Risk Factors for COVID-19 and Respiratory Tract Infections during the Coronavirus Pandemic

DOI record: { "DOI": "10.3390/vaccines12030329", "ISSN": [ "2076-393X" ], "URL": "http://dx.doi.org/10.3390/vaccines12030329", "abstract": "<jats:p>(1) Background: Some individuals are more susceptible to developing respiratory tract infections (RTIs) or coronavirus disease (COVID-19) than others. The aim of this work was to identify risk factors for symptomatic RTIs including COVID-19 and symptomatic COVID-19 during the coronavirus pandemic by using infection incidence, participant baseline, and regional COVID-19 burden data. (2) Methods: Data from a prospective study of 1000 frontline healthcare workers randomized to Bacillus Calmette–Guérin vaccination or placebo, and followed for one year, was analyzed. Parametric time-to-event analysis was performed to identify the risk factors associated with (a) non-specific symptomatic respiratory tract infections including COVID-19 (RTIs+COVID-19) and (b) symptomatic RTIs confirmed as COVID-19 using a polymerase chain reaction or antigen test (COVID-19). (3) Results: Job description of doctor or nurse (median hazard ratio [HR] 1.541 and 95% confidence interval [CI] 1.299–1.822), the reported COVID-19 burden (median HR 1.361 and 95% CI 1.260–1.469 for 1.4 COVID-19 cases per 10,000 capita), or a BMI &gt; 30 kg/m2 (median HR 1.238 and 95% CI 1.132–1.336 for BMI of 35.4 kg/m2) increased the probability of RTIs+COVID-19, while positive SARS-CoV-2 serology at enrollment (median HR 0.583 and 95% CI 0.449–0.764) had the opposite effect. The reported COVID-19 burden (median HR 2.372 and 95% CI 2.116–2.662 for 1.4 COVID-19 cases per 10,000 capita) and a job description of doctor or nurse (median HR 1.679 and 95% CI 1.253–2.256) increased the probability of developing COVID-19, while smoking (median HR 0.428 and 95% CI 0.284–0.648) and positive SARS-CoV-2 serology at enrollment (median HR 0.076 and 95% CI 0.026–0.212) decreased it. (4) Conclusions: Nurses and doctors with obesity had the highest probability of developing RTIs including COVID-19. Non-smoking nurses and doctors had the highest probability of developing COVID-19 specifically. The reported COVID-19 burden increased the event probability, while positive SARS-CoV-2 IgG serology at enrollment decreased the probability of RTIs including COVID-19, and COVID-19 specifically.</jats:p>", "alternative-id": [ "vaccines12030329" ], "author": [ { "ORCID": "http://orcid.org/0000-0002-7008-4946", "affiliation": [ { "name": "Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden" } ], "authenticated-orcid": false, "family": "Mockeliunas", "given": "Laurynas", "sequence": "first" }, { "affiliation": [ { "name": "Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden" } ], "family": "van Wijk", "given": "Rob C.", "sequence": "additional" }, { "affiliation": [ { "name": "TASK, Cape Town 7500, South Africa" } ], "family": "Upton", "given": "Caryn M.", "sequence": "additional" }, { "affiliation": [ { "name": "Allergy and Immunology Unit, University of Cape Town Lung Institute and Division of Allergy and Clinical Immunology, University of Cape Town, Cape Town 7700, South Africa" } ], "family": "Peter", "given": "Jonathan", "sequence": "additional" }, { "affiliation": [ { "name": "TASK, Cape Town 7500, South Africa" } ], "family": "Diacon", "given": "Andreas H.", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-3424-9686", "affiliation": [ { "name": "Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden" } ], "authenticated-orcid": false, "family": "Simonsson", "given": "Ulrika S. H.", "sequence": "additional" } ], "container-title": "Vaccines", "container-title-short": "Vaccines", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2024, 3, 20 ] ], "date-time": "2024-03-20T09:04:12Z", "timestamp": 1710925452000 }, "deposited": { "date-parts": [ [ 2024, 3, 20 ] ], "date-time": "2024-03-20T10:47:14Z", "timestamp": 1710931634000 }, "funder": [ { "DOI": "10.13039/501100001713", "award": [ "RIA2020EF-2968" ], "doi-asserted-by": "publisher", "name": "the European Union" } ], "indexed": { "date-parts": [ [ 2024, 3, 21 ] ], "date-time": "2024-03-21T01:05:32Z", "timestamp": 1710983132694 }, "is-referenced-by-count": 0, "issue": "3", "issued": { "date-parts": [ [ 2024, 3, 19 ] ] }, "journal-issue": { "issue": "3", "published-online": { "date-parts": [ [ 2024, 3 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2024, 3, 19 ] ], "date-time": "2024-03-19T00:00:00Z", "timestamp": 1710806400000 } } ], "link": [ { "URL": "https://www.mdpi.com/2076-393X/12/3/329/pdf", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "1968", "original-title": [], "page": "329", "prefix": "10.3390", "published": { "date-parts": [ [ 2024, 3, 19 ] ] }, "published-online": { "date-parts": [ [ 2024, 3, 19 ] ] }, "publisher": "MDPI AG", "reference": [ { "key": "ref_1", "unstructured": "(2024, January 18). World Health Organisation WHO Coronavirus (COVID-19) Dashboard. Available online: https://data.who.int/dashboards/covid19/cases?n=c." }, { "key": "ref_2", "unstructured": "(2024, January 18). CDC Key Facts about Flu Season, Influenza Viruses, How Flu Spreads, and Information for Specific High Risk Groups, Available online: https://www.cdc.gov/flu/about/index.html." }, { "key": "ref_3", "unstructured": "(2024, January 17). CDC Tuberculosis Risk Factors, Available online: https://www.cdc.gov/tb/topic/basics/risk.htm." }, { "DOI": "10.1136/bmjopen-2020-040402", "article-title": "Modifiable and Non-Modifiable Risk Factors for COVID-19, and Comparison to Risk Factors for Influenza and Pneumonia: Results from a UK Biobank Prospective Cohort Study", "author": "Ho", "doi-asserted-by": "crossref", "first-page": "e040402", "journal-title": "BMJ Open", "key": "ref_4", "volume": "10", "year": "2020" }, { "article-title": "Predisposing Risk Factors for COVID-19 Infection: A Case-Control Study", "author": "Shahbazi", "first-page": "495", "journal-title": "Casp. J. Intern. Med.", "key": "ref_5", "volume": "11", "year": "2020" }, { "DOI": "10.1038/s41467-022-29880-7", "article-title": "Trends and Associated Factors for COVID-19 Hospitalisation and Fatality Risk in 2.3 Million Adults in England", "author": "Beaney", "doi-asserted-by": "crossref", "first-page": "2356", "journal-title": "Nat. Commun.", "key": "ref_6", "volume": "13", "year": "2022" }, { "DOI": "10.1080/22221751.2020.1787799", "article-title": "Risk Factors Associated with COVID-19 Infection: A Retrospective Cohort Study Based on Contacts Tracing", "author": "Liu", "doi-asserted-by": "crossref", "first-page": "1546", "journal-title": "Emerg. Microbes Infect.", "key": "ref_7", "volume": "9", "year": "2020" }, { "DOI": "10.3389/fpubh.2021.645739", "article-title": "Risk Factors for SARS-CoV-2 Infection, Pneumonia, Intubation, and Death in Northeast Mexico", "doi-asserted-by": "crossref", "first-page": "645739", "journal-title": "Front. Public Health", "key": "ref_8", "volume": "9", "year": "2021" }, { "DOI": "10.3389/fimmu.2022.841868", "article-title": "Efficacy and Safety of BCG Revaccination with M. Bovis BCG Moscow to Prevent COVID-19 Infection in Health Care Workers: A Randomized Phase II Clinical Trial", "author": "Cardoso", "doi-asserted-by": "crossref", "first-page": "841868", "journal-title": "Front. Immunol.", "key": "ref_9", "volume": "13", "year": "2022" }, { "DOI": "10.1007/s10654-021-00732-w", "article-title": "Risk Factors for COVID-19 Diagnosis, Hospitalization, and Subsequent All-Cause Mortality in Sweden: A Nationwide Study", "author": "Bergman", "doi-asserted-by": "crossref", "first-page": "287", "journal-title": "Eur. J. Epidemiol.", "key": "ref_10", "volume": "36", "year": "2021" }, { "DOI": "10.1186/s12889-019-7174-6", "doi-asserted-by": "crossref", "key": "ref_11", "unstructured": "Guerrisi, C., Ecollan, M., Souty, C., Rossignol, L., Turbelin, C., Debin, M., Goronflot, T., Boëlle, P.