Hospitalizations for COVID-19 in a tertiary hospital in Brazil: a parallel with vaccination

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ABSTRACT

This study aimed to evaluate the COVID-19 hospitalizations in a tertiary hospital by age group and month, considering the introduction and the advance of the vaccination against the disease. The laboratory-confirmed COVID-19-associated hospitalizations among people aged 20 years or older, that occurred between March 2020 and June 2021, were distributed by month of symptom onset and age group. The proportion of hospitalizations by age group was calculated for the year 2021. The proportions were compared using the chi-square test for trends. The marks of vaccination advances among different age groups were taken from the official website LocalizaSUS. In 2020, hospitalizations among people aged 60–80 years old were the most frequent (39.1%). From January–June 2021, when the vaccination commenced, while hospitalizations of patients aged 20 to < 40 and 40 to 60 years old showed an increasing trend, the older age groups and those with vaccination recommendations (from 60 to < 80 and from 80 or over) showed a downward trend. As of June 2021, with widespread vaccination, a drop in hospitalizations was observed in > 60 years old. At 20 to <40 and 40 to < 60, an increase in hospitalizations was observed. It demonstrates the important role of vaccination in combating the COVID-19 pandemic.

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Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study

Jamie Lopez Bernal, Nick Andrews, Charlotte Gower … (2021)

Objective To estimate the real world effectiveness of the Pfizer-BioNTech BNT162b2 and Oxford-AstraZeneca ChAdOx1-S vaccines against confirmed covid-19 symptoms (including the UK variant of concern B.1.1.7), admissions to hospital, and deaths. Design Test negative case-control study. Setting Community testing for covid-19 in England. Participants 156 930 adults aged 70 years and older who reported symptoms of covid-19 between 8 December 2020 and 19 February 2021 and were successfully linked to vaccination data in the National Immunisation Management System. Interventions Vaccination with BNT162b2 or ChAdOx1-S. Main outcome measures Primary outcomes were polymerase chain reaction confirmed symptomatic SARS-CoV-2 infections, admissions to hospital for covid-19, and deaths with covid-19. Results Participants aged 80 years and older vaccinated with BNT162b2 before 4 January 2021 had a higher odds of testing positive for covid-19 in the first nine days after vaccination (odds ratio up to 1.48, 95% confidence interval 1.23 to 1.77), indicating that those initially targeted had a higher underlying risk of infection. Vaccine effectiveness was therefore compared with the baseline post-vaccination period. Vaccine effects were noted 10 to 13 days after vaccination, reaching a vaccine effectiveness of 70% (95% confidence interval 59% to 78%), then plateauing. From 14 days after the second dose a vaccination effectiveness of 89% (85% to 93%) was found compared with the increased baseline risk. Participants aged 70 years and older vaccinated from 4 January (when ChAdOx1-S delivery commenced) had a similar underlying risk of covid-19 to unvaccinated individuals. With BNT162b2, vaccine effectiveness reached 61% (51% to 69%) from 28 to 34 days after vaccination, then plateaued. With ChAdOx1-S, effects were seen from 14 to 20 days after vaccination, reaching an effectiveness of 60% (41% to 73%) from 28 to 34 days, increasing to 73% (27% to 90%) from day 35 onwards. On top of the protection against symptomatic disease, a further 43% (33% to 52%) reduced risk of emergency hospital admission and 51% (37% to 62%) reduced risk of death was observed in those who had received one dose of BNT162b2. Participants who had received one dose of ChAdOx1-S had a further 37% (3% to 59%) reduced risk of emergency hospital admission. Follow-up was insufficient to assess the effect of ChAdOx1-S on mortality. Combined with the effect against symptomatic disease, a single dose of either vaccine was about 80% effective at preventing admission to hospital with covid-19 and a single dose of BNT162b2 was 85% effective at preventing death with covid-19. Conclusion Vaccination with either one dose of BNT162b2 or ChAdOx1-S was associated with a significant reduction in symptomatic covid-19 in older adults, and with further protection against severe disease. Both vaccines showed similar effects. Protection was maintained for the duration of follow-up (>6 weeks). A second dose of BNT162b2 was associated with further protection against symptomatic disease. A clear effect of the vaccines against the B.1.1.7 variant was found.

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Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile

Alejandro Jara, Eduardo Undurraga, Cecilia SENÉN GONZÁLEZ … (2021)

Background Mass vaccination campaigns to prevent coronavirus disease 2019 (Covid-19) are occurring in many countries; estimates of vaccine effectiveness are urgently needed to support decision making. A countrywide mass vaccination campaign with the use of an inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine (CoronaVac) was conducted in Chile starting on February 2, 2021. Methods We used a prospective national cohort, including participants 16 years of age or older who were affiliated with the public national health care system, to assess the effectiveness of the inactivated SARS-CoV-2 vaccine with regard to preventing Covid-19 and related hospitalization, admission to the intensive care unit (ICU), and death. We estimated hazard ratios using the extension of the Cox proportional-hazards model, accounting for time-varying vaccination status. We estimated the change in the hazard ratio associated with partial immunization (≥14 days after receipt of the first dose and before receipt of the second dose) and full immunization (≥14 days after receipt of the second dose). Vaccine effectiveness was estimated with adjustment for individual demographic and clinical characteristics. Results The study was conducted from February 2 through May 1, 2021, and the cohort included approximately 10.2 million persons. Among persons who were fully immunized, the adjusted vaccine effectiveness was 65.9% (95% confidence interval [CI], 65.2 to 66.6) for the prevention of Covid-19 and 87.5% (95% CI, 86.7 to 88.2) for the prevention of hospitalization, 90.3% (95% CI, 89.1 to 91.4) for the prevention of ICU admission, and 86.3% (95% CI, 84.5 to 87.9) for the prevention of Covid-19–related death. Conclusions Our results suggest that the inactivated SARS-CoV-2 vaccine effectively prevented Covid-19, including severe disease and death, a finding that is consistent with results of phase 2 trials of the vaccine. (Funded by Agencia Nacional de Investigación y Desarrollo and others.)

