Impact of COVID-19 Vaccination on the Trend of Hospital Admission and
Mortality in Two Tertiary Care Hospitals in the United Arab Emirates: A
Retrospective Study

Rohit      Pradhan; Luai   A.   Ahmed; Nawal      Al Kaabi; Waddah   Ibrahim   El Subki; Ashraf   Al   Zaabi

doi:10.2174/04666230316121757

Abstract

Objectives: To investigate the impact of COVID-19 vaccines in the United Arab Emirates (UAE) on the trend of COVID-19-related hospitalization, intensive care unit (ICU) admissions, and case fatality rate (CFR), this retrospective chart review was conducted.

Methods: We included patients admitted to two tertiary hospitals from October 2020 to July 2022. Patients were categorized into non-vaccinated, partiallyvaccinated, and fully-vaccinated groups.

Results: A total of 2277 cases were included, with 27.49% being non-vaccinated. The monthly trend of admitted patients dropped from 1264 (56.50%) cases in the first half of 2021 to 194 (8.67%) cases in the first half of 2022, with a reduction rate of 84.65%. The trend of ICU admission followed the overall hospital admission rate, with an overall CFR of 0.88%, 95% CI (0.54% to 1.35%), and a virulence rate of 1.76%, 95% CI (1.26% to 2.38%). The incidence of ICU admission in the unvaccinated group was 4.79%, compared to 0% and 0.97% in the partially-vaccinated and fullyvaccinated groups, respectively (p <0.001). The CFR was significantly (p <0.001) higher in the unvaccinated group 2.88%, 95% CI (1.71 to 4.51) than in the partially-vaccinated 0%, 95% CI (0% to 0.59%) and fully-vaccinated groups 0.19%, 95% CI (0.02% to 0.70%).

Conclusion: Among the study population, COVID-19 vaccines showed promising efficacy in reducing the trend of COVID-19-related hospitalization, ICU admission, and mortality. Full vaccination might reduce the burden of COVID-19 on healthcare.

Keywords: COVID-19, Vaccine, Intensive care, Mortality, Fatality rate, Hospital.

[1]
Schnitzler L, Janssen LMM, Evers SMAA, et al. The broader societal impacts of COVID-19 and the growing importance of capturing these in health economic analyses. Int J Technol Assess Health Care  2021; 37(1): e43.
 [http://dx.doi.org/10.1017/S0266462321000155] [PMID: 33686927]

[2]
Ahmed H, Sayed A, Munir M, et al. A clinical review of COVID-19; pathogenesis, diagnosis, and management. Curr Pharm Des  2021; 27(41): 4232-4.

[3]
World Health Organization. Coronavirus disease (COVID-19). Weekly Epidemiological Update and Weekly Operational Update 2022.

[4]
Mason RJ. Pathogenesis of COVID-19 from a cell biology perspective. Eur Respir J  2020; 55(4): 2000607.
 [http://dx.doi.org/10.1183/13993003.00607-2020]

[5]
Omran D, Al Soda M, Bahbah E. Predictors of severity and development of critical illness of Egyptian COVID-19 patients: A multicenter study. PLoS One  2021; 16(9): e0256203.
 [http://dx.doi.org/10.1371/journal.pone.0256203] [PMID: 34555027]

[6]
Cheng S, Wu D, Li J, et al. Risk factors for the critical illness in SARS-CoV-2 infection: A multicenter retrospective cohort study. Respir Res  2020; 21(1): 277.
 [http://dx.doi.org/10.1186/s12931-020-01492-z] [PMID: 33087114]

[7]
Gao Y, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy  2021; 76(2): 428-55.
 [http://dx.doi.org/10.1111/all.14657] [PMID: 33185910]

[8]
Anesi GL, Kerlin MP. The impact of resource limitations on care delivery and outcomes: Routine variation, the coronavirus disease 2019 pandemic, and persistent shortage. Curr Opin Crit Care  2021; 27(5): 513-9.
 [http://dx.doi.org/10.1097/MCC.0000000000000859] [PMID: 34267075]