-Y., Hanslik, T., and Colizza, V. (2019). Factors Associated with Influenza-like-Illness: A Crowdsourced Cohort Study from 2012/13 to 2017/18. BMC Public Health, 19." }, { "DOI": "10.1001/archinte.160.20.3082", "article-title": "A Prospective Study of Age and Lifestyle Factors in Relation to Community-Acquired Pneumonia in US Men and Women", "author": "Baik", "doi-asserted-by": "crossref", "first-page": "3082", "journal-title": "Arch. Intern. Med.", "key": "ref_12", "volume": "160", "year": "2000" }, { "DOI": "10.1016/j.rmed.2016.10.015", "article-title": "Burden and Risk Factors of Ambulatory or Hospitalized CAP: A Population Based Cohort Study", "author": "Kolditz", "doi-asserted-by": "crossref", "first-page": "32", "journal-title": "Respir. Med.", "key": "ref_13", "volume": "121", "year": "2016" }, { "article-title": "Disease Burden and Attributable Risk Factors of Respiratory Infections in China from 1990 to 2019", "author": "Ruan", "first-page": "100153", "journal-title": "Lancet Reg. Health—West. Pac.", "key": "ref_14", "volume": "11", "year": "2021" }, { "DOI": "10.2169/internalmedicine.48.1918", "article-title": "Influence of Human T Lymphotropic Virus Type I Infection on the Etiology of Community-Acquired Pneumonia", "author": "Atsumi", "doi-asserted-by": "crossref", "first-page": "959", "journal-title": "Intern. Med.", "key": "ref_15", "volume": "48", "year": "2009" }, { "DOI": "10.1183/23120541.00429-2021", "article-title": "The Risk of Respiratory Tract Infections and Antibiotic Use in a General Population and among People with Asthma", "author": "Kisiel", "doi-asserted-by": "crossref", "first-page": "00429", "journal-title": "ERJ Open Res.", "key": "ref_16", "volume": "7", "year": "2021" }, { "DOI": "10.1378/chest.12-1956", "article-title": "A Prospective Study of Respiratory Viral Infection in Pregnant Women with and without Asthma", "author": "Murphy", "doi-asserted-by": "crossref", "first-page": "420", "journal-title": "Chest", "key": "ref_17", "volume": "144", "year": "2013" }, { "DOI": "10.1038/s41366-018-0029-x", "article-title": "Association between Body Mass Index and Laboratory-Confirmed Influenza in Middle Aged and Older Adults: A Prospective Cohort Study", "author": "Karki", "doi-asserted-by": "crossref", "first-page": "1480", "journal-title": "Int. J. Obes.", "key": "ref_18", "volume": "42", "year": "2018" }, { "DOI": "10.1186/1741-7015-12-61", "doi-asserted-by": "crossref", "key": "ref_19", "unstructured": "Nie, W., Zhang, Y., Jee, S.H., Jung, K.J., Li, B., and Xiu, Q. (2014). Obesity Survival Paradox in Pneumonia: A Meta-Analysis. BMC Med., 12." }, { "DOI": "10.1186/s12889-018-5172-8", "doi-asserted-by": "crossref", "key": "ref_20", "unstructured": "Maccioni, L., Weber, S., Elgizouli, M., Stoehlker, A.-S., Geist, I., Peter, H.-H., Vach, W., and Nieters, A. (2018). Obesity and Risk of Respiratory Tract Infections: Results of an Infection-Diary Based Cohort Study. BMC Public Health, 18." }, { "DOI": "10.1016/j.jaci.2015.12.1307", "article-title": "Obesity and Rhinitis in a Nationwide Study of Children and Adults in the United States", "author": "Han", "doi-asserted-by": "crossref", "first-page": "1460", "journal-title": "J. Allergy Clin. Immunol.", "key": "ref_21", "volume": "137", "year": "2016" }, { "DOI": "10.2105/AJPH.83.9.1277", "article-title": "Smoking, Alcohol Consumption, and Susceptibility to the Common Cold", "author": "Cohen", "doi-asserted-by": "crossref", "first-page": "1277", "journal-title": "Am. J. Public Health", "key": "ref_22", "volume": "83", "year": "1993" }, { "DOI": "10.1001/jama.1982.03330020025023", "article-title": "Association between Cigarette Smoking and Acute Respiratory Tract Illness in Young