Viral and host factors associated with SARS-CoV-2 disease severity in Georgia, USA
While SARS-CoV-2 vaccines have shown strong efficacy, the continued emergence of new viral variants raises concerns about the ongoing and future public health impact of COVID-19, especially in locations with suboptimal vaccination uptake. We investigated viral and host factors, including vaccination status, that were associated with SARS-CoV-2 disease severity in a setting with low vaccination rates. We analyzed clinical and demographic data from 1,957 individuals in the state of Georgia, USA, coupled with viral genome sequencing from 1,185 samples. We found no specific mutations associated with disease severity. Compared to those who were unvaccinated, vaccinated individuals experienced less severe SARS-CoV-2 disease, and the effect was similar for both variants. Vaccination within the prior 3-9 months was associated with decreased odds of moderate disease, severe disease, and death. Older age and underlying health conditions, especially immunosuppression and renal disease, were associated with increased disease severity. Overall, this study provides insights into the impact of vaccination status, variants/mutations, and clinical factors on disease severity in SARS-CoV-2 infection when vaccination rates are low. Understanding these associations will help refine and reinforce messaging around the crucial importance of vaccination in mitigating the severity of SARS-CoV-2 disease.
Authors
- Andrei Bombin (ORCID: https://orcid.org/0000-0003-2445-304X)
- Laura Johnson (ORCID: https://orcid.org/0000-0002-5368-224X)
- Anne L Piantadosi (ORCID: https://orcid.org/0000-0002-5942-1534)
- Cara Chen
- Colleen S. Kraft (ORCID: https://orcid.org/0000-0003-1757-8477)
- Dalia Gulick
- Robert A. Arthur (ORCID: https://orcid.org/0000-0003-4824-4971)
- Allison Dorothy Roebling
- Dara Khosravi (ORCID: https://orcid.org/0000-0003-3422-5315)
- Adrianna Westbrook (ORCID: https://orcid.org/0000-0001-9309-6205)
- Ahmed Babiker (ORCID: https://orcid.org/0000-0003-0578-4871)
- Rose M. Langsjoen (ORCID: https://orcid.org/0000-0001-9008-425X)
- Azmain Taz
- Wilbur Aaron Lam (ORCID: https://orcid.org/0000-0002-0325-7990)
- Kyle P. Openo
- Jesse J. Waggoner (ORCID: https://orcid.org/0000-0002-0244-5957)
- Eric C. Fitts (ORCID: https://orcid.org/0000-0001-6632-2246)
- Dustin Higginbotham
- John Hunter Crumpler (ORCID: https://orcid.org/0009-0006-5970-5170)
- Bri Bixler
- A. Razzaque Ahmed (ORCID: https://orcid.org/0000-0003-0017-9269)
- Lu Yang (ORCID: https://orcid.org/0000-0002-2370-2609)
- Ziduo Zheng
- Ethan Wang
- Ludy Registre Carmola
- Alex W. N. Reid (ORCID: https://orcid.org/0009-0006-9838-6897)
- Phuong-Vi Nguyen
- Rebecca Zhang (ORCID: https://orcid.org/0000-0001-7325-283X)
Institutions
- Georgia Institute of Technology (US)
- Emory University (US)
- Veterans Health Administration (US)
- The Wallace H. Coulter Department of Biomedical Engineering (US)
- Premiere Global Services (United States) (US)
- Georgia Department of Public Health (US)
- Children's Healthcare of Atlanta (US)
Publication Details
- Journal
- PLoS ONE
- Published
- 2025-04-01
- DOI
- https://doi.org/10.1371/journal.pone.0317972
- Primary Topic
- SARS-CoV-2 and COVID-19 Research
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Centers for Disease Control and Prevention Foundation
- National Institutes of Health
- Centers for Disease Control and Prevention
- National Institute of Allergy and Infectious Diseases
- National Institute of Biomedical Imaging and Bioengineering
- National Center for Advancing Translational Sciences