ABSTRACT
Intro: Vaccinations have decreased the case fatality rate of COVID-19. Nonetheless, there appear to be differences in the duration of vaccine efficacy against death across populations.We aim to model the duration between vaccine type and time to death stratified by primary and booster series vaccination in Malaysia. Method(s): Data for all COVID-19 deaths between 1 February 2020 and 31 August 2022 were extracted from the Ministry of Health Malaysia data repository. Information was available on age, sex, nationality, region, vaccine status, vaccine type, and the duration from vaccination to death. The duration between primary or booster vaccination and death was modelled using Poisson regression. Finding(s): A total of 25,759 (77%), 7,421 (20%), and 1,036 (2.9%) unvaccinated, primary series vaccinated, and booster vaccinated COVID-19 deaths were respectively reported between 1 February 2020-31 August 2022 in Malaysia. The median duration between primary series vaccination and death, with AstraZeneca, Pfizer and Sinovac vaccines was respectively 150 (IQR: 73-211), 158 (IQR:88-229) and 105 (65-139) days. The median duration between booster vaccine and death with a Homologous or Heterologous vaccine was 86 (IQR: 59- 139) and 106 (66-139) days, respectively. Individuals with an AstraZeneca and Sinovac primary series had 19% (95% CI: 0.8-0.82) and 33% (95% CI: 66-0.68, p<0.01) shorter duration from vaccination to death than individuals with Pfizer vaccines. Individuals with a heterologous booster vaccination had an 8% (95% CI: 1.07-1.10, p<0.01) longer duration from vaccination to death than individuals receiving a homologous booster dose. Conclusion(s): There appear to be differences in the duration between vaccination and death by vaccine type. This must be considered alongside immune evasive variants and level of naturally acquired immunity when planning for vaccination programmes that are central to keeping COVID-19-associated mortalities low.Copyright © 2023
ABSTRACT
INTRODUCTION: Periodic benchmarking of the epidemiology of COVID-19 in the Association of Southeast Asian Nations (ASEAN) countries is critical for the continuous understanding of the transmission and control of COVID-19 in the region. The incidence, mortality, testing and vaccination rates within the ASEAN region from 1 January 2020 to 15 October 2021 is analysed in this paper. METHODS: COVID-19 data on cases, deaths, testing, and vaccinations were extracted from the Our World in Data (OWID) COVID-19 data repository for all the ten ASEAN countries. Comparative time-trends of the epidemiology of COVID-19 using the incidence rate, cumulative case fatality rate (CFR), delay-adjusted case fatality rate, cumulative mortality rate (MR), test positivity rate (TPR), cumulative testing rate (TR) and vaccination rate was carried out. RESULTS: Over the study period, a total of 12,720,661 cases and 271,475 deaths was reported within the ASEAN region. Trends of daily per capita cases were observed to peak between July and September 2021 for the ASEAN region. The cumulative case fatality rate (CFR) in Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam, was of 0.9% (N=68), 2.2% (N=2,610), 3.5% (N=142,889), 0.1% (N=36), 1.2% (N=27,700), 4.0% (N=18,297), 1.6% (N=40,424), 0.1% (N=215), 1.7% (N=18,123), and 2.6% (N=21,043), respectively. CFR was consistently highest between January-June 2020. The cumulative mortality rate (MR) was 9.5, 13.7, 51.4, 0.2, 80.3, 32.4, 34.5, 1.6, 23.9 and 19.7 per 100,000 population, respectively. The cumulative test positivity rate (TPR) was 8.4%, 16.9%, 4.6%, 7.5%, 11.1%, 12.9%, 0.5%, 11.7%, and 3.6%, with the cumulative testing rate (TR) at 25.0, 90.1, 27.4, 917.7, 75.8, 177.8, 3303.3, 195.2, and 224.9 tests per 1,000 population in Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam, respectively. The percentage of population that completed vaccinations (VR) was 44.5%, 65.3%, 18.5%, 28.2%, 61.8%, 6.8%, 19.2%, 76.8%, 22.7%, and 10% in Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam, respectively. CONCLUSION: In 2020, most countries in ASEAN had higher case fatality rates but lower mortalities per population when compared to the third quarter of 2021 where higher mortalities per population were observed. Low testing rates have been one of the factors leading to high test positivity rates. Slow initiation of vaccination programs was found to be the key factor leading to high incidence and case fatality rate in most countries in ASEAN. Effective public health measures were able to interrupt the transmission of this novel virus to some extent. Increasing preparedness capacity within the ASEAN region is critical to ensure that any future similar outbreaks can be dealt with collectively.