Self-assembled Protein Nanoparticles Decorated with SARS-CoV-1 and MERS-CoV Spikes Trigger Potent Neutralizing Responses against Both Viruses

Background: Reports of persistent symptoms after COVID-19 infection have raised concern about post-COVID conditions (PCC).We describe patient characteristics and risk factors for COVID-19 infection and PCC at six months after enrollment in febrile patients presenting to six hospitals in Nakhon Phanom and Tak provinces, along the Thai-Lao and Thai-Myanmar borders, respectively.Methods: During June 2022-May 2023, we enrolled patients aged > 2 years presenting to outpatient departments/emergency rooms with temperature 37.5 C or history of fever 14 days.Saliva, nasal and nasopharyngeal/oropharyngeal swabs were tested for SARS-CoV-2 using real-time RT-PCR.Interviews and medical record reviews were conducted.Differences between COVID-19 cases (patients with RT-PCR positive for SARS-CoV-2) and noncases were measured using Chi-square test.Multivariate analysis assessed factors associated with COVID-19; adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated.Follow-up of cases has occurred every three months following enrollment to assess PCC (defined as any persistent symptoms at each follow-up period) and degree of depression using the Patient Health Questionnaire (PHQ-9), compared to baseline at enrollment.Results: COVID-19 was detected in 1,694/3,031 (56%) persons, including 1,173/1,802 (65%) from Nakhon Phanom and 521/1,229 (42%) from Tak (p < 0.001).Compared to non-cases, cases were more likely to be older (median 38 [interquartile range 28-54] vs. 28 [IQR 13-49] years, p < 0.001) and female (63% vs. 53%, p < 0.001).Cases were more likely to report contact with other COVID-19 cases (aOR 10.0; 95%CI 7.8-12.0),history of travel (aOR 2.8; 95%CI 2.0-4.1),visiting crowded places (aOR 1.3; 95%CI 1.1-1.6),current alcohol consumption (aOR 1.9; 95%CI 1.3-2.8)and obesity (aOR1.5;95%CI 1.3-1.8).Of 1,694 cases, 842 (50%) agreed to be monitored for PCC, 420 (50%) completed six months of follow-up.Half (210/420) of these cases reported persistent symptoms at the 6-month follow-up visit; fatigue (n = 80, 19%), muscle pain (n = 79, 19%), forgetfulness (n = 76, 18%), insomnia (n = 74, 18%) and shortness of breath (n = 38, 9.0%) were the most common symptoms described by cases.A similar pattern of symptoms was observed among 442 participants at the 3-month follow-up visit.The proportion of cases with moderate to severe depression decreased from 4.3% (19/442) at baseline to 1.9% (8/420) at six months (p = 0.08).A greater proportion of females than males reported moderate to severe depression at baseline (5.8% vs. 1.3%, p = 0.03) and at 6-month follow-up (2.6% vs. 0.4%, p = 0.04).Discussion: SARS-CoV-2 was detected in more than half of febrile patients visiting hospitals in two border provinces of Thailand.Understanding the risk factors may inform prevention strategies for SARS-CoV-2 infections.PCC was found in half of the COVID-19 patients six months after COVID-19 diagnosis.Conclusion: Public health authorities and health care providers should work with communities to reduce risks for infection and monitor patients for PCC and mental health status after infection.