Adults", "author": "Aronson", "doi-asserted-by": "crossref", "first-page": "181", "journal-title": "JAMA", "key": "ref_23", "volume": "248", "year": "1982" }, { "DOI": "10.1111/irv.12750", "article-title": "Are Healthcare Workers More Likely than the General Population to Consult in Primary Care for an Influenza-like Illness? Results from a Case-control Study", "author": "Peytremann", "doi-asserted-by": "crossref", "first-page": "524", "journal-title": "Influenza Other Respir. Viruses", "key": "ref_24", "volume": "14", "year": "2020" }, { "DOI": "10.1186/1471-2334-10-8", "doi-asserted-by": "crossref", "key": "ref_25", "unstructured": "Williams, C.J., Schweiger, B., Diner, G., Gerlach, F., Haaman, F., Krause, G., Nienhaus, A., and Buchholz, U. (2010). Seasonal Influenza Risk in Hospital Healthcare Workers Is More Strongly Associated with Household than Occupational Exposures: Results from a Prospective Cohort Study in Berlin, Germany, 2006/07. BMC Infect. Dis., 10." }, { "DOI": "10.3390/antibiotics11030315", "doi-asserted-by": "crossref", "key": "ref_26", "unstructured": "Tang, H.-J., Lai, C.-C., and Chao, C.-M. (2022). Changing Epidemiology of Respiratory Tract Infection during COVID-19 Pandemic. Antibiotics, 11." }, { "DOI": "10.1016/j.eclinm.2022.101414", "article-title": "Safety and Efficacy of BCG Re-Vaccination in Relation to COVID-19 Morbidity in Healthcare Workers: A Double-Blind, Randomised, Controlled, Phase 3 Trial", "author": "Upton", "doi-asserted-by": "crossref", "first-page": "101414", "journal-title": "eClinicalMedicine", "key": "ref_27", "volume": "48", "year": "2022" }, { "key": "ref_28", "unstructured": "(2020). Western Cape Government Population Data (Standard No. CIRCULAR H 102/2020)." }, { "DOI": "10.1002/psp4.13006", "article-title": "Seasonal Influence on Respiratory Tract Infection Severity Including COVID-19 Quantified through Markov Chain Modeling", "author": "Mockeliunas", "doi-asserted-by": "crossref", "first-page": "1250", "journal-title": "CPT Pharmacomet. Syst. Pharmacol.", "key": "ref_29", "volume": "12", "year": "2023" }, { "DOI": "10.1002/psp4.12797", "article-title": "Finding the Right Hazard Function for Time-to-Event Modeling: A Tutorial and Shiny Application", "author": "Simonsson", "doi-asserted-by": "crossref", "first-page": "991", "journal-title": "CPT Pharmacomet. Syst. Pharmacol.", "key": "ref_30", "volume": "11", "year": "2022" }, { "DOI": "10.1208/ps040427", "article-title": "Comparison of Stepwise Covariate Model Building Strategies in Population Pharmacokinetic-Pharmacodynamic Analysis", "author": "Jonsson", "doi-asserted-by": "crossref", "first-page": "68", "journal-title": "AAPS PharmSci", "key": "ref_31", "volume": "4", "year": "2002" }, { "DOI": "10.1007/s10928-017-9542-0", "article-title": "An Automated Sampling Importance Resampling Procedure for Estimating Parameter Uncertainty", "author": "Dosne", "doi-asserted-by": "crossref", "first-page": "509", "journal-title": "J. Pharmacokinet. Pharmacodyn.", "key": "ref_32", "volume": "44", "year": "2017" }, { "DOI": "10.1208/s12248-017-0162-9", "article-title": "Kernel-Based Visual Hazard Comparison (kbVHC): A Simulation-Free Diagnostic for Parametric Repeated Time-to-Event Models", "author": "Goulooze", "doi-asserted-by": "crossref", "first-page": "5", "journal-title": "AAPS J.", "key": "ref_33", "volume": "20", "year": "2018" }, { "DOI": "10.1038/s41598-023-43412-3", "article-title": "Reproducibility in Pharmacometrics Applied in a Phase III Trial of BCG-Vaccination for COVID-19", "author": "Mockeliunas", "doi-asserted-by": "crossref", "first-page": "16292", "journal-title": "Sci. Rep.", "key": "ref_34", "volume": "13", "year": "2023" }, { "key": "ref_35", "unstructured": "(2020). R Core Team R: A Language and Environment for Statistical Computing 2020, R Core Team." }, { "key": "ref_36", "unstructured": "(2022). RStudio Team RStudio: Integrated Development Environment for R 2022, RStudio