte Gower … (2021)
          Background The B.1.617.2 (delta) variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), has contributed to a surge in cases in India and has now been detected across the globe, including a notable increase in cases in the United Kingdom. The effectiveness of the BNT162b2 and ChAdOx1 nCoV-19 vaccines against this variant has been unclear. Methods We used a test-negative case–control design to estimate the effectiveness of vaccination against symptomatic disease caused by the delta variant or the predominant strain (B.1.1.7, or alpha variant) over the period that the delta variant began circulating. Variants were identified with the use of sequencing and on the basis of the spike ( S ) gene status. Data on all symptomatic sequenced cases of Covid-19 in England were used to estimate the proportion of cases with either variant according to the patients’ vaccination status. Results Effectiveness after one dose of vaccine (BNT162b2 or ChAdOx1 nCoV-19) was notably lower among persons with the delta variant (30.7%; 95% confidence interval [CI], 25.2 to 35.7) than among those with the alpha variant (48.7%; 95% CI, 45.5 to 51.7); the results were similar for both vaccines. With the BNT162b2 vaccine, the effectiveness of two doses was 93.7% (95% CI, 91.6 to 95.3) among persons with the alpha variant and 88.0% (95% CI, 85.3 to 90.1) among those with the delta variant. With the ChAdOx1 nCoV-19 vaccine, the effectiveness of two doses was 74.5% (95% CI, 68.4 to 79.4) among persons with the alpha variant and 67.0% (95% CI, 61.3 to 71.8) among those with the delta variant. Conclusions Only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses. Absolute differences in vaccine effectiveness were more marked after the receipt of the first dose. This finding would support efforts to maximize vaccine uptake with two doses among vulnerable populations. (Funded by Public Health England.)
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            Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant

            Nick Andrews, Julia Stowe, Freja Kirsebom … (2022)
            Background A rapid increase in coronavirus disease 2019 (Covid-19) cases due to the omicron (B.1.1.529) variant of severe acute respiratory syndrome coronavirus 2 in highly vaccinated populations has aroused concerns about the effectiveness of current vaccines. Methods We used a test-negative case–control design to estimate vaccine effectiveness against symptomatic disease caused by the omicron and delta (B.1.617.2) variants in England. Vaccine effectiveness was calculated after primary immunization with two doses of BNT162b2 (Pfizer–BioNTech), ChAdOx1 nCoV-19 (AstraZeneca), or mRNA-1273 (Moderna) vaccine and after a booster dose of BNT162b2, ChAdOx1 nCoV-19, or mRNA-1273. Results Between November 27, 2021, and January 12, 2022, a total of 886,774 eligible persons infected with the omicron variant, 204,154 eligible persons infected with the delta variant, and 1,572,621 eligible test-negative controls were identified. At all time points investigated and for all combinations of primary course and booster vaccines, vaccine effectiveness against symptomatic disease was higher for the delta variant than for the omicron variant. No effect against the omicron variant was noted from 20 weeks after two ChAdOx1 nCoV-19 doses, whereas vaccine effectiveness after two BNT162b2 doses was 65.5% (95% confidence interval [CI], 63.9 to 67.0) at 2 to 4 weeks, dropping to 8.8% (95% CI, 7.0 to 10.5) at 25 or more weeks. Among ChAdOx1 nCoV-19 primary course recipients, vaccine effectiveness increased to 62.4% (95% CI, 61.8 to 63.0) at 2 to 4 weeks after a BNT162b2 booster before decreasing to 39.6% (95% CI, 38.0 to 41.1) at 10 or more weeks. Among BNT162b2 primary course recipients, vaccine effectiveness increased to 67.2% (95% CI, 66.5 to 67.8) at 2 to 4 weeks after a BNT162b2 booster before declining to 45.7% (95% CI, 44.7 to 46.7) at 10 or more weeks. Vaccine effectiveness after a ChAdOx1 nCoV-19 primary course increased to 70.1% (95% CI, 69.5 to 70.7) at 2 to 4 weeks after an mRNA-1273 booster and decreased to 60.9% (95% CI, 59.7 to 62.1) at 5 to 9 weeks. After a BNT162b2 primary course, the mRNA-1273 booster increased vaccine effectiveness to 73.9% (95% CI, 73.1 to 74.6) at 2 to 4 weeks; vaccine effectiveness fell to 64.4% (95% CI, 62.6 to 66.1) at 5 to 9 weeks. Conclusions Primary immunization with two doses of ChAdOx1 nCoV-19 or BNT162b2 vaccine provided limited protection against symptomatic disease caused by the omicron variant. A BNT162b2 or mRNA-1273 booster after either the ChAdOx1 nCoV-19 or BNT162b2 primary course substantially increased protection, but that protection waned over time. (Funded by the U.K. Health Security Agency.)
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              Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA.

