28 augustus 2021: Bron: The Lancet

Een grote landelijke Engelse studie vond een hoger risico op ziekenhuisopname of spoedeisende hulp voor patiënten met COVID-19 die besmet waren met de delta-variant in vergelijking met de alfa-variant. Uit een totale groep van patiënten (N =  43.338 mensen) die waren besmet met COVID-19 (N = 8682 met de delta-variant, N = 34.656 met de alfa-variant; mediane leeftijd 31 jaar [IQR 17-43]) werden opgenomen in een analyse. 

498 patiënten met de delta-variant (5,7%) versus 1448 patiënten met de alfa-variant (4,2%) werden binnen 14 dagen na de eerste positieve test opgenomen in het ziekenhuis of gingen naar de spoedeisende hulp.
De meeste patiënten waren niet gevaccineerd (32 078 [74,0%] in beide groepen, maar dus nog altijd 26 procent van de gevaccineerden werd ook ernstig ziek). En toch wel opvallend: het verschil tussen de Delta variant en de Alfa variant was voor beide groepen, gevaccineerd of niet gevaccineerd, nagenoeg gelijk. (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 voor beide groepen).

Conclusie van de onderzoekers:

Deze grote landelijke studie vond een hoger risico op ziekenhuisopname of spoedeisende hulp voor patiënten met COVID-19 die besmet waren met de delta-variant in vergelijking met de alfa-variant. Resultaten suggereren dat uitbraken van de delta-variant in niet-gevaccineerde populaties kunnen leiden tot een grotere belasting van de gezondheidszorg dan de alfa-variant.

Het studierapport is gepubliceerd in the Lancet. Klik op de titel van het abstract voor het gratis studieverslag.

Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study

Open AccessPublished:August 27, 2021DOI:https://doi.org/10.1016/S1473-3099(21)00475-8

Summary

Background

The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes.

Methods

This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status.

Findings

Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years [IQR 17–43]) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio 2·26 [95% CI 1·32–3·89]). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 [1·08–1·95]). Most patients were unvaccinated (32 078 [74·0%] across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 [95% CI 0·47–8·05] and for hospital admission or emergency care attendance 1·58 [0·69–3·61]) were similar to the HRs for unvaccinated patients (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 for both) but the precision for the vaccinated subgroup was low.

Interpretation

This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant.

Funding

Medical Research Council; UK Research and Innovation; Department of Health and Social Care; and National Institute for Health Research.



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