Team." }, { "key": "ref_37", "unstructured": "Beal, S., Sheiner, L., Boeckmann, A., and Bauer, R. (2014). NONMEM 7.4 Users Guides 1989, Icon Development Solutions." }, { "DOI": "10.18637/jss.v070.i08", "article-title": "Flexsurv: A Platform for Parametric Survival Modeling in R", "author": "Jackson", "doi-asserted-by": "crossref", "first-page": "i08", "journal-title": "J. Stat. Softw.", "key": "ref_38", "volume": "70", "year": "2016" }, { "DOI": "10.1007/s10654-008-9278-7", "article-title": "Survival Analysis: Up from Kaplan–Meier–Greenwood", "author": "Miettinen", "doi-asserted-by": "crossref", "first-page": "585", "journal-title": "Eur. J. Epidemiol.", "key": "ref_39", "volume": "23", "year": "2008" }, { "DOI": "10.1002/psp4.13116", "doi-asserted-by": "crossref", "key": "ref_40", "unstructured": "Jonsson, N., and Nyberg, J. (2024, January 05). Checklists and Best Practices to Support the Informed Use of Forest Plots to Illustrate the Impact of Covariates in Pharmacometric Models; November 2023; Vol. Poster M-122L. Available online: https://pharmetheus.com/publications/checklists-and-best-practices-to-support-the-informed-use-of-forest-plots-to-illustrate-the-impact-of-covariates-in-pharmacometric-models/." }, { "DOI": "10.1016/S0140-6736(21)00675-9", "article-title": "SARS-CoV-2 Infection Rates of Antibody-Positive Compared with Antibody-Negative Health-Care Workers in England: A Large, Multicentre, Prospective Cohort Study (SIREN)", "author": "Hall", "doi-asserted-by": "crossref", "first-page": "1459", "journal-title": "Lancet", "key": "ref_41", "volume": "397", "year": "2021" }, { "DOI": "10.1093/ntr/ntab004", "article-title": "Impact of Tobacco Smoking on the Risk of COVID-19: A Large Scale Retrospective Cohort Study", "author": "Paleiron", "doi-asserted-by": "crossref", "first-page": "1398", "journal-title": "Nicotine Tob. Res.", "key": "ref_42", "volume": "23", "year": "2021" }, { "DOI": "10.1093/ntr/ntaa121", "article-title": "Smoking Prevalence and COVID-19 in Europe", "author": "Tsigaris", "doi-asserted-by": "crossref", "first-page": "1646", "journal-title": "Nicotine Tob. Res.", "key": "ref_43", "volume": "22", "year": "2020" }, { "DOI": "10.15585/mmwr.mm6925e1", "article-title": "Characteristics Associated with Hospitalization Among Patients with COVID-19—Metropolitan Atlanta, Georgia, March–April 2020", "author": "Killerby", "doi-asserted-by": "crossref", "first-page": "790", "journal-title": "Morb. Mortal. Wkly. Rep.", "key": "ref_44", "volume": "69", "year": "2020" }, { "DOI": "10.1093/ntr/ntaa107", "article-title": "Impact of Smoking Status on Disease Severity and Mortality of Hospitalized Patients with COVID-19 Infection: A Systematic Review and Meta-Analysis", "author": "Karanasos", "doi-asserted-by": "crossref", "first-page": "1657", "journal-title": "Nicotine Tob. Res.", "key": "ref_45", "volume": "22", "year": "2020" }, { "article-title": "Factors Associated with Contracting Severe Acute Respiratory Syndrome Corona Virus Type-2 in Norton Town, Zimbabwe, 2021: A Case-Control Study", "author": "Chimsimbe", "first-page": "9", "journal-title": "J. Interv. Epidemiol. Public Health", "key": "ref_46", "volume": "5", "year": "2022" }, { "DOI": "10.1186/s12879-021-06780-7", "doi-asserted-by": "crossref", "key": "ref_47", "unstructured": "Albani, V., Loria, J., Massad, E., and Zubelli, J. (2021). COVID-19 Underreporting and Its Impact on Vaccination Strategies. BMC Infect. Dis., 21." } ], "reference-count": 47, "references-count": 47, "relation": {}, "resource": { "primary": { "URL": "https://www.mdpi.com/2076-393X/12/3/329" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [ "Pharmacology (medical)", "Infectious Diseases", "Drug Discovery", "Pharmacology", "Immunology" ], "subtitle": [], "title": "Risk Factors for COVID-19 and Respiratory Tract Infections during the Coronavirus Pandemic", "type": "journal-article", "volume": "12" }