A multi-country analysis of COVID-19 hospitalizations by vaccination status

ISARIC clinical characterisation group; Bronner P Gonçalves; Ewen M Harrison

doi:10.1016/j.medj.2023.08.005

A multi-country analysis of COVID-19 hospitalizations by vaccination status

ISARIC clinical characterisation group, Bronner P Gonçalves, Ewen M Harrison

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Individuals vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), when infected, can still develop disease that requires hospitalization. It remains unclear whether these patients differ from hospitalized unvaccinated patients with regard to presentation, coexisting comorbidities, and outcomes.

METHODS: Here, we use data from an international consortium to study this question and assess whether differences between these groups are context specific. Data from 83,163 hospitalized COVID-19 patients (34,843 vaccinated, 48,320 unvaccinated) from 38 countries were analyzed.

FINDINGS: While typical symptoms were more often reported in unvaccinated patients, comorbidities, including some associated with worse prognosis in previous studies, were more common in vaccinated patients. Considerable between-country variation in both in-hospital fatality risk and vaccinated-versus-unvaccinated difference in this outcome was observed.

CONCLUSIONS: These findings will inform allocation of healthcare resources in future surges as well as design of longer-term international studies to characterize changes in clinical profile of hospitalized COVID-19 patients related to vaccination history.

FUNDING: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z, and 220757/Z/20/Z); the Bill & Melinda Gates Foundation (OPP1209135); and the philanthropic support of the donors to the University of Oxford's COVID-19 Research Response Fund (0009109). Additional funders are listed in the "acknowledgments" section.

Original language	English
Number of pages	19
Journal	Med
Early online date	12 Sept 2023
DOIs	https://doi.org/10.1016/j.medj.2023.08.005
Publication status	E-pub ahead of print - 12 Sept 2023

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@article{0340bb599db7475c99d0b01c7d026257,

title = "A multi-country analysis of COVID-19 hospitalizations by vaccination status",

abstract = "BACKGROUND: Individuals vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), when infected, can still develop disease that requires hospitalization. It remains unclear whether these patients differ from hospitalized unvaccinated patients with regard to presentation, coexisting comorbidities, and outcomes.METHODS: Here, we use data from an international consortium to study this question and assess whether differences between these groups are context specific. Data from 83,163 hospitalized COVID-19 patients (34,843 vaccinated, 48,320 unvaccinated) from 38 countries were analyzed.FINDINGS: While typical symptoms were more often reported in unvaccinated patients, comorbidities, including some associated with worse prognosis in previous studies, were more common in vaccinated patients. Considerable between-country variation in both in-hospital fatality risk and vaccinated-versus-unvaccinated difference in this outcome was observed.CONCLUSIONS: These findings will inform allocation of healthcare resources in future surges as well as design of longer-term international studies to characterize changes in clinical profile of hospitalized COVID-19 patients related to vaccination history.FUNDING: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z, and 220757/Z/20/Z); the Bill & Melinda Gates Foundation (OPP1209135); and the philanthropic support of the donors to the University of Oxford's COVID-19 Research Response Fund (0009109). Additional funders are listed in the {"}acknowledgments{"} section.",

author = "{ISARIC clinical characterisation group} and Gon{\c c}alves, {Bronner P} and Waasila Jassat and Joaqu{\'i}n Baruch and Madiha Hashmi and Amanda Rojek and Abhishek Dasgupta and Ignacio Martin-Loeches and Reyes, {Luis Felipe} and Chiara Piubelli and Citarella, {Barbara Wanjiru} and Christiana Kartsonaki and Benjamin Lef{\`e}vre and {L{\'o}pez Revilla}, {Jos{\'e} W} and Miles Lunn and Harrison, {Ewen M} and Kraemer, {Moritz U G} and Sally Shrapnel and Peter Horby and Zeno Bisoffi and Olliaro, {Piero L} and Laura Merson",

