Outcomes of laboratory-confirmed SARS-CoV-2 infection during resurgence driven by Omicron lineages BA.4 and BA.5 compared with previous waves in the Western Cape Province, South Africa

Objectives: We aimed to compare the clinical severity of Omicron BA.4/BA.5 infection with BA.1 and ear-lier variant infections among laboratory-confirmed SARS-CoV-2 cases in the Western Cape, South Africa, using timing of infection to infer the lineage/variant causing infection.Methods: We included public sector patients aged >= 20 years with laboratory-confirmed COVID-19 be-tween May 01-May 21, 2022 (BA.4/BA.5 wave) and equivalent previous wave periods. We compared the risk between waves of (i) death and (ii) severe hospitalization/death (all within 21 days of diagnosis) using Cox regression adjusted for demographics, comorbidities, admission pressure, vaccination, and pre-vious infection.Results: Among 3793 patients from the BA.4/BA.5 wave and 190,836 patients from previous waves, the risk of severe hospitalization/death was similar in the BA.4/BA.5 and BA.1 waves (adjusted hazard ratio [aHR] 1.12; 95% confidence interval [CI] 0.93; 1.34). Both Omicron waves had a lower risk of severe out -comes than previous waves. Previous infection (aHR 0.29, 95% CI 0.24; 0.36) and vaccination (aHR 0.17; 95% CI 0.07; 0.40 for at least three doses vs no vaccine) were protective.Conclusion: Disease severity was similar among diagnosed COVID-19 cases in the BA .4/BA .5 and BA .1 pe-riods in the context of growing immunity against SARS-CoV-2 due to previous infection and vaccination, both of which were strongly protective.(c) 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

Automated summary

The clinical severity of Omicron BA.4/BA.5 infection was compared to BA.1 and earlier variant infections, and it was found that vaccination and previous infection were protective against disease severity.