[9]
Richards F, Kodjamanova P, Chen X, et al. Economic Burden of COVID-19: A Systematic Review. Clinicoecon Outcomes Res  2022; 14: 293-307.
 [http://dx.doi.org/10.2147/CEOR.S338225] [PMID: 35509962]

[10]
Talic S, Shah S, Wild H, et al. Effectiveness of public health measures in reducing the incidence of COVID-19, SARS-CoV-2 transmission, and COVID-19 mortality: Systematic review and meta-analysis. BMJ  2021; 375: e068302.
 [http://dx.doi.org/10.1136/bmj-2021-068302] [PMID: 34789505]

[11]
Moghadas SM, Vilches TN, Zhang K, Wells CR, Shoukat A, Singer BH. The impact of vaccination on COVID-19 outbreaks in the United States. medRxiv  2020; 20240051.
 [http://dx.doi.org/10.1101/2020.11.27.20240051]

[12]
Rotshild V, Hirsh-Raccah B, Miskin I, Muszkat M, Matok I. Comparing the clinical efficacy of COVID-19 vaccines: A systematic review and network meta-analysis. Sci Rep  2021; 11(1): 22777.
 [http://dx.doi.org/10.1038/s41598-021-02321-z] [PMID: 34815503]

[13]
World Health Organization. COVID-19 vaccines.  Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/COVID-19-vaccines

[14]
Au WY, Cheung PPH. Effectiveness of heterologous and homologous COVID-19 vaccine regimens: Living systematic review with network meta-analysis. BMJ  2022; 377: e069989.
 [http://dx.doi.org/10.1136/bmj-2022-069989] [PMID: 35640925]

[15]
Anand P, Stahel VP. Review the safety of COVID-19 mRNA vaccines: A review. Patient Saf Surg  2021; 15(1)

[16]
Patel MK, Bergeri I, Bresee JS, et al. Evaluation of post-introduction COVID-19 vaccine effectiveness: Summary of interim guidance of the World Health Organization. Vaccine  2021; 39(30): 4013-24.
 [http://dx.doi.org/10.1016/j.vaccine.2021.05.099] [PMID: 34119350]

[17]
Agrawal U, Katikireddi SV, McCowan C, et al. COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): A prospective cohort study. Lancet Respir Med  2021; 9(12): 1439-49.
 [http://dx.doi.org/10.1016/S2213-2600(21)00380-5] [PMID: 34599903]

[18]
Iacobucci G. COVID-19: How is vaccination affecting hospital admissions and deaths? BMJ  2021; 374(2306): n2306.
 [http://dx.doi.org/10.1136/bmj.n2306] [PMID: 34544731]

[19]
Tenforde MW, Self WH, Adams K, et al. Association between mRNA vaccination and COVID-19 hospitalization and disease severity. JAMA  2021; 326(20): 2043-54.
 [http://dx.doi.org/10.1001/jama.2021.19499] [PMID: 34734975]

[20]
Home | UAE Coronavirus (COVID-19) Updates.  Available from: https://covid19.ncema.gov.ae/en

[21]
Ismail AlHosani F, Eduardo Stanciole A, Aden B, et al. Impact of the Sinopharm’s BBIBP-CorV vaccine in preventing hospital admissions and death in infected vaccinees: Results from a retrospective study in the emirate of Abu Dhabi, United Arab Emirates (UAE). Vaccine  2022; 40(13): 2003-10.
 [http://dx.doi.org/10.1016/j.vaccine.2022.02.039] [PMID: 35193793]

[22]
von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Int J Surg  2014; 12(12): 1495-9.
 [http://dx.doi.org/10.1016/j.ijsu.2014.07.013] [PMID: 25046131]

