Résumé
Background: Hong Kong experienced four epidemic waves caused by the ancestral strain of SARS-CoV-2 in 2020-2021 and a large Omicron wave in 2022. Few studies have assessed antibacterial drug prescribing for COVID-19 inpatients throughout the pandemic. Objectives: To describe inpatient antibacterial drug prescribing for COVID-19 patients throughout the pandemic and to determine factors associated with their prescription. Methods: This cohort study used electronic health records of COVID-19 cases admitted to public hospitals in Hong Kong from 21 January 2020 to 30 September 2022. We assessed the prevalence and rates of inpatient antibacterial drug use, using days of therapy/1000 patient days (DOT/1000PD), and examined the association of baseline factors and disease severity with receipt of an inpatient antibacterial drug prescription. Results: Among 65,810 inpatients, 54.0% were prescribed antibacterial drugs at a rate of 550.5 DOT/1000PD. Antibacterial use was lowest during wave 4 (28.0%; 246.9 DOT/1000PD), peaked in early wave 5 (64.6%; 661.2 DOT/1000PD), and then modestly declined in late wave 5 (43.2%; 464.1 DOT/1000PD) starting on 23 May 2022. Older age, increased disease severity, and residing in an elderly care home were strongly associated with increased odds of prescription, while receiving [≥] 2 doses of COVID-19 vaccines and pre-admission use of coronavirus antivirals were associated with lower odds. Conclusions: The rate of inpatient antibacterial prescribing initially declined during the pandemic, but increased during the Omicron wave when hospital capacity was overwhelmed. Despite the availability of COVID-19 vaccines and antiviral drugs, antibacterial drug use among COVID-19 inpatients remained high into late 2022.
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COVID-19Résumé
Background Concerns regarding the autoimmune safety of COVID-19 vaccines may negatively impact vaccine uptake. We aimed to describe the incidence of autoimmune conditions following BNT162b2 and CoronaVac vaccination and compare these with age-standardized incidence rates in non-vaccinated individuals. Methods This is a descriptive cohort study conducted in public healthcare service settings. Territory-wide longitudinal electronic medical records of Hong Kong Hospital Authority users (≥16 years) were linked with COVID-19 vaccination records between February 23, 2021 and June 30, 2021. We classified participants into first/second dose BNT162b2 groups, first/second dose CoronaVac groups and non-vaccinated individuals for incidence comparison. The study outcomes include hospitalized autoimmune diseases (16 types of immune-mediated diseases across six body systems) within 28 days after first and second dose of vaccination. Age-standardized incidence rate ratios (IRRs) with exact 95% confidence intervals (CIs) were estimated using Poisson distribution. Results This study included around 3.9 million Hong Kong residents, of which 1,122,793 received at least one dose of vaccine (BNT162b2: 579,998; CoronaVac: 542,795), and 721,588 completed two doses (BNT162b2: 388,881; CoronaVac: 332,707). Within 28 days following vaccination, cumulative incidences for all autoimmune conditions were below 9 per 100,000 persons, for both vaccines and both doses. None of the age-standardized incidence rates were significantly higher than the non-vaccinated individuals, except for an observed increased incidence of hypersomnia following the first dose of BNT162b2 (standardized IRR: 1.47; 95% CI: 1.10–1.94). Conclusions Autoimmune conditions requiring hospital care are rare following mRNA and inactivated virus COVID-19 vaccination with similar incidence to non-vaccinated individuals. The association between first dose BNT162b2 vaccination and immune-related sleeping disorders requires further research. Population-based robust safety surveillance is essential to detect rare and unexpected vaccine safety events. Funding Research Grant from the Food and Health Bureau, the Government of the Hong Kong Special Administrative Region (Ref. No. COVID19F01).