Real-world Evidence of COVID-19 Vaccines Effectiveness in Solid-organ Transplant Recipient Population in Colombia: A Study Nested in the Esperanza Cohort.

BACKGROUND: Solid-organ transplant recipients (SOTRs) have a higher risk of coronavirus disease 2019 (COVID-19) complications and death and a less powerful and lasting response to vaccines and to natural infection. In Colombia, this population was prioritized in the National Vaccination Plan against COVID-19 and received vaccines from different platforms. The aim of this study was to estimate the effectiveness of the complete vaccination schedule and of the vaccine booster for COVID-19 administered to SOTRs in Colombia. METHODS: A nested-cohort was assembled within the population-based ESPERANZA cohort and included the subset of 16 y and older SOTRs (n = 6963); the follow-up period spanned March 11, 2021, to May 11, 2022. The vaccine effectiveness was estimated with Cox proportional-hazards models so that the overall effectiveness of the complete vaccination schedule, the vaccine booster, each used vaccine, and the homologous and heterologous schedules were estimated, adjusting by the main confounders. RESULTS: The overall effectiveness of being fully vaccinated was 73.7% (95% confidence interval [CI], 68.9%-77.0%) to prevent COVID-19 infection, 83.7% (95% CI, 78.7%-87.5%) to prevent hospitalization, and 92.1% (95% CI, 88.8%-94.4%) to prevent death due to COVID-19. Similarly, the effectiveness of the vaccine booster was 76.7% (95% CI, 70.6%-81.5%), 86.9% (95% CI, 79.4%-91.6%), and 94.5% (95% CI, 89.8%-97.1%) to prevent confirmed COVID-19 infection, hospitalization, and death due to COVID-19, respectively. In both cases, there were no statistically significant differences across age groups. CONCLUSIONS: Findings from this work show a high protection of vaccination against infection, hospitalization, and death due to COVID-19 in SOTRs, which increases with the vaccine booster.

Effectiveness of COVID-19 vaccines in older adults in Colombia: a retrospective, population-based study of the ESPERANZA cohort.

Background: Although clinical trials showed that vaccines have high efficacy and safety, differences in study designs and populations do not allow for comparison between vaccines and age groups. The objective of this study was to evaluate the effectiveness of vaccines against COVID-19 in real-world conditions in adults aged 60 years and older in Colombia. Methods: In this retrospective, population-based, matched cohort study, we evaluated the effectiveness of vaccines against COVID-19-related hospitalisation and death in people aged 60 years and older. The full cohort consisted of every person who was eligible to receive a COVID-19 vaccine in Colombia (the ESPERANZA cohort). The exposed cohort consisted of older adults who were fully vaccinated with Ad26.COV2-S, BNT162b2, ChAdOx1 nCoV-19, or CoronaVac, and who did not have a history of confirmed SARS-CoV-2 infection. The unexposed cohort were people aged 60 years and older who had not received any dose of a COVID-19 vaccine during the study period. Participant follow-up was done between March 11, 2021, and Oct 26, 2021. Vaccine effectiveness was estimated as 1- hazard ratio from cause-specific proportional hazards models in the presence of competing risks. We estimated the overall effectiveness of being fully vaccinated, as well as effectiveness for each vaccine, adjusting by main potential confounders. The effectiveness of each vaccine was also assessed by age groups (ages 60-69 years, 70-79 years, and ≥80 years). Findings: 2 828 294 participants were assessed between March 11 and Oct 26, 2021. For all ages, the overall effectiveness across all assessed COVID-19 vaccines at preventing hospitalisation without subsequent death was 61·6% (95% CI 58·0-65·0, p<0·0001), 79·8% (78·5-81·1, p<0·0001) for preventing death after hospitalisation with COVID-19, and 72·8% (70·1-75·3, p<0·0001) for preventing death without previous COVID-19 hospitalisation. The effectiveness of all vaccines analysed at preventing death after hospitalisation for COVID-19 was 22·6% lower in adults who were aged 80 and older (68·4% [65·7-70·9], p<0·0001) compared with adults aged between 60 and 69 years (91·0% [89·0-92·6], p<0·0001). Interpretation: All vaccines analysed in this study were effective at preventing hospitalisation and death from COVID-19 in fully vaccinated older adults, which is a promising result for the national vaccination programme against COVID-19 in Colombia and in countries where these biologics have been applied. Efforts should be improved to increase coverage among older adults. In addition, given that we observed that the effectiveness of vaccines declined with increasing age, a booster dose is also justified, which should be prioritised for older adults. Funding: Colombian Ministry of Health and Social Protection.

