ABSTRACT
BackgroundBy March 2023, 54 countries, areas and territories (thereafter "CAT") reported over 2.2 million coronavirus disease 2019 (COVID-19) deaths to the World Health Organization (WHO) Regional Office for Europe (1). Here, we estimate how many lives were directly saved by vaccinating adults in the Region, from December 2020 through March 2023. MethodsWe estimated the number of lives directly saved by age-group, vaccine dose and circulating Variant of Concern (VOC) period, both regionally and nationally, using weekly data on COVID-19 mortality and COVID-19 vaccine uptake reported by 34 CAT, and vaccine effectiveness (VE) data from the literature. We calculated the percentage reduction in the number of expected and reported deaths. FindingsWe found that vaccines reduced deaths by 57% overall (CAT range: 15% to 75%), representing [~]1.4 million lives saved in those aged [≥]25 years (range: 0.7 million to 2.6 million): 96% of lives saved were aged [≥]60 years and 52% were aged [≥]80 years; first boosters saved 51%, and 67% were saved during the Omicron period. InterpretationOver nearly 2.5 years, most lives saved by COVID-19 vaccinationwere in older adults by first booster dose and during the Omicron period, reinforcing the importance of up-to-date vaccination among these most at-risk individuals. Further modelling work should evaluate indirect effects of vaccination and public health and social measures. FundingThis work was supported by a US Centers for Disease Control cooperative agreement (Grant number 6 NU511P000936-02-020), who had no role in data analysis or interpretation. DisclaimerThe authors affiliated with the World Health Organization (WHO) are alone responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the WHO. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSSince first identified in late 2019, COVID-19 has caused disproportionately high mortality rates in older adults. With the rapid development and licensing of novel COVID-19 vaccines, immunization campaigns across the WHO European Region started in late 2020 and early 2021, initially targeting the most vulnerable and exposed populations, including older adults, people with comorbidities and healthcare professionals. Several studies have estimated the number of lives saved by COVID-19 vaccination, both at national and multi-country level in the earlier stages of the pandemic. However, only one multi-country study has assessed the number of lives saved beyond the first year of the pandemic, particularly when the Omicron variant of concern (VOC) circulated, a period when vaccination coverage was high in many countries, areas and territories (CAT), but COVID-19 transmission was at its highest. Added value of this studyHere we quantified the impact of COVID-19 vaccination in adults by age-group, vaccine dose and period of circulation of VOC, across diverse settings, using real world data reported by 34 CAT in the WHO European Region for the period December 2020 to April 2023. We estimated that COVID-19 vaccination programs were associated with a 57% reduction (CAT range: 15% to 75%) in the number of deaths among the [≥]25 years old, representing over 1.5 million lives saved (range: 0.7 million to 2.6 million) in 34 European CAT during the first 2.5 years following vaccine introduction. The first booster savedthe most lives (721,122 / 1,408,967, (57%) of all lives saved). The [≥]60 years old age group accounted for 96% of the total lives saved (1,349,617 / 1,408,967) whereas the [≥]80 years old age group represented 52% of the total lives saved (728,858 / 1,408,967 lives saved) and 67% of all lives were saved during the Omicron period (942,571 / 1,408,967). Implications of all the available evidenceOur results reinforce the importance of up-to-date COVID-19 vaccination, particularly among older age-groups. Communication campaigns supporting COVID-19 vaccination should stress the value of COVID-19 vaccination in saving lives to ensure vulnerable groups are up-to-date with vaccination ahead of periods of potential increased transmission.
Subject(s)
COVID-19ABSTRACT
Background: Zoonotic coronaviruses have repeatedly taken the spotlight leading to severe global epidemics over the last two decades. In addition, seasonal coronaviruses (sCoVs) broadly circulate in humans. Their epidemiology could have broad impacts on the spread of emerging coronaviruses, but has been neglected so far.Methods: Clinical samples and data were collected from hospitalized patients with severe acute respiratory infection (SARI) and primary care patients with influenza-like illness (ILI), recruited through the national influenza surveillance networks in Belgium. Multiplex RT-qPCRs for respiratory viruses, including sCoVs OC43, NL63 and 229E, and SARS-CoV-2 were performed. Incidence rates of sCoV infection between 2015-2020 were estimated by season and age group. The impact of co-infections and comorbidities on the outcome of hospitalized patients was assessed.Findings: Hospitalized children under five carry the highest burden of disease for OC43 (IR =9·0, 95%CI 7·2-11·2 per 100,000 person-months) and NL63 (IR=5·2, 95%CI 3·9-6·9 per 100,000 person-months), while adults over 65 carry the highest burden of disease for 229E (IR=1·7, 95%CI 1·3-2·2 per 100,000 person-months). In hospitalized children under five, complications were associated with co-infections (p=0·02). Overall, comorbidities were strongly associated with a severe outcome following sCoV infection (p=0·006). In early March 2020, the SARI surveillance detected the first SARS-CoV-2-positive sample concomitantly with the first confirmed COVID-19 case without travel history to China. The ILI surveillance system captured two peaks in the number of primary care visits at weeks five (influenza) and 12 (SARS-CoV-2).Interpretation: We show that sCoVs can cause severe complications and death, especially in combination with pre-existing comorbidities and/or co-infections. Furthermore, we encourage the leverage of national influenza surveillance systems for early detection and monitoring of emerging coronaviruses such as SARS-CoV-2.Funding: Federal Public Service ‘Health, Food Chain Safety, and Environment’, National Insurance Health Care (INAMI/RIZIV), Regional Health Authorities (Flanders: AZG, Brussels: COCOM, Wallonia: AVIQ).Declaration of Interests: The authors declare no conflict of interest.Ethics Approval Statement: The study surveillance protocol was approved by a central Ethical Committee (reference AK/12-02- 11/4111; in 2011: Centre Hospitalier Universitaire St-Pierre, Brussels, Belgium; since 2014: Universitair Ziekenhuis Vrije Universiteit Brussel, Brussels, Belgium) and the local ethical committees of each participating hospital. Informed consent was obtained from all participants or parents/guardians.
Subject(s)
COVID-19 , Influenza, Human , Respiratory Tract InfectionsABSTRACT
Background: In response to the COVID-19 epidemic, caused by a novel coronavirus, it was of great importance to rapidly collect as much accurate information as possible in order to characterize the public health threat and support the health authorities in its management. Hospital-based surveillance is paramount to monitor the severity of a disease in the population. Methods: Two separate surveillance systems, a Surge Capacity survey and a Clinical survey, were set up to collect complementary data on COVID-19 from Belgium’s hospitals. The Surge Capacity survey collects aggregated data to monitor the hospital capacity through occupancy rates of beds and medical devices, and to follow a set of key epidemiological indicators over time. Participation is mandatory and the daily data collection includes prevalence and incidence figures on the number of COVID-19 patients in the hospital. The Clinical survey is strongly recommended by health authorities, focusses on specific patient characteristics and relies on individual patient data provided by the hospitals at admission and discharge. Conclusions: This national double-level hospital surveillance was implemented very rapidly after the first COVID-19 patients were hospitalized and revealed to be crucial to monitor hospital capacity over time and to better understand the disease in terms of risk groups and outcomes. The two approaches are complementary and serve different needs.