Factors associated with COVID-19 in-hospital death and COVID-19 vaccine effectiveness against COVID-19 hospitalization in the Philippines during pre-omicron and omicron period: A case-control study (MOTIVATE-P study)

Abstract

COVID-19 vaccine effectiveness (VE) studies are limited in low- and middle-income countries. A case-control study was conducted among COVID-19 and other pneumonia patients admitted to a hospