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National Center for Immunization & Respiratory Diseases
Update: E pidemiologic
Characteristics of Long COVID
Sharon Saydah, PhD, MHS, CDR USPHS
Coronaviruses and Other Respiratory Viruses Division,
Epidemiology Branch
Post COVID Conditions -Longer Term Sequelae Team Lead
September 12, 2023
A general framework for Post -COVID Conditions
Conditions frequently overlap
Patients may experience any combination
*ME/CFS: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
** MIS -C: Multisystem Inflammatory Syndrome in ChildrenWide range of physical and mental health consequences continue or
develop at least 4 weeks after initial COVID -19 or SARS -CoV-2 infection
General consequences of illness and
hospitalization
•Post ICU syndrome
•Other complications of treatment
or illnessPost acute sequelae of SARS -CoV-2
infection
•System specific pathology (e.g.
lung fibrosis, stroke)
•Clinicall y significant symptoms
with unclear pathology (e.g.
ME/CFS* -like, dysautonomia)
•On-going symptoms following
MIS-C**
Long COVID commonly used term for Post -COVID
Conditions
Estimating the Occurrence of Post -COVID Conditions
Prevalence of on -going symptoms lasting at least 3 months
after COVID -19 by age, regardless of COVID status: U.S.
10.81.96.89
7.4
4.2
0.2 0.30.82.74.7
3.8
2.3
0.01.02.03.04.05.06.07.08.09.010.0
0 - 5 years 6 - 11 years 12 - 17 years 18-34 years 35-49 years 50-64 years ≥ 65 yearsPrevalence (%)
Ever Current
UNPUBLISHED CDC DATA –Preliminary estimates from 2022 National Health Interview SurveyNationally representative of non -institutional population in the U.S., s tatistical software was used to account for NHIS’s complex sampling design.
Trends of Long COVID and significant activity limitations among
adults -United States, June 1 –13, 2022, to June 7 –19, 2023
The prevalence of Long COVID
(currently reporting symptoms lasting ≥
3 months) among non -institutionalized
adults:
•Decreased from June 2022 to January
2023
•Remained unchanged through June
2023Almost 1 in 4 adults with Long COVID
report significant activity limitations
Long COVID and Significant Activity Limitation Among Adults, by Age —United States, June 1 –13, 2022, to June 7 –19, 2023 |
MMWR (cdc.gov)
Using electronic health records and comparing patients with COVID -19 to those
without evidence of COVID -19:
•Among children and adolescents, increased risk of four symptoms and eight
conditions 31–365 days following COVID -19 1,2
–Associated with an increased risk of heart conditions, kidney failure, blood clots,
diabetes, fatigue, smell and taste disorders, neurological conditions
•Among adults, 1 in 5 COVID -19 survivors may have a health condition associated
with previous COVID -19 in the 31 –365 days following COVID -19 3
–Associated with an increased risk of cardiovascular events, kidney disease,
respiratory conditions, diabetes, and neurological conditions 2,4,5,6SARS -CoV-2 infection associated with diagnosis of
incident conditions
1) Post –COVID -19 Symptoms and Conditions Among Children and Adolescents —United States, March 1, 2020 –January 31, 2022 | MMWR ( cdc.gov)
2) Hernandez -Romieu AC et al. JAMA Netw Open. 2022; 5(2 )
3) Bull-Otterson et al. Post -COVID Conditions Among Adult COVID -19 Survivors Aged 18 –64 and ≥65 Years –United States, March 2020 –November 2021 . MMWR May 27, 2022.
4)Post –acute sequalae of COVID -19 and cardiac outcomes in U. S. military members -ScienceDirect
5) Risk of persistent and new clinical sequelae among adults aged 65 years and older during the post -acute phase of SARS -CoV-2 infe ction: retrospective cohort study | The BMJ
6) Long -term neurologic outcomes of COVID -19 | Nature Medicine
In a prospective study of adults testing positive and negative for COVID -19:
•Following acute -COVID -like illness among adults, on -going symptoms decrease after
3 months, but 16% continue to experience on -going symptoms at 12 months
•Many adults reported new emerging or re -emerging symptoms at 6, 9, and 12
months following acute COVID -like illness
•Symptoms were not unique to SARS -CoV-2 infection
In the Veterans Affairs patient population:
•Post -COVID Conditions decreased 90 days after acute COVID -19, with increased risk
of new conditions continuing for up to 2 years.Post -COVID Conditions symptoms and duration
Prevalence of Symptoms ≤12 Months After Acute Illness, by COVID -19 Testing Status Among Adults —United States,
