COMPARATIVE CHARACTERISTICS OF THE CLINICAL COURSE OF NEW CORONAVIRUS INFECTION IN VACCINATED PATIENTS

UDC 615.371:578.834.1

COMPARATIVE CHARACTERISTICS OF THE CLINICAL COURSE

OF NEW CORONAVIRUS INFECTION IN VACCINATED PATIENTS

N.Yu. Miropolskaya, Candidate of Medical Sciences, Associate Professor of the Department

of "Polyclinic Pediatrics with a Course of Children's Infectious Diseases"

Far Eastern State Medical University of the Ministry of Health of the Russian Federation

(680000, Russia, Khabarovsk, st. Muravyov-Amursky, 35)

Email: miropolskayanatasha@mail.ru

V.А. Borodulina, Resident Doctor of the Department of Polyclinic Pediatrics

with a Course of Children's Infectious Diseases, Specialty: "Infectious diseases"

Far Eastern State Medical University of the Ministry of Health of the Russian Federation

(680000, Russia, Khabarovsk, st. Muravyov-Amursky, 35)

Email: nauka@mail.fesmu.ru

А.V. Zakharov, Otorhinolaryngologist, Head of ENT Department

"City Clinical Hospital" named after D.N. Matveev of the Ministry of Health of the Khabarovsk Territory

(680000, Russia, Khabarovsk, st. Muravyov-Amursky, 54)

Email: D.N.Matveeva@yandex.ru

Abstract. In December 2019, for the first time, WHO was informed about the appearance in Wuhan (Hubei Province, China) of a severe acute illness, accompanied in some cases by the development of severe respiratory distress syndrome (SARS). The disease caused by the novel coronavirus has been named COVID-19 and the virus has been named SARS-CoV-2. Starting January 30, 2020, the World Health Organization (WHO) declared the outbreak of COVID-19 as a public health emergency, and from March 11, 2020, due to the rapid and widespread spread of the infection, a COVID-19 pandemic. At the same time, the only way to prevent a severe course of a new pathology was vaccination with the formation of herd immunity. An analysis was made of the features of the clinical course and outcomes of a new coronavirus infection in vaccinated and unvaccinated patients on the basis of the D.N. Matveev City Clinical Hospital of the Ministry of Health of the Kharkiv Republic (Khabarovsk) for the period from October 11, 2021 to March 14, 2022 of the year.

Keywords: novel coronavirus infection, vaccination against COVID-19, adults.

At the beginning of the 21st century, infectious diseases continue to be one of the leading causes of premature death of people. The main successes achieved in the fight against infectious diseases relate primarily to vaccine-preventable infections, thus confirming that it is vaccine prophylaxis that is the most promising and economical way to reduce morbidity, up to the possible elimination of some infections [3]. Global spread of Covid-19 coronovirus infection, high incidence rates without a clear downward trend, the predominant lesion of the elderly determine the significance of this infection [1, 2, 4]. Of great importance is a set of measures to ensure the suppression of the airborne transmission of the coronovirus. However, the creation of artificial immunity through vaccination also plays an important role in the fight against infection. At present, there is no doubt about the feasibility and effectiveness of mass routine vaccination against coronovirus infection Covid-19 in countries with high incidence. With a decrease in the overall incidence of Covid-19 coronovirus infection and in conditions of systematic outbreaks of infection, the only method for regulating and stopping the epidemic process may be emergency vaccination.

In December 2019, for the first time, WHO was informed about the appearance in Wuhan (Hubei Province, China) of a severe acute illness, accompanied in some cases by the development of severe respiratory distress syndrome (SARS). The disease caused by the novel coronavirus has been named COVID-19 and the virus has been named SARS-CoV-2. Starting January 30, 2020, the World Health Organization (WHO) declared the outbreak of COVID-19 as a public health emergency, and from March 11, 2020, due to the rapid and widespread spread of the infection, a COVID-19 pandemic. At the same time, the only way to prevent a severe course of a new pathology was vaccination with the formation of herd immunity. The aim of our study was to analyze the features of the clinical course and outcomes of a new coronavirus infection in vaccinated and unvaccinated patients in comparison [1, 4].

We examined 731 hospitalized people at the D.N. Matveev City Clinical Hospital of the Ministry of Health of the Kharkiv Republic (Khabarovsk) for the period from October 11, 2021 to March 14, 2022, redeveloped into an infectious diseases hospital for the treatment of patients with new covid-19 infection, of which 200 patients (main group) were vaccinated with vaccines available in the country, both complete and incomplete vaccine complex. The remaining 531 patients were referred by us to the comparison group. In all cases, the disease was confirmed by obtaining a positive result of the polymerase chain reaction (PCR) in a swab from the nasopharynx of patients for the presence of SARS-CoV-2 RNA or a rapid test (immunochromatographic method – ICA).

The groups were comparable in all respects. According to the survey, the maximum age group consisted of 64 patients (32 %) who were elderly, on average 63 years. The distribution of patients by sex was characterized by a slight predominance of the number of women (54,7 %) over men. Patients were hospitalized, mainly on the 8th day of illness. The most common complaints on admission were weakness (86,4 %) and cough (84,8 %). 60 % of patients had arterial hypertension of varying severity, 17,51 % had a history of type 2 diabetes mellitus or prediabetes as a background disease. Damage to the lung tissue, according to MSCT of the OGK, most often corresponded to CT-1 (table 1).

Table 1

Clinical and anamnestic characteristics of patients

Indicator

Gender

Day of illness at the time of hospitalization

Complaints on admission

Weakness

Cough

Anosmia/Hyposmia

Headache

Dyspnea

loose stool

The volume of lung damage according to the results of CT

Chronic diseases

Diabetes mellitus type 1; type 2; prediabetes

arterial hypertension

Other

The level of SPO2 at admission in the vaccinated group corresponded, on average, to 97,17 %, in the unvaccinated group 95,45 %.

