Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Aug 31, 2025
Date Accepted: Nov 5, 2025
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Long COVID Among French Civil Servants: Prevalence, Risk Factors, Disease-related knowledge, and Vaccination Attitudes and Behaviors
ABSTRACT
Background:
Long COVID, is a diagnostic and epidemiological challenge in the general population, with symptoms often evolving and difficult to categorize, particularly among self-suspected cases. Despite its public health and workforce implications, it remains poorly documented.
Objective:
This study aimed to estimate the prevalence of long COVID among a large French civil servant population, identify associated sociodemographic, occupational, and health-related factors, and assess disease-related knowledge of long COVID, as well as vaccination attitudes and behaviors.
Methods:
This nationwide, cross-sectional, anonymous survey was conducted in 2024 among active or retired civil servants in France. A KAB-validated questionnaire, based on WHO guidelines, was designed. KAB responses were compared across four COVID-19 status groups (No COVID, COVID-19 without long COVID, Diagnosed long COVID, Suspected long COVID). Statistical analyses included univariate tests and multivariable logistic regressions to identify factors associated with diagnosed or suspected Long COVID.
Results:
Among 3,962 eligible respondents, 1.54% reported a formal diagnosis of long COVID and 6.08% reported symptoms without diagnosis. Multivariable analyses showed that diagnosed long COVID was significantly associated with long-term sick leave (OR = 1.15) and long-term illness coverage (OR = 0.72). Suspected long COVID was associated with being in a couple or widowed, and with uncertain or incomplete COVID-19 vaccination status (OR = 1.90 for uncertain, OR = 1.67 for not up to date). Among diagnosed cases, 59.0% were already vaccinated, 21.3% intended to get vaccinated, and 19.7% were unvaccinated; for suspected cases, these proportions were 71.8%, 12.4%, and 15.8%, respectively.
Conclusions:
Long COVID is underdiagnosed among French civil servants. Knowledge and health behaviors vary by COVID-19 status. Furthermore, the results reinforce growing evidence that vaccination may help reduce the risk of developing long COVID and highlight the need for workplace education, early detection strategies, and support strategies to mitigate its public health and workforce impact.
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