[23]
Egan C, Turtle L, Thorpe M, Harrison EM, Semple MG, Docherty AB. Hospital admission for symptomatic COVID ‐19 and impact of vaccination: Analysis of linked data from the Coronavirus Clinical Information Network and the National Immunisation Management Service. Anaesthesia  2022; 77(5): 605-8.
 [http://dx.doi.org/10.1111/anae.15677] [PMID: 35178709]

[24]
Kow CS, Hasan SS. Real-world effectiveness of BNT162b2 mRNA vaccine: A meta-analysis of large observational studies. Inflammopharmacology  2021; 29(4): 1075-90.
 [http://dx.doi.org/10.1007/s10787-021-00839-2] [PMID: 34241782]

[25]
Abate SM, Ahmed Ali S, Mantfardo B, Basu B. Rate of intensive care unit admission and outcomes among patients with coronavirus: A systematic review and meta-analysis. PLoS One  2020; 15(7): e0235653.
 [http://dx.doi.org/10.1371/journal.pone.0235653] [PMID: 32649661]

[26]
French G, Hulse M, Nguyen D, et al. Impact of hospital strain on excess deaths during the COVID-19 Pandemic — United States, July 2020–July 2021. MMWR Morb Mortal Wkly Rep  2021; 70(46): 1613-6.
 [http://dx.doi.org/10.15585/mmwr.mm7046a5] [PMID: 34793414]

[27]
Mohammed I, Nauman A, Paul P, et al. The efficacy and effectiveness of the COVID-19 vaccines in reducing infection, severity, hospitalization, and mortality: A systematic review. Hum Vaccin Immunother  2022; 18(1): 2027160.
 [http://dx.doi.org/10.1080/21645515.2022.2027160]

[28]
Al Kaabi N, Oulhaj A, Ganesan S, Al Hosani FI, Najim O, Ibrahim H. Effectiveness of BBIBP-CorV vaccine against severe outcomes of COVID-19 in Abu Dhabi, United Arab Emirates. Nat Commun  2022; 13(1): 1-9.

[29]
Office for National Statistics. Deaths involving COVID-19 by vaccination status, England - Office for National Statistics. 

[30]
Monge S, Olmedo C, Alejos B, Lapeña MF, Sierra MJ, Limia A. Direct and indirect eff ectiveness of mrna vaccination against severe acute respiratory syndrome coronavirus 2 in long-term care facilities, spain. Emerg Infect Dis  2021; 27(10): 2595-603.
 [http://dx.doi.org/10.3201/eid2710.211184] [PMID: 34314670]

[31]
Hitchings MDT, Ranzani OT, Torres MSS, et al. Effectiveness of CoronaVac in the setting of high SARS-CoV-2 P.1 variant transmission in Brazil: A test-negative case-control study. medRxiv 2021.

[32]
Dagan N, Barda N, Kepten E, et al. BNT162b2 mRNA COVID-19 vaccine in a nationwide mass vaccination setting. N Engl J Med  2021; 384(15): 1412-23. Preprint.
 [http://dx.doi.org/10.1056/NEJMoa2101765] [PMID: 33626250]

[33]
Björk J, Inghammar M, Moghaddassi M, Rasmussen M, Malmqvist U, Kahn F. Effectiveness of the BNT162b2 vaccine in preventing COVID-19 in the working age population – first results from a cohort study in Southern Sweden. medRxiv  2021; 2021.04.20.21254636.
 [http://dx.doi.org/10.1101/2021.04.20.21254636]

[34]
Mor V, Gutman R, Yang X, et al. Short-term impact of nursing home SARS-CoV -2 vaccinations on new infections, hospitalizations, and deaths. J Am Geriatr Soc  2021; 69(8): 2063-9.
 [http://dx.doi.org/10.1111/jgs.17176] [PMID: 33861873]

