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Irala S, Hamid S, Penayo E, Michel F, Couto P, Vazquez C, Ortega MJ, Domínguez C, Battaglia S, Von Horoch M, Montoya R, Sequera G, Nogareda F. COVID-19 vaccine effectiveness against hospitalizations in Paraguay, May 2021-April 2022: A test-negative design. Vaccine 2023; 41:6453-6460. [PMID: 37716830 DOI: 10.1016/j.vaccine.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Vaccine effectiveness (VE) estimates vary by population characteristics and circulating variants. North America and Europe have generated many COVID-19 VE estimates but relied heavily on mRNA vaccines. Fewer estimates are available for non-mRNA vaccines and from Latin America. We aimed to estimate the effectiveness of several COVID-19 vaccines in preventing SARS-CoV-2-associated severe acute respiratory infection (SARI) in Paraguay from May 2021 to April 2022. METHODS Using sentinel surveillance data from four hospitals in Paraguay, we conducted a test-negative case-control study to estimate COVID-19 vaccine effectiveness against SARI by vaccine type/brand and period of SARS-CoV-2 variant predominance (Gamma, Delta, Omicron). We used multivariable logistic regression adjusting for month of symptom onset, age group, and presence of ≥1 comorbidity to estimate the odds of COVID-19 vaccination in SARS-CoV-2 test-positive SARI case-patients compared to SARS-CoV-2 test-negative SARI control-patients. RESULTS Of 4,229 SARI patients, 2,381 (56%) were SARS-CoV-2-positive case-patients and 1,848 (44%) were SARS-CoV-2-negative control-patients. A greater proportion of case-patients (73%; 95% CI: 71-75) than of control-patients (40%; 95% CI: 38-42) were unvaccinated. During the Gamma variant-predominant period, VE estimates for partial vaccination with mRNA vaccines and Oxford/AstraZeneca Vaxzevria were 90.4% (95% CI: 66.4-97.6) and 52.2% (95% CI: 25.0-69.0), respectively. During the Delta variant-predominant period, VE estimates for complete vaccination with mRNA vaccines, Oxford/AstraZeneca Vaxzevria, or Gamaleya Sputnik V were 90.4% (95% CI: 74.3-97.3), 83.2% (95% CI: 67.8-91.9), and 82.9% (95% CI: 53.0-95.2), respectively. The effectiveness of all vaccines declined substantially during the Omicron variant-predominant period. CONCLUSIONS This study contributes to our understanding of COVID-19 VE in Latin America and to global understanding of vaccines that have not been widely used in North America and Europe. VE estimates from Paraguay can parameterize models to estimate the impact of the national COVID-19 vaccination campaign in Paraguay and similar settings.
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Affiliation(s)
- Sandra Irala
- Directorate General for Health Surveillance, Ministry of Public Health and Social Welfare, Paraguay
| | - Sarah Hamid
- National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Elena Penayo
- Directorate General for Health Surveillance, Ministry of Public Health and Social Welfare, Paraguay.
| | | | - Paula Couto
- Pan American Health Organization, Washington, DC, USA
| | - Cynthia Vazquez
- Department of Virology, Central Laboratory for Public Health, Asunción, Paraguay
| | - María José Ortega
- Department of Virology, Central Laboratory for Public Health, Asunción, Paraguay
| | - Chavely Domínguez
- Directorate General for Health Surveillance, Ministry of Public Health and Social Welfare, Paraguay
| | - Silvia Battaglia
- National Program for Vaccine Preventable Diseases and Expanded Program on Immunization, Asunción, Paraguay
| | - Marta Von Horoch
- National Program for Vaccine Preventable Diseases and Expanded Program on Immunization, Asunción, Paraguay
| | - Romeo Montoya
- Pan American Health Organization, Asunción, Paraguay
| | - Guillermo Sequera
- Directorate General for Health Surveillance, Ministry of Public Health and Social Welfare, Paraguay
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Chard AN, Nogareda F, Regan AK, Barraza MFO, Fasce RA, Vergara N, Avendaño M, Penayo E, Vázquez C, Von Horoch M, Michel F, Alfonso A, Mogdasy C, Chiparelli H, Goñi N, Alegretti M, Loayza S, Couto P, Rodriguez A, Salas D, Fowlkes AL, Azziz-Baumgartner E. End-of-season influenza vaccine effectiveness during the Southern Hemisphere 2022 influenza season - Chile, Paraguay, and Uruguay. Int J Infect Dis 2023; 134:39-44. [PMID: 37201863 PMCID: PMC10404161 DOI: 10.1016/j.ijid.2023.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/27/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES This study estimated the 2022 end-of-season influenza vaccine effectiveness (VE) against severe acute respiratory illness (SARI) hospitalization in Chile, Paraguay, and Uruguay. METHODS We pooled surveillance data from SARI cases in 18 sentinel surveillance hospitals in Chile (n = 9), Paraguay (n = 2), and Uruguay (n = 7) from March 16-November 30, 2022. VE was estimated using a test-negative design and logistic regression models adjusted for country, age, sex, presence of ≥1 comorbidity, and week of illness onset. VE estimates were stratified by influenza virus type and subtype (when available) and influenza vaccine target population, categorized as children, individuals with comorbidities, and older adults, defined per countries' national immunization policies. RESULTS Among the 3147 SARI cases, there were 382 (12.1%) influenza test-positive case patients; 328 (85.9%) influenza case patients were in Chile, 33 (8.6%) were in Paraguay, and 21 (5.5%) were in Uruguay. In all countries, the predominant subtype was influenza A(H3N2) (92.6% of influenza cases). Adjusted VE against any influenza-associated SARI hospitalization was 33.8% (95% confidence interval: 15.3%, 48.2%); VE against influenza A(H3N2)-associated SARI hospitalization was 30.4% (95% confidence interval: 10.1%, 46.0%). VE estimates were similar across target populations. CONCLUSION During the 2022 influenza season, influenza vaccination reduced the odds of hospitalization among those vaccinated by one-third. Health officials should encourage influenza vaccination in accordance with national recommendations.
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Affiliation(s)
- Anna N Chard
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, USA.
| | | | - Annette K Regan
- Pan American Health Organization, Washington DC, USA; School of Nursing and Health Professions, University of San Francisco, San Francisco, USA; Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
| | | | - Rodrigo A Fasce
- Virology Department, Public Health Institute of Chile, Santiago, Chile
| | | | | | - Elena Penayo
- Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - Cynthia Vázquez
- Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - Marta Von Horoch
- Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | | | | | | | | | | | | | - Sergio Loayza
- Pan American Health Organization, Washington DC, USA
| | - Paula Couto
- Pan American Health Organization, Washington DC, USA
| | | | - Daniel Salas
- Pan American Health Organization, Washington DC, USA
| | - Ashley L Fowlkes
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, USA
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