According to the dynamics of laboratory parameters, in both groups at the time of admission, coagulopathy was noted with an increase in the level of D-dimer, and in the group of unvaccinated this indicator corresponded to an average of 682,5, and in the group of vaccinated 381,55. Also, in both groups, an increased level of CRP was noted, in the unvaccinated group, this figure corresponded to 49,35 mg/l, and in the vaccinated group – 38,11 mg/l (table 2).

Table 2

Clinical and laboratory dynamics

Indicator

Fever

White blood cell count

Number of lymphocytes

Absolute number of lymphocytes

ESR

CRP level

ALAT level

ASAT level

D-dimer level

INR level

It should be noted that in the group of vaccinated patients, deterioration in the condition of patients was noted in 2,5 % of cases, and deaths occurred in 2 patients or in 1 % of cases, in the group of unvaccinated patients, deterioration occurred in 3 % of cases, deaths occurred in 15 patients. (2,8 %). As for the duration of hospitalization, in the vaccinated group, the average number of bed-days was 9,28, in the unvaccinated group – 10,48 (Table 3).

Table 3

The severity of the disease and the outcome of hospitalization

Indicator

Conclusions:

Thus, despite the presence of specific vaccination against coronovirus infection, the pathogen continues to circulate among the population, posing a danger to unvaccinated individuals and those with weakened immunity.

In the group of vaccinated patients, according to laboratory parameters, the inflammatory process and the process of thrombosis proceeded less intensively than in the group of non-vaccinated patients, which ultimately reduces the risk of developing a cytokine storm and thromboembolic complications. Also, in the group of vaccinated patients, the percentage of death was lower than in the group of unvaccinated patients.

REFERENCES

1. Interim guidelines Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19), version 15 of 02.22.2022.
2. Linets, Yu.P., Artyukhov S.V., Kazantsev A.N., et al. The course of COVID-19 in vaccinated patients. Journal named after N.V. Sklifosovsky Emergency Medical Care. 2021. No 10(4). P. 636-641.
3. Samoilovich, E.O., Ermolovich M.A., Kolodkina V.L. The role of vaccination in the control and elimination of infectious diseases. Health. 2010. No. 10. P. 5-12.
4. Zubov, V.V., Rodionova M.E., Emelin A.A. Attitude of the population towards vaccination against coronavirus: a comparative analysis of studies. Issues of national and federal relations. 2021. No 11(2). P. 432-441.

REFERENCES

1. Interim guidelines Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19), version 15 of 02.22.2022 (In English).
2. Linets Yu.P., Artyukhov S.V., Kazantsev A.N. The course of COVID-19 in vaccinated patients. Journal named after N.V. Sklifosovsky Emergency Medical Care. 2021. no 10 (4). pp. 636-641 (In English).
3. Samoilovich E.O., Ermolovich M.A., Kolodkina V.L. The role of vaccination in the control and elimination of infectious diseases. Health. 2010. no. 10. pp. 5-12 (In English).
4. Zubov V.V., Rodionova M.E., Emelin A.A. Attitude of the population towards vaccination against coronavirus: a comparative analysis of studies. Issues of national and federal relations. 2021. no 11(2). pp. 432-441 (In English).

Материал поступил в редакцию 05.05.23

Сравнительная характеристика клинического течения новой коронавирусной инфекции у вакцинированных пациентов

Н.Ю. Миропольская, кандидат медицинских наук,

доцент кафедры «Поликлинической педиатрии с курсом детских инфекционных болезней»

ФГБОУ ВО Дальневосточный государственный медицинский университет Минздрава России

(680000, Россия, г. Хабаровск, ул. Муравьева-Амурского, 35)

Email: miropolskayanatasha@mail.ru

В.А. Бородулина, врач-ординатор кафедры «Поликлинической педиатрии

с курсом детских инфекционных болезней» по специальности: «Инфекционные болезни»

ФГБОУ ВО Дальневосточный государственный медицинский университет Минздрава России

(680000, Россия, г. Хабаровск, ул. Муравьева-Амурского, 35)

Email: nauka@mail.fesmu.ru

А.В Захаров, врач-оториноларинголог, заведующий ЛОР-отделением

КГБУЗ «Городская клиническая больница» имени Д.Н. Матвеева

Министерства Здравоохранения Хабаровского края

(680000, Россия, г. Хабаровск, ул. Муравьева-Амурского, 54)

Email: D.N.Matveeva@yandex.ru

Аннотация. В декабре 2019 г. впервые ВОЗ была информирована о появлении в г. Ухань (провинция Хубей, Китай) тяжелого острого заболевания, сопровождающегося в ряде случаев развитием тяжелого респираторного дистресс-синдрома (ТОРС). Болезнь, вызванная новым коронавирусом, была названа COVID-19, а вирус – SARS-CoV-2. Начиная с 30 января 2020 г., Всемирная организация здравоохранения (ВОЗ) объявила о вспышке СOVID-19, как чрезвычайной ситуации в здравоохранении, а с 11 марта 2020 г., вследствие быстрого и повсеместного распространения инфекции, – о пандемии COVID-19. При этом единственным способом предупреждения тяжелого течения новой патологии стала вакцинация с формированием коллективного иммунитета. Был проведен анализ особенностей клинического течения и вариантов исхода новой коронавирусной инфекции у вакцинированных и невакцинированных пациентов на базе КГБУЗ «Городская клиническая больница" имени Д.Н. Матвеева» МЗ ХК (г. Хабаровск) за период с 11 октября 2021 года по 14 марта 2022 года.

Ключевые слова: новая коронавирусная инфекция, вакцинация против COVID-19, взрослые.