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. 2022 Sep 11;9(9):ofac469.
doi: 10.1093/ofid/ofac469. eCollection 2022 Sep.

COVID-19 Vaccine Effectiveness Against Progression to In-Hospital Mortality in Zambia, 2021-2022

Duncan Chanda  1   2 , Jonas Z Hines  3 , Megumi Itoh  3 , Sombo Fwoloshi  1   2   4 , Peter A Minchella  3 , Khozya D Zyambo  1   2 , Suilanji Sivile  1   2 , Davies Kampamba  2 , Bob Chirwa  2 , Raphael Chanda  1 , Katongo Mutengo  5 , Mazinga F Kayembe  6 , Webster Chewe  1 , Peter Chipimo  7 , Aggrey Mweemba  8 , Simon Agolory  3 , Lloyd B Mulenga  2
Affiliations

COVID-19 Vaccine Effectiveness Against Progression to In-Hospital Mortality in Zambia, 2021-2022

Duncan Chanda et al. Open Forum Infect Dis. .

Abstract

Background: Coronavirus disease 2019 (COVID-19) vaccines are highly effective for reducing severe disease and mortality. However, vaccine effectiveness data are limited from Sub-Saharan Africa. We report COVID-19 vaccine effectiveness against progression to in-hospital mortality in Zambia.

Methods: We conducted a retrospective cohort study among admitted patients at 8 COVID-19 treatment centers across Zambia during April 2021 through March 2022, when the Delta and Omicron variants were circulating. Patient demographic and clinical information including vaccination status and hospitalization outcome (discharged or died) were collected. Multivariable logistic regression was used to assess the odds of in-hospital mortality by vaccination status, adjusted for age, sex, number of comorbid conditions, disease severity, hospitalization month, and COVID-19 treatment center. Vaccine effectiveness of ≥1 vaccine dose was calculated from the adjusted odds ratio.

Results: Among 1653 patients with data on their vaccination status and hospitalization outcome, 365 (22.1%) died. Overall, 236 (14.3%) patients had received ≥1 vaccine dose before hospital admission. Of the patients who had received ≥1 vaccine dose, 22 (9.3%) died compared with 343 (24.2%) among unvaccinated patients (P < .01). The median time since receipt of a first vaccine dose (interquartile range) was 52.5 (28-107) days. Vaccine effectiveness for progression to in-hospital mortality among hospitalized patients was 64.8% (95% CI, 42.3%-79.4%).

Conclusions: Among patients admitted to COVID-19 treatment centers in Zambia, COVID-19 vaccination was associated with lower progression to in-hospital mortality. These data are consistent with evidence from other countries demonstrating the benefit of COVID-19 vaccination against severe complications. Vaccination is a critical tool for reducing the consequences of COVID-19 in Zambia.

Keywords: Africa; COVID-19 vaccines; COVID-19/mortality; SARS-CoV-2; Zambia; vaccine efficacy.

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Conflict of interest statement

Potential conflicts of interest. The authors: no reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Sample size flow diagram for analysis of COVID-19 vaccine effectiveness against in-hospital mortality in Zambia, 2021–2022. Abbreviation: COVID-19, coronavirus disease 2019.
See this image and copyright information in PMC

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