[35]
Levin EG, Lustig Y, Cohen C, et al. Waning immune humoral response to BNT162b2 COVID-19 vaccine over 6 months. N Engl J Med  2021; 385(24): e84.
 [http://dx.doi.org/10.1056/NEJMoa2114583] [PMID: 34614326]

[36]
Jeewandara C, Aberathna IS, Pushpakumara PD, et al. Persistence of antibody and T cell responses to the Sinopharm/BBIBP-CorV vaccine in Sri Lankan individuals. medRxiv  2021; 21265030.
 [http://dx.doi.org/10.1101/2021.10.14.21265030]

[37]
Chemaitelly H, Tang P, Hasan MR. Waning of BNT162b2 Vaccine Protection against SARS-CoV-2 Infection in Qatar. N Engl J Med  2021; 385(24): e83.
 [http://dx.doi.org/10.1056/NEJMoa2114114] [PMID: 34614327]

[38]
Novel Coronavirus (COVID-19): Information on UAE Response | UAE Embassy in Washington, DC.  Available from: https://www.uae-embassy.org/discover-uae/traveling-in-the-uae/uae-response-to-COVID-19

[39]
Ba A, Changed VOI, Added VOC, Ba A, Replaced O. Changes to list of SARS-CoV-2 variants of concern, variants of interest, and variants under monitoring. Eur Cent Dis Prev Control 2022.

[40]
Moore JP, Offit PA. SARS-CoV-2 vaccines and the growing threat of viral variants. JAMA  2021; 325(9): 821-2.
 [http://dx.doi.org/10.1001/jama.2021.1114] [PMID: 33507218]

[41]
Dagan N, Barda N, Biron-Shental T. Effectiveness of the BNT162b2 mRNA COVID-19 vaccine in pregnancy. Nat Med  2021; 27(10): 1693-5.
 [http://dx.doi.org/10.1038/s41591-021-01490-8] [PMID: 34493859]

[42]
Al Kaabi N, Oulhaj A, Al Hosani FI, et al. The incidence of COVID-19 infection following emergency use authorization of BBIBP-CORV inactivated vaccine in frontline workers in the United Arab Emirates. Sci Rep  2022; 12(1): 490.
 [http://dx.doi.org/10.1038/s41598-021-04244-1] [PMID: 35017530]

[43]
Zhang Y, Belayachi J, Yang Y. Real-world study of the effectiveness of BBIBP-CorV (Sinopharm) COVID-19 vaccine in the Kingdom of Morocco. medRxiv  2022; 2022.04.23.22274112.

[44]
Al Kaabi N, Zhang Y, Xia S. Effect of 2 inactivated SARS-CoV-2 vaccines on symptomatic COVID-19 infection in adults. JAMA  2021; 326(1): 35-45.
 [http://dx.doi.org/10.1001/jama.2021.8565] [PMID: 34037666]

[45]
Rogliani P, Chetta A, Cazzola M, Calzetta L. Sars-cov-2 neutralizing antibodies: A network meta-analysis across vaccines. Vaccines  2021; 9(3): 227.

[46]
Wang H, Zhang Y, Huang B. Development of an inactivated vaccine candidate, BBIBP-CorV, with potent protection against SARS-CoV-2. Cell  2020; 182(3): 713-721.e9.
 [http://dx.doi.org/10.1016/j.cell.2020.06.008] [PMID: 32778225]

[47]
Mallapaty S. China’s COVID vaccines have been crucial — now immunity is waning. Nature  2021; 598(7881): 398-9.
 [http://dx.doi.org/10.1038/d41586-021-02796-w] [PMID: 34650240]

[48]
Holt SG, Mahmoud S, Ahmed W, et al. An analysis of antibody responses and clinical sequalae of the Sinopharm HB02 COVID19 vaccine in dialysis patients in the United Arab Emirates. Nephrology  2022; 27(3): 260-8.
 [http://dx.doi.org/10.1111/nep.13980] [PMID: 34569677]