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Urquidi C, Sepúlveda-Peñaloza A, Valenzuela MT, Ponce A, Menares V, Cortes CP, Benítez R, Santelices E, Anfossi R, Moller A, Santolaya ME. Vaccine effectiveness in reducing COVID-19-related hospitalization after a risk-age-based mass vaccination program in a Chilean municipality: A comparison of observational study designs. Vaccine 2024; 42:3851-3856. [PMID: 38749822 DOI: 10.1016/j.vaccine.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Case-control studies involving test-negative (TN) and syndrome-negative (SN) controls are reliable for evaluating influenza and rotavirus vaccine effectiveness (VE) during a random vaccination process. However, there is no empirical evidence regarding the impact in real-world mass vaccination campaigns against SARS-CoV-2 using TN and SN controls. OBJECTIVE To compare in the same population the effectiveness of SARS-CoV-2 vaccination on COVID-19-related hospitalization rates across a cohort design, TN and SN designs. METHOD We conducted an unmatched population-based cohort, TN and SN case-control designs linking data from four data sources (public primary healthcare system, hospitalization registers, epidemiological surveillance systems and the national immunization program) in a Chilean municipality (Rancagua) between March 1, 2021 and August 31, 2021. The outcome was COVID-19-related hospitalization. To ensure sufficient sample size in the unexposed group, completion of follow-up in the cohort design, and sufficient time between vaccination and hospitalization in the case-control design, VE was estimated comparing 8-week periods for each individual. RESULTS Among the 191,505 individuals registered in the primary healthcare system of Rancagua in Chile on March 1, 2021; 116,453 met the cohort study's inclusion criteria. Of the 9,471 hospitalizations registered during the study period in the same place, 526 were COVID-19 cases, 108 were TN controls, and 1,628 were SN controls. For any vaccine product, the age- and sex-adjusted vaccine effectiveness comparing fully and nonvaccinated individuals was 67.2 (55.7-76.3) in the cohort design, whereas it was 67.8 (44.1-81.4) and 77.9 (70.2-83.8) in the TN and SN control designs, respectively. CONCLUSION The VE of a COVID-19 vaccination program based on age and risk groups tended to differ across the three observational study designs. The SN case-control design may be an efficient option for evaluating COVID-19 VE in real-world settings.
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Affiliation(s)
- Cinthya Urquidi
- Department of Epidemiology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | | | - María T Valenzuela
- Department of Epidemiology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Alexander Ponce
- Information Technology Services, Development Department, Universidad de O'Higgins, Rancagua, Chile
| | | | - Claudia P Cortes
- Department of Internal Medicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Rosana Benítez
- Infectious Diseases Department, Clínica Dávila, Santiago, Chile
| | - Emilio Santelices
- Policy and Innovation Center, Universidad de Desarrollo, Santiago, Chile
| | - Renato Anfossi
- Hospital Regional Libertador Bernardo ÓHiggins, Rancagua, Chile
| | - Andrea Moller
- Hospital Regional Libertador Bernardo ÓHiggins, Rancagua, Chile
| | - María E Santolaya
- Department of Pediatrics, Hospital Dr. Luis Calvo Mackenna, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
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Platas-Abenza G, Guerrero-Soler M, Silva-Afonso RDF, Gallardo-Rodriguez P, Gil-Sánchez F, Escribano-Cañadas I, Benito-Miralles CM, Solis-Aniorte N, Carnicer-Bueno R, Esclapez-Martínez A, Chico-Sánchez P, Sánchez-Payá J, Gras-Valentí P. Effectiveness of influenza vaccine in preventing severe cases of influenza: Season 2022/2023. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:140-145. [PMID: 38342648 DOI: 10.1016/j.eimce.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/04/2023] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Influenza poses a significant burden in terms of morbidity and mortality, with vaccination being one of the most effective measures for its prevention. Therefore, the aim of this study is to determine the effectiveness of the influenza vaccine in preventing cases of severe influenza in patients admitted to a tertiary hospital during the 2022/23 season. METHODS Case-control study. All hospitalised patients with a positive result in an RT-PCR for influenza were included. Those who met the criteria for a severe case (pneumonia, sepsis, multi-organ failure, admission to ICU or exitus) were considered cases. Those who did not meet these criteria were considered controls. Vaccine effectiveness (VE) to prevent severe cases and its 95% confidence interval were calculated. RESULTS A total of 403 patients were admitted with confirmed influenza. Of these, 98 (24.3%) developed severe influenza. Of the total, 50.6% were men and 47.1% were over 65 years of age. VE adjusted for influenza type, age and certain comorbidities was 40.6% (-21.9 to 71.1). In a segmented analysis, influenza vaccine was effective in preventing severe cases in all categories. It was particularly relevant in the 65+ age group (VEa = 60.9%; -2.0 to 85.0) and in patients with influenza A (VEa = 56.7%; 1.5-80.9). CONCLUSION Influenza vaccination markedly reduced the occurrence of severe cases of influenza in hospitalised patients, therefore, it remains the main strategy to reduce morbidity and mortality and associated costs.
