COVID-19 vaccination and patient-reported health one year after SARS-CoV-2 infection

Abstract COVID-19 vaccination reduces the risk of symptom-defined post-COVID syndrome (PCS), but its association with patient-perceived health and health-related quality of life remains insufficiently understood. We aimed to evaluate the association between pre-infection vaccination and patient-reported outcome measures (PROMs) across multiple health domains. We analyzed data from the prospective nationwide German NAPKON cohort, including adults infected with SARS-CoV-2 between July 2020 and May 2023. PROMs were assessed over 12 months and included EQ-5D-5L​ , PHQ-4 , PROMIS Cognitive Function , PROMIS-29 , and PROMIS Global . Associations with vaccination status were estimated using multivariable linear regression models. Among 2,680 COVID-19 patients in the NAPKON cohort, 660 adults with documented vaccination status were included; 464 (70.3%) were unvaccinated, 91 (13.8%) fully vaccinated (2 doses), and 105 (15.9%) booster vaccinated (≥ 3 doses). WHO-defined symptom-based PCS was more frequent in unvaccinated patients (70.7%) than in fully vaccinated (45.6%) and booster vaccinated patients (52.4%). In adjusted analyses, booster vaccination was associated with better EQ-5D-VAS at end-of-acute COVID-19 (β = 10.72, 95% CI 1.55 to 19.90). At 3 and 12 months, between-group differences were small and no longer significant after adjustment, while selected within-person changes were greater among unvaccinated patients. Using multiple validated PROM domains, this exploratory study provides a patient-centered perspective on vaccination-related post-COVID recovery, showing limited, domain-specific differences that largely attenuated by 12 months. Larger within-person improvements among unvaccinated patients may reflect poorer post-acute health status. Generalizability to the broader population, particularly individuals with mild COVID-19, is limited by the predominantly hospitalized cohort (85%); nevertheless, these findings suggest that symptom-based PCS definitions alone may insufficiently capture patient-perceived health burden, supporting PROMs as complementary measures in post-COVID research and care. Trial registration : NAPKON is registered on ClinicalTrials.gov (identifier NCT04768998).