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Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of covid-19 in Brazil: test negative case-control study

Otavio Ranzani, Matt D. T. Hitchings, Murilo Dorion … (2021)

Objective To estimate the effectiveness of the inactivated whole virus vaccine, CoronaVac (Sinovac Biotech), against symptomatic covid-19 in the elderly population of São Paulo state, Brazil during widespread circulation of the gamma variant. Design Test negative case-control study. Setting Community testing for covid-19 in São Paulo state, Brazil. Participants 43 774 adults aged ≥70 years who were residents of São Paulo state and underwent reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 from 17 January to 29 April 2021. 26 433 cases with symptomatic covid-19 and 17 622 test negative controls with covid-19 symptoms were formed into 13 283 matched sets, one case with to up to five controls, according to age, sex, self-reported race, municipality of residence, previous covid-19 status, and date of RT-PCR test (±3 days). Intervention Vaccination with a two dose regimen of CoronaVac. Main outcome measures RT-PCR confirmed symptomatic covid-19 and associated hospital admissions and deaths. Results Adjusted vaccine effectiveness against symptomatic covid-19 was 24.7% (95% confidence interval 14.7% to 33.4%) at 0-13 days and 46.8% (38.7% to 53.8%) at ≥14 days after the second dose. Adjusted vaccine effectiveness against hospital admissions was 55.5% (46.5% to 62.9%) and against deaths was 61.2% (48.9% to 70.5%) at ≥14 days after the second dose. Vaccine effectiveness ≥14 days after the second dose was highest for the youngest age group (70-74 years)—59.0% (43.7% to 70.2%) against symptomatic disease, 77.6% (62.5% to 86.7%) against hospital admissions, and 83.9% (59.2% to 93.7%) against deaths—and declined with increasing age. Conclusions Vaccination with CoronaVac was associated with a reduction in symptomatic covid-19, hospital admissions, and deaths in adults aged ≥70 years in a setting with extensive transmission of the gamma variant. Vaccine protection was, however, low until completion of the two dose regimen, and vaccine effectiveness was observe to decline with increasing age among this elderly population.

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Author and article information

Journal

Journal ID (nlm-ta): Rev Inst Med Trop Sao Paulo

Journal ID (iso-abbrev): Rev Inst Med Trop Sao Paulo

Journal ID (publisher-id): rimtsp

Title: Revista do Instituto de Medicina Tropical de São Paulo

Publisher: Instituto de Medicina Tropical de São Paulo

ISSN (Print): 0036-4665

ISSN (Electronic): 1678-9946

Publication date (Electronic, pub): 30 September 2022

Publication date (Electronic, collection): 2022

Volume: 64

Electronic Location Identifier: e62

Affiliations

[1 ]Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil

[2 ]Fundação Faculdade Regional Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil

[3 ]Secretaria de Estado da Saúde de São Paulo, Coordenadoria de Controle de Doenças, Divisão de Imunização, Centro de Vigilância Epidemiológica “Prof. Alexandre Vranjac”, São Paulo, São Paulo, Brazil

Author notes

Correspondence to: Maria Lúcia Machado Salomão Faculdade de Medicina de São José do Rio Preto, Avenida Brigadeiro Faria Lima, CEP 15090-000, São José do Rio Preto, SP, Brazil Tel: +55 17 3201-5000 E-mail: nhe@ 123456hospitaldebase.com.br , maria.salomao@ 123456edu.famerp.br

AUTHORS’ CONTRIBUTIONS

MLMS, MNM, EGF, FQ, LMM, HTA and MST participated in all stages of the work from the conception, planning, analysis, interpretation and writing of the work; MNL, SAL and MWC contributed to the critical review of the content. All authors approved the final manuscript as submitted.

CONFLICT OF INTERESTS

EGF is linked to the Butantan Institute (a vaccine producer) as a safety doctor. The other authors have no conflict of interest.

Author information

Maria Lúcia Machado Salomão http://orcid.org/0000-0003-0975-3271

Maurício Nassau Machado http://orcid.org/0000-0002-9581-5215

Eder Gatti Fernandes http://orcid.org/0000-0001-6907-7063

Flávia Queiroz http://orcid.org/0000-0002-0430-7195

Lina de Moura Mendes http://orcid.org/0000-0002-9704-2244

Murillo de Souza Tuckumantel http://orcid.org/0000-0003-3632-9556

Haislaine Tarraf de Andrade http://orcid.org/0000-0002-9816-2838

Suzana Ajeje Lobo http://orcid.org/0000-0003-2726-2441

Mauricio Lacerda Nogueira http://orcid.org/0000-0003-1102-2419

Marcia Wakai Catelan http://orcid.org/0000-0002-6672-703X

Article

Other ID: 00609

DOI: 10.1590/S1678-9946202264062

PMC ID: 9528308

PubMed ID: 36197423

SO-VID: 3b585ed9-b478-4b14-a2fd-c0186f12def9

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 11 May 2022

Date accepted : 22 July 2022

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Hospitalizations for COVID-19 in a tertiary hospital in Brazil: a parallel with vaccination

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Most cited references 18

Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study

Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile

Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of covid-19 in Brazil: test negative case-control study

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