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Affiliation(s)
- Guillermo Platas-Abenza
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - María Guerrero-Soler
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Raissa de Fatima Silva-Afonso
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Pilar Gallardo-Rodriguez
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Francisco Gil-Sánchez
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Isabel Escribano-Cañadas
- Servicio de Microbiología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Carmen M Benito-Miralles
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Noemi Solis-Aniorte
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Rocio Carnicer-Bueno
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Ana Esclapez-Martínez
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Pablo Chico-Sánchez
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - José Sánchez-Payá
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Paula Gras-Valentí
- Unidad de Epidemiología, Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
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Bennett JC, Luiten KG, O'Hanlon J, Han PD, McDonald D, Wright T, Wolf CR, Lo NK, Acker Z, Regelbrugge L, McCaffrey KM, Pfau B, Stone J, Schwabe-Fry K, Lockwood CM, Guthrie BL, Gottlieb GS, Englund JA, Uyeki TM, Carone M, Starita LM, Weil AA, Chu HY. Utilizing a university testing program to estimate relative effectiveness of monovalent COVID-19 mRNA booster vaccine versus two-dose primary series against symptomatic SARS-CoV-2 infection. Vaccine 2024; 42:1332-1341. [PMID: 38307746 DOI: 10.1016/j.vaccine.2024.01.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
Vaccine effectiveness (VE) studies utilizing the test-negative design are typically conducted in clinical settings, rather than community populations, leading to bias in VE estimates against mild disease and limited information on VE in healthy young adults. In a community-based university population, we utilized data from a large SARS-CoV-2 testing program to estimate relative VE of COVID-19 mRNA vaccine primary series and monovalent booster dose versus primary series only against symptomatic SARS-CoV-2 infection from September 2021 to July 2022. We used the test-negative design and logistic regression implemented via generalized estimating equations adjusted for age, calendar time, prior SARS-CoV-2 infection, and testing frequency (proxy for test-seeking behavior) to estimate relative VE. Analyses included 2,218 test-positive cases (59 % received monovalent booster dose) and 9,615 test-negative controls (62 %) from 9,066 individuals, with median age of 21 years, mostly students (71 %), White (56 %) or Asian (28 %), and with few comorbidities (3 %). More cases (23 %) than controls (6 %) had COVID-19-like illness. Estimated adjusted relative VE of primary series and monovalent booster dose versus primary series only against symptomatic SARS-CoV-2 infection was 40 % (95 % CI: 33-47 %) during the overall analysis period and 46 % (39-52 %) during the period of Omicron circulation. Relative VE was greater for those without versus those with prior SARS-CoV-2 infection (41 %, 34-48 % versus 33 %, 9 %-52 %, P < 0.001). Relative VE was also greater in the six months after receiving a booster dose (41 %, 33-47 %) compared to more than six months (27 %, 8-42 %), but this difference was not statistically significant (P = 0.06). In this relatively young and healthy adult population, an mRNA monovalent booster dose provided increased protection against symptomatic SARS-CoV-2 infection, overall and with the Omicron variant. University testing programs may be utilized for estimating VE in healthy young adults, a population that is not well-represented by routine VE studies.