note = "This work was also funded by grants from the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (MRC; grant MC_PC_ 19059), and the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at the University of Liverpool in partnership with Public Health England (PHE) (award 200907), NIHR HPRU in Respiratory Infections at Imperial College London with PHE (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award ISBRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support; CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and the coordination in Canada by Sunnybrook Research Institute; funding by the Health Research Board of Ireland (CTN-2014-12); the Rapid European COVID-19 Emergency Response research (RECOVER) (H2020 project 101003589) and European Clinical Research Alliance on Infectious Diseases (ECRAID) (965313); Cambridge NIHR Biomedical Research Centre (award NIHR203312); a Research Council of Norway grant no. 312780 and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner; the Comprehensive Local Research Networks (CLRNs), of which P.J.M.O. is an NIHR Senior Investigator (NIHR201385); Stiftungsfonds zur Fo¨ rderung der Beka¨mpfung der Tuberkulose und anderer Lungenkrankheiten of the City of Vienna, project number APCOV22BGM; funding from Medical University of Vienna, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine; Italian Ministry of Health {\textquoteleft}{\textquoteleft}Fondi Ricerca corrente–L1P6{\textquoteright}{\textquoteright} to IRCCS Ospedale Sacro Cuore– Don Calabria; Australian Department of Health grant (3273191); Gender Equity Strategic Fund at University of Queensland, Artificial Intelligence for Pandemics (A14PAN) at University of Queensland, the Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS, CE170100009), the Prince Charles Hospital Foundation, Australia; a grant from foundation Bevordering Onderzoek Franciscus; the South Eastern Norway Health Authority and the Research Council of Norway; Institute of Cancer Research (ICR), National Institutes of Health (NIH) supported by the Ministry of Health Malaysia; and the US DoD Armed Forces Health Surveillance Division, Global Emerging Infectious Diseases Branch to the US Naval Medical ResearchUnit no. TWO (NAMRU-2) (Work Unit #: P0153_21_N2). These authors would like to thank Vysnova Partners, Inc., for the management of this research project. The Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit is funded by the Wellcome Trust; M.U.G.K. was supported by the Branco Weiss Fellowship, Google. org, the Oxford Martin School, the Rockefeller Foundation, and the European Union Horizon 2020 project MOOD (#874850). The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views of the European Commission.",

