Evaluation of COVID-19 vaccines in primary prevention against infections and reduction in severity of illness following the outbreak of SARS-CoV-2 omicron variant in Shanghai

Dawei Yang; Huifen Weng; Rui Wang; You Li; Hao Zhang; Shifeng Shao; Hunan Huang; Yuanlin Song; Xiaoyan Chen; Dongni Hou; Yin Wu; Xingwei Lu; Wei Yang; Zhengguo Chen; Xiaohan Hu; Jianwei Xuan; Chunxue Bai; Yaoli Wang

doi:10.3389/fmed.2023.1079165

Evaluation of COVID-19 vaccines in primary prevention against infections and reduction in severity of illness following the outbreak of SARS-CoV-2 omicron variant in Shanghai

Front Med (Lausanne). 2023 Feb 8:10:1079165. doi: 10.3389/fmed.2023.1079165. eCollection 2023.

Authors

Dawei Yang^{1

2}, Huifen Weng³, Rui Wang⁴, You Li⁴, Hao Zhang⁴, Shifeng Shao⁴, Hunan Huang⁵, Yuanlin Song^{1

2

6}, Xiaoyan Chen^{1

2}, Dongni Hou^{1

2}, Yin Wu⁷, Xingwei Lu⁸, Wei Yang³, Zhengguo Chen⁹, Xiaohan Hu⁷, Jianwei Xuan⁷, Chunxue Bai^{1

2}, Yaoli Wang⁴

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
² Shanghai Engineer and Technology Research Center of Internet of Things for Respiratory Medicine, Shanghai Respiratory Research Institution, Shanghai, China.
³ Shanghai Suvalue Healthcare Scientific Co., Ltd., Shanghai, China.
⁴ State Key Laboratory of Trauma, Burns and Combined Injury, Wound Trauma Medical Center, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, China.
⁵ Hospital of the People's Liberation Army Joint Logistics Support Force, Yingtan, Jiangxi, China.
⁶ Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China.
⁷ School of Pharmaceutical Sciences, Health Economic Research Institute, Sun Yat-sen University, Guangzhou, China.
⁸ Shanghai Centennial Scientific Co., Ltd., Shanghai, China.
⁹ Department of Clinical Research Management Office, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Abstract

Objectives: To evaluate COVID-19 vaccines in primary prevention against infections and lessen the severity of illness following the most recent outbreak of the SARS-CoV-2 Omicron variant in Shanghai.

Data sources: Data from 153,544 COVID-19 patients admitted to the Shanghai "Four-Leaf Clover" Fangcang makeshift shelter hospital were collected using a structured electronic questionnaire, which was then merged with electronic medical records of the hospital. For healthy controls, data on vaccination status and other information were obtained from 228 community-based residents, using the same structured electronic questionnaire.

Methods: To investigate whether inactivated vaccines were effective in protecting against SARS-CoV-2 virus, we estimated the odds ratio (OR) of the vaccination by comparing cases and matched community-based healthy controls. To evaluate the potential benefits of vaccination in lowering the risk of symptomatic infection (vs. asymptomatic), we estimated the relative risk (RR) of symptomatic infections among diagnosed patients. We also applied multivariate stepwise logistic regression analyses to measure the risk of disease severity (symptomatic vs. asymptomatic and moderate/severe vs. mild) in the COVID-19 patient cohort with vaccination status as an independent variable while controlling for potential confounding factors.

Results: Of the 153,544 COVID-19 patients included in the analysis, the mean age was 41.59 years and 90,830 were males (59.2%). Of the study cohort, 118,124 patients had been vaccinated (76.9%) and 143,225 were asymptomatic patients (93.3%). Of the 10,319 symptomatic patients, 10,031 (97.2%), 281 (2.7%), and 7 (0.1%) experienced mild, moderate, and severe infections, respectively. Hypertension (8.7%) and diabetes (3.0%) accounted for the majority of comorbidities. There is no evidence that the vaccination helped protect from infections (OR = 0.82, p = 0.613). Vaccination, however, offered a small but significant protection against symptomatic infections (RR = 0.92, p < 0.001) and halved the risk of moderate/severe infections (OR = 0.48, 95% CI: 0.37-0.61). Older age (≥60 years) and malignant tumors were significantly associated with moderate/severe infections.

Conclusion: Inactivated COVID-19 vaccines helped provide small but significant protection against symptomatic infections and halved the risk of moderate/severe illness among symptomatic patients. The vaccination was not effective in blocking the SARS-CoV-2 Omicron Variant community spread.

Keywords: COVID-19; epidemiology; health policy; public health; respiratory tract infections; vaccines.