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Affiliation(s)
- Julia C Bennett
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Kyle G Luiten
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jessica O'Hanlon
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Peter D Han
- Brotman Baty Institute, Seattle, WA, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Devon McDonald
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Tessa Wright
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Caitlin R Wolf
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Natalie K Lo
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Zack Acker
- Brotman Baty Institute, Seattle, WA, USA
| | | | | | - Brian Pfau
- Brotman Baty Institute, Seattle, WA, USA
| | - Jeremey Stone
- Brotman Baty Institute, Seattle, WA, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | | | - Christina M Lockwood
- Brotman Baty Institute, Seattle, WA, USA; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA
| | - Brandon L Guthrie
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Geoffrey S Gottlieb
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, WA, USA; Environmental Health & Safety Department, University of Washington, Seattle, WA, USA
| | - Janet A Englund
- Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Lea M Starita
- Brotman Baty Institute, Seattle, WA, USA; Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Ana A Weil
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, WA, USA
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Stoliaroff-Pepin A, Peine C, Herath T, Lachmann J, Perriat D, Dörre A, Nitsche A, Michel J, Grossegesse M, Hofmann N, Rinner T, Kohl C, Brinkmann A, Meyer T, Dorner BG, Stern D, Treindl F, Hein S, Werel L, Hildt E, Gläser S, Schühlen H, Isner C, Peric A, Ghouzi A, Reichardt A, Janneck M, Lock G, Schaade L, Wichmann O, Harder T. Effectiveness of vaccines in preventing hospitalization due to COVID-19: A multicenter hospital-based case-control study, Germany, June 2021 to January 2022. Vaccine 2023; 41:290-293. [PMID: 36509640 PMCID: PMC9715487 DOI: 10.1016/j.vaccine.2022.11.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/16/2022] [Accepted: 11/27/2022] [Indexed: 12/04/2022]
Abstract
We included 852 patients in a prospectively recruiting multicenter matched case-control study in Germany to assess vaccine effectiveness (VE) in preventing COVID-19-associated hospitalization during the Delta-variant dominance. The two-dose VE was 89 % (95 % CI 84-93 %) overall, 79 % in patients with more than two comorbidities and 77 % in adults aged 60-75 years. A third dose increased the VE to more than 93 % in all patient-subgroups.
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Affiliation(s)
- Anna Stoliaroff-Pepin
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany.
| | - Caroline Peine
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany.
| | - Tim Herath
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany
| | - Johannes Lachmann
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany
| | - Delphine Perriat
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany
| | - Achim Dörre
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Germany
| | - Andreas Nitsche
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Janine Michel
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Marica Grossegesse
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Natalie Hofmann
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Thomas Rinner
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Claudia Kohl
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Annika Brinkmann
- Centre for Biological Threats and Special Pathogens, ZBS1 Highly Pathogenic Viruses, Robert Koch Institute, Germany
| | - Tanja Meyer
- Centre for Biological Threats and Special Pathogens, ZBS3 Biological Toxins, Robert Koch Institute, Germany
| | - Brigitte G Dorner
- Centre for Biological Threats and Special Pathogens, ZBS3 Biological Toxins, Robert Koch Institute, Germany
| | - Daniel Stern
- Centre for Biological Threats and Special Pathogens, ZBS3 Biological Toxins, Robert Koch Institute, Germany
| | - Fridolin Treindl
- Centre for Biological Threats and Special Pathogens, ZBS3 Biological Toxins, Robert Koch Institute, Germany
| | - Sascha Hein
- Division Virology, Paul-Ehrlich-Institute, Germany
| | - Laura Werel
- Division Virology, Paul-Ehrlich-Institute, Germany
| | | | - Sven Gläser
- Klinik für Innere Medizin - Pneumologie und Infektiologie, Vivantes Klinikum Neukölln und Spandau, Berlin, Germany
| | - Helmut Schühlen
- Vivantes Netzwerk für Gesundheit GmbH, Direktorat Klinische Forschung & Akademische Lehre, Berlin, Germany
| | - Caroline Isner
- Klinik für Innere Medizin - Infektiologie, Vivantes Auguste-Viktoria-Klinikum, Rubensstr. 125, 12157 Berlin, Germany
| | - Alexander Peric
- Klinik für Pneumologie und Infektiologie, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249 Berlin, Germany
| | - Ammar Ghouzi
- Schön Klinik Düsseldorf, Interdisziplinäre Notaufnahme, Am Heerdter Krankenhaus 2, 40549 Düsseldorf, Germany
| | - Annette Reichardt
- Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - Matthias Janneck
- Klinik für Kardiologie, Sektion Nephrologie, Albertinen Krankenhaus, Süntelstraße 11a, 22457 Hamburg, Germany
| | - Guntram Lock
- Klinik für Innere Medizin, Albertinen Krankenhaus, Süntelstraße 11a, 22457 Hamburg, Germany
| | - Lars Schaade
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Germany
| | - Ole Wichmann
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany
| | - Thomas Harder
- Department for Infectious Disease Epidemiology, Immunization Unit, Robert Koch Institute, Germany
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