year = "2023",

month = sep,

day = "12",

doi = "10.1016/j.medj.2023.08.005",

language = "English",

journal = "Med",

issn = "2666-6340",

publisher = "Cell Press",

}

TY - JOUR

T1 - A multi-country analysis of COVID-19 hospitalizations by vaccination status

AU - ISARIC clinical characterisation group

AU - Gonçalves, Bronner P

AU - Jassat, Waasila

AU - Baruch, Joaquín

AU - Hashmi, Madiha

AU - Rojek, Amanda

AU - Dasgupta, Abhishek

AU - Martin-Loeches, Ignacio

AU - Reyes, Luis Felipe

AU - Piubelli, Chiara

AU - Citarella, Barbara Wanjiru

AU - Kartsonaki, Christiana

AU - Lefèvre, Benjamin

AU - López Revilla, José W

AU - Lunn, Miles

AU - Harrison, Ewen M

AU - Kraemer, Moritz U G

AU - Shrapnel, Sally

AU - Horby, Peter

AU - Bisoffi, Zeno

AU - Olliaro, Piero L

AU - Merson, Laura

N1 - This work was also funded by grants from the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (MRC; grant MC_PC_ 19059), and the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at the University of Liverpool in partnership with Public Health England (PHE) (award 200907), NIHR HPRU in Respiratory Infections at Imperial College London with PHE (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award ISBRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support; CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and the coordination in Canada by Sunnybrook Research Institute; funding by the Health Research Board of Ireland (CTN-2014-12); the Rapid European COVID-19 Emergency Response research (RECOVER) (H2020 project 101003589) and European Clinical Research Alliance on Infectious Diseases (ECRAID) (965313); Cambridge NIHR Biomedical Research Centre (award NIHR203312); a Research Council of Norway grant no. 312780 and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner; the Comprehensive Local Research Networks (CLRNs), of which P.J.M.O. is an NIHR Senior Investigator (NIHR201385); Stiftungsfonds zur Fo¨ rderung der Beka¨mpfung der Tuberkulose und anderer Lungenkrankheiten of the City of Vienna, project number APCOV22BGM; funding from Medical University of Vienna, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine; Italian Ministry of Health ‘‘Fondi Ricerca corrente–L1P6’’ to IRCCS Ospedale Sacro Cuore– Don Calabria; Australian Department of Health grant (3273191); Gender Equity Strategic Fund at University of Queensland, Artificial Intelligence for Pandemics (A14PAN) at University of Queensland, the Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS, CE170100009), the Prince Charles Hospital Foundation, Australia; a grant from foundation Bevordering Onderzoek Franciscus; the South Eastern Norway Health Authority and the Research Council of Norway; Institute of Cancer Research (ICR), National Institutes of Health (NIH) supported by the Ministry of Health Malaysia; and the US DoD Armed Forces Health Surveillance Division, Global Emerging Infectious Diseases Branch to the US Naval Medical ResearchUnit no. TWO (NAMRU-2) (Work Unit #: P0153_21_N2). These authors would like to thank Vysnova Partners, Inc., for the management of this research project. The Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit is funded by the Wellcome Trust; M.U.G.K. was supported by the Branco Weiss Fellowship, Google. org, the Oxford Martin School, the Rockefeller Foundation, and the European Union Horizon 2020 project MOOD (#874850). The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views of the European Commission.

PY - 2023/9/12

Y1 - 2023/9/12

N2 - BACKGROUND: Individuals vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), when infected, can still develop disease that requires hospitalization. It remains unclear whether these patients differ from hospitalized unvaccinated patients with regard to presentation, coexisting comorbidities, and outcomes.METHODS: Here, we use data from an international consortium to study this question and assess whether differences between these groups are context specific. Data from 83,163 hospitalized COVID-19 patients (34,843 vaccinated, 48,320 unvaccinated) from 38 countries were analyzed.FINDINGS: While typical symptoms were more often reported in unvaccinated patients, comorbidities, including some associated with worse prognosis in previous studies, were more common in vaccinated patients. Considerable between-country variation in both in-hospital fatality risk and vaccinated-versus-unvaccinated difference in this outcome was observed.CONCLUSIONS: These findings will inform allocation of healthcare resources in future surges as well as design of longer-term international studies to characterize changes in clinical profile of hospitalized COVID-19 patients related to vaccination history.FUNDING: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z, and 220757/Z/20/Z); the Bill & Melinda Gates Foundation (OPP1209135); and the philanthropic support of the donors to the University of Oxford's COVID-19 Research Response Fund (0009109). Additional funders are listed in the "acknowledgments" section.

AB - BACKGROUND: Individuals vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), when infected, can still develop disease that requires hospitalization. It remains unclear whether these patients differ from hospitalized unvaccinated patients with regard to presentation, coexisting comorbidities, and outcomes.METHODS: Here, we use data from an international consortium to study this question and assess whether differences between these groups are context specific. Data from 83,163 hospitalized COVID-19 patients (34,843 vaccinated, 48,320 unvaccinated) from 38 countries were analyzed.FINDINGS: While typical symptoms were more often reported in unvaccinated patients, comorbidities, including some associated with worse prognosis in previous studies, were more common in vaccinated patients. Considerable between-country variation in both in-hospital fatality risk and vaccinated-versus-unvaccinated difference in this outcome was observed.CONCLUSIONS: These findings will inform allocation of healthcare resources in future surges as well as design of longer-term international studies to characterize changes in clinical profile of hospitalized COVID-19 patients related to vaccination history.FUNDING: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z, and 220757/Z/20/Z); the Bill & Melinda Gates Foundation (OPP1209135); and the philanthropic support of the donors to the University of Oxford's COVID-19 Research Response Fund (0009109). Additional funders are listed in the "acknowledgments" section.

U2 - 10.1016/j.medj.2023.08.005

DO - 10.1016/j.medj.2023.08.005

M3 - Article

C2 - 37738979

SN - 2666-6340

JO - Med

JF - Med

ER -

A multi-country analysis of COVID-19 hospitalizations by vaccination status

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