              Scott Simpson, Fernando U Kay, Suhny Abbara … (2020)
              Routine screening CT for the identification of COVID-19 pneumonia is currently not recommended by most radiology societies. However, the number of CTs performed in persons under investigation (PUI) for COVID-19 has increased. We also anticipate that some patients will have incidentally detected findings that could be attributable to COVID-19 pneumonia, requiring radiologists to decide whether or not to mention COVID-19 specifically as a differential diagnostic possibility. We aim to provide guidance to radiologists in reporting CT findings potentially attributable to COVID-19 pneumonia, including standardized language to reduce reporting variability when addressing the possibility of COVID-19. When typical or indeterminate features of COVID-19 pneumonia are present in endemic areas as an incidental finding, we recommend contacting the referring providers to discuss the likelihood of viral infection. These incidental findings do not necessarily need to be reported as COVID-19 pneumonia. In this setting, using the term “viral pneumonia” can be a reasonable and inclusive alternative. However, if one opts to use the term "COVID-19" in the incidental setting, consider the provided standardized reporting language. In addition, practice patterns may vary, and this document is meant to serve as a guide. Consultation with clinical colleagues at each institution is suggested to establish a consensus reporting approach. The goal of this expert consensus is to help radiologists recognize findings of COVID-19 pneumonia and aid their communication with other healthcare providers, assisting management of patients during this pandemic. Published under a CC BY 4.0 license.
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                Author and article information

                Contributors
                Yeon Joo Jeong:
                ORCID: https://orcid.org/0000-0002-1741-9604
                Journal
                Journal ID (nlm-ta): Radiology
                Journal ID (iso-abbrev): Radiology
                Journal ID (publisher-id): Radiology
                Title: Radiology
                Publisher: Radiological Society of North America
                ISSN (Print): 0033-8419
                ISSN (Electronic): 1527-1315
                Publication date (Electronic): 27 September 2022
                Publication date PMC-release: 27 September 2022
                Electronic Location Identifier: 221795
                Affiliations
                [1] 1Department of Radiology, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Korea
                [2] 2Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea, 179 Gudeok-ro, Seo-gu, Busan, Korea
                [3] 3Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
                [4] 4Department of Radiology, Namwon Medical Center, 365, Chungjeong-ro, Namwon- si, Jeollabuk-do, Korea
                [5] 5Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
                Author notes
                Author for correspondence: Yeon Joo Jeong, M.D., PhD. Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine 20, Geumo-ro, Mulgeum-eup, Yangsan, Korea E-mail) jeongyj0610@ 123456gmail.com

                Author contributions: JEL, MJC, and YJJ contributed to the study conception and design. JEL, MH, and BHS participated in data acquisition. JEL and YJJ contributed to data analysis. All authors participated in data interpretation. JEL and YJJ drafted the manuscript. All authors contributed to manuscript revisions and approved the submitted work. All authors agree to be accountable for the accuracy and integrity of their contributions.

                Author information
                https://orcid.org/0000-0002-8754-6801
                https://orcid.org/0000-0003-2603-616X
                https://orcid.org/0000-0002-0047-0729
                https://orcid.org/0000-0002-6271-3343
                https://orcid.org/0000-0003-4779-7355
                https://orcid.org/0000-0003-2821-2788
                https://orcid.org/0000-0002-1741-9604
                Article
                Publisher-manuscript ID: 221795
                DOI: 10.1148/radiol.221795
                PMC ID: 9527969
                PubMed ID: 36165791
                SO-VID: dc77ac26-3d1e-4efb-a8ad-61b41ce14c1e
                Copyright © © 2022 by the Radiological Society of North America, Inc.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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                Subject: Original Research
                Subject: Thoracic Imaging

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