December 2020 –March 2023 | MMWR (cdc.gov)
Postacute sequelae of COVID -19 at 2 years | Nature Medicine
•Female sex
•Older age (sometimes)
–Adolescents compared to younger children
–Middle -aged adults compared to younger and older adults for symptoms
–Older adults compared to younger adults for incident conditions
•Severity of COVID -19 illness
•Underlying health conditions prior to COVID -19
•Lower socio -economic status
•Did not get COVID -19 vaccineGroups associated with a higher likelihood of
developing Long COVID
Maglietta G et al. Prognostic Factors for Post -COVID -19 Syndrome: A Systematic Review and Meta -Analysis. JCM
2022
Socioeconomic inequalities of Long COVID -UK. Shabnam et al. 2023 (sagepub.com)
Hastie. et al. Outcomes among confirmed cases and matched comparison group in the Long COVID in Scotland
Study. Nature 2022
Epidemiology of Long Coronavirus Disease in US Adults | Clinical Infectious Diseases | Oxford Academic (oup.com)
Frontiers | Hospital admission and vaccination as predictive factors of long COVID -19 symptoms (frontiersin.org)
COVID -19 Vaccines and Post -COVID Conditions
COVID -19 vaccination
(1 or 2 doses) reduces
Post -COVID Conditions
compared to no
vaccination among
those with SARS -CoV-2
infection
Protective effect of COVID -19 vaccination against
long COVID syndrome: A systematic review and
meta -analysis -ScienceDirect
•COVID -19 cases diagnosed from
March 2021 –February 2022,
followed through August 2022
•161,531 with COVID vaccination
prior to infection matched 1:1
with patients without
vaccinationAssociations of prior
COVID -19 vaccination and
risk of PCC categories 6
months following SARS -
CoV-2 infection, by age
group: Mar 2021 -Feb 2022
UNPUBLISHED DATA
Vaccine Safety Datalink Adjusted RR (95% CI)
COVID -19 mRNA vaccination associated with reduced occurrence of Post COVID
Conditions following SARS -CoV-2 infection in a US cohort of adult essential workers,
June 2021 --September 2022
Unpublished data from the HEROES/RECOVER cohort. HEROES Protocol ; RECOVER ProtocolTotal (N =936)Unvaccinated
(n= 157)Vaccinated 2 doses (≥ 14 days)
(n= 301)Vaccinated 3 doses (≥ 7 days)
(n=478)
N (Col %) N (Row %) N (Row%) aOR (95% CI)a N (Row%) aOR (95% CI)a
1 or more symptoms 221 (23.6) 42 (19.0) 74 (33.5) 1.00 (0.80 -1.27) 105 (47.5) 0.84 (0.67 -1.06)
2 or more symptoms 158 (16.9) 27 (17.1) 62 (39.2) 1.22 (0.94 -1.59) 69 (43.7) 0.76 (0.58 -0.99)
Cardiovascular symptoms 107 (11.4) 19 (17.8) 44 (41.1) 1.32 (0.98 -1.78) 44 (41.1) 0.73 (0.54 -0.99)
Gastrointestinal
symptoms 46 (4.9) 12 (26.1) 17 (37.0) 1.04 (0.67 -1.61) 17 (37.0) 0.60 (0.39 -0.94)
General symptoms 142 (15.2) 26 (18.3) 58 (40.8) 1.22 (0.94 -1.60) 58 (40.8) 0.81 (0.62 -1.05)
Neurological symptoms 128 (13.7) 26 (20.3) 44 (34.4) 1.08 (0.81 -1.43) 58 (45.3) 0.75 (0.57 -0.99)
Other symptoms 80 (8.5) 19 (23.8) 29 (36.3) 1.08 (0.77 -1.51) 32 (40.0) 0.68 (0.48 -0.95)
COVID -19 mRNA vaccination associated with reduced occurrence of
Post COVID Conditions following Omicron SARS -CoV-2 infection in a US
cohort of children aged 5 -17 years, July 2021 --September 2022
Unvaccinated,
148 (row %)Vaccinated1,
474 (row %)OR (95% CI) Adjusted OR2
(95% CI)
1 or more PCC symptoms 12 (43) 16 (57) 0.63 (0.43 -0.93) 0.66 (0.43 -0.99)
2 or more PCC symptoms 11 (52) 10 (48) 0.52 (0.34 -0.81) 0.52 (0.32 -0.83)
Respiratory PCC symptoms 10 (53) 9 (47) 0.52 (0.33 -0.82) 0.53 (0.32 -0.86)
Non -Respiratory PCC symptoms 10 (42) 14 (58) 0.64 (0.42 -0.98) 0.70 (0.45 -1.10)
PCC Impact on function 9 (56) 7 (44) 0.51 (0.22 -1.15) 0.62 (0.21 -1.83)
Unpublished data from the PROTECT cohort. PROTECT Protocol
Summary
•Post -COVID Conditions are common following SARS -CoV-2 infection, decrease
with time since infection, and has decreased since the start of the pandemic
•Symptoms and conditions associated with Post -COVID Conditions are not
unique to having had SARS -CoV-2 infection
•Post -COVID Conditions are associated with increased health care utilization and
significant activity limitations
•Accumulating evidence that COVID -19 vaccination reduces Post -COVID
Conditions among both children and adultsImportant take home messages
For more information, contact CDC
1-800-CDC-INFO (232 -4636)
TTY: 1 -888-232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the
official position of the Centers for Disease Control and Prevention.
For more information:
Sharon Saydah, PhD, MHS [email protected]?