Aslam Javaria, Rauf Ul Hassan Muhammad, Fatima Qindeel, Bashir Hashmi Hala, Alshahrani Mohammad Y, Alkhathami Ali G, Aneela Irrum
Department of Medicine, Quaid-e-Azam Medical College, Sadiq Abbasi Hospital, Bahawalpur 63100, Pakistan.
Department of Pulmonology, Quaid-e-Azam Medical College, Bahawalpur 63100, Pakistan.
Saudi J Biol Sci. 2022 Jul;29(7):103329. doi: 10.1016/j.sjbs.2022.103329. Epub 2022 May 31.
To understand the effectual role of COVID-19 vaccination, we must analyze its effectiveness in dampening the disease severity and death outcome in patients who acquire infection and require hospitalization. The goal of this study was to see if there was an association between disease progression in admitted COVID-19 patients and their prior vaccination exposure. A prospective cohort study based on 1640 admitted COVID-19 patients were carried between June 2021 and October 2021. Depending on vaccination exposure they were divided into vaccinated (exposed) and unvaccinated (unexposed) groups, excluding partially vaccinated patients. Disease severity was assessed at admission on severity index scale. Disease progression to mortality or need of mechanical ventilation and survival were taken as outcome. Absolute difference with 95%CI and Risk Ratio were calculated using cross tabulation, Chi square test and multivariable logistic regression analysis. Among 1514 total analyzed cohort (median age, 53 years [IQR, 17,106]; 43.7% from 46 to 65 years of age group, 56.2% males,33.4% with no comorbid factor for disease progression) 369(24.4%) were vaccinated breakthrough cases and 1145(75.6%) were unvaccinated controls. 556(36.7%) progressed to death or mechanical ventilation, 958(63.3%) patients survived and were discharged home. Disease progression to death or mechanical ventilation was significantly associated with decreased likelihood of vaccination (24.9% among vaccinated breakthrough vs 40.5% unvaccinated controls, [Absolute difference -15.6% 95%CI (-10.2% to -20.6%); RR 0.615 95%CI (0.509, 0.744); p <.001]). This association was stronger for old age population and for increase time span between second dose of vaccine and onset of symptoms. There was no statistically significant difference among different types of vaccination and occurrence of outcome when compared to unvaccinated controls (RR 0.607(0.482, 0.763); 0.673(0.339, 1.33) and 0.623(0.441, 0.881) for Inactivated virus vaccine, mRNA and Adenovirus vector-based vaccine respectively. The patients who were fully vaccinated against SARS-COV-2 die or shift to mechanical ventilation less frequently than unvaccinated COVID-19 admitted patients.
为了解新冠病毒疫苗接种的实际作用，我们必须分析其在减轻感染并需要住院治疗患者的疾病严重程度和死亡结局方面的有效性。本研究的目的是观察住院的新冠病毒感染患者的疾病进展与其先前的疫苗接种情况之间是否存在关联。2021年6月至2021年10月期间，对1640例住院的新冠病毒感染患者进行了一项前瞻性队列研究。根据疫苗接种情况，将他们分为接种疫苗（暴露）组和未接种疫苗（未暴露）组，不包括部分接种疫苗的患者。入院时根据严重程度指数量表评估疾病严重程度。将疾病进展至死亡或需要机械通气以及生存情况作为结局。使用交叉表、卡方检验和多变量逻辑回归分析计算95%置信区间的绝对差异和风险比。在总共1514例分析队列中（中位年龄53岁[四分位间距，17,106]；46至65岁年龄组占43.7%，男性占56.2%，33.4%无疾病进展的合并症因素），369例（24.4%）为接种疫苗后突破病例，1145例（75.6%）为未接种疫苗的对照。556例（36.7%）进展至死亡或需要机械通气，958例（63.3%）患者存活并出院回家。疾病进展至死亡或需要机械通气与疫苗接种可能性降低显著相关（接种疫苗后突破病例中为24.9%，未接种疫苗的对照中为40.5%，[绝对差异-15.6%，95%置信区间（-10.2%至-20.6%）；风险比0.615，95%置信区间（0.509，0.744）；p<0.001]）。这种关联在老年人群以及第二剂疫苗接种与症状出现之间的时间跨度增加时更强。与未接种疫苗的对照相比，不同类型的疫苗接种与结局发生之间没有统计学上的显著差异（灭活病毒疫苗、mRNA疫苗和腺病毒载体疫苗的风险比分别为0.607（0.482，0.763）；0.673（0.339，1.33）和0.623（0.441，0.881））。与未接种疫苗的住院新冠病毒感染患者相比，完全接种新冠病毒疫苗的患者死亡或转为机械通气的频率更低。