Sobre las “reflexiones críticas” al Índice de resiliencia epidemiológica municipal

En junio de 2021, un grupo de distinguidos académicos colombianos sometieron a su revista algunas reflexiones1 sobre el Índice de Resiliencia Epidemiológica Municipal (IREM), el cual fue propuesto por el Ministerio de Salud y Protección Social de Colombia como una herramienta para la toma de decisiones en los territorios del país respecto a la reactivación económica que se plantea en el proceso de superación de la crisis social y económica relacionada con la pandemia por COVID-19. A continuación, deseamos aportar algunos elementos analíticos e interpretativos sobre dichas reflexiones con el ánimo de enriquecer la discusión. Alternate abstract: In June 2021, a group of renowned Colombian scholars submitted to your Journal1 an article with some reflections on the Municipal Epidemiological Resilience Index (IREM by its acronym in Spanish) proposed by the Colombian Ministry of Health and Social Protection as a tool for decision-making in the country’s territories to boost economic reactivation and overcome the social and economic crisis caused by the COVID-19 pandemic. We would like to take advantage of this space to provide some analytical and interpretative insights on these reflections with the aim of enriching the discussion.

Cost-Effectiveness of the COVID-19 Test, Trace and Isolate Program in Colombia.

BACKGROUND: During the COVID-19 pandemic, Test-Trace-Isolate (TTI) programs have been recommended as a risk mitigation strategy. However, many governments have hesitated to implement them due to their costs. This study aims to estimate the cost-effectiveness of implementing a national TTI program to reduce the number of severe and fatal cases of COVID-19 in Colombia. METHODS: We developed a Markov simulation model of COVID-19 infection combined with a Susceptible-Infected-Recovered structure. We estimated the incremental cost-effectiveness of a comprehensive TTI strategy compared to no intervention over a one-year horizon, from both the health system and the societal perspective. Hospitalization and mortality rates were retrieved from Colombian surveillance data. We included program costs of TTI intervention, health services utilization, PCR diagnosis test, productivity loss, and government social program costs. We used the number of deaths and quality-adjusted life years (QALYs) as health outcomes. Sensitivity analyses were performed. FINDINGS: Compared with no intervention, the TTI strategy reduces COVID-19 mortality by 67%. In addition, the program saves an average of $1,045 and $850 per case when observed from the social and the health system perspective, respectively. These savings are equivalent to two times the current health expenditures in Colombia per year. INTERPRETATION: The TTI program is a highly cost-effective public health intervention to reduce the burden of COVID-19 in Colombia. TTI programs depend on their successful and speedy implementation. FUNDING: This study was supported by the Colombian Ministry of Health through award number PUJ-04519-20 received by EPQ AVO and SDS declined to receive any funding support for this study. The contents are the responsibility of all the individual authors.

Socioeconomic inequalities associated with mortality for COVID-19 in Colombia: a cohort nationwide study.

BACKGROUND: After 8 months of the COVID-19 pandemic, Latin American countries have some of the highest rates in COVID-19 mortality. Despite being one of the most unequal regions of the world, there is a scarce report of the effect of socioeconomic conditions on COVID-19 mortality in their countries. We aimed to identify the effect of some socioeconomic inequality-related factors on COVID-19 mortality in Colombia. METHODS: We conducted a survival analysis in a nation-wide retrospective cohort study of confirmed cases of COVID-19 in Colombia from 2 March 2020 to 26 October 2020. We calculated the time to death or recovery for each confirmed case in the cohort. We used an extended multivariable time-dependent Cox regression model to estimate the HR by age groups, sex, ethnicity, type of health insurance, area of residence and socioeconomic strata. RESULTS: There were 1 033 218 confirmed cases and 30 565 deaths for COVID-19 in Colombia between 2 March and 26 October. The risk of dying for COVID-19 among confirmed cases was higher in males (HR 1.68 95% CI 1.64 to 1.72), in people older than 60 years (HR 296.58 95% CI 199.22 to 441.51), in indigenous people (HR 1.20 95% CI 1.08 to 1.33), in people with subsidised health insurance regime (HR 1.89 95% CI 1.83 to 1.96) and in people living in the very low socioeconomic strata (HR 1.44 95% CI 1.24 to 1.68). CONCLUSION: Our study provides evidence of socioeconomic inequalities in COVID-19 mortality in terms of age groups, sex, ethnicity, type of health insurance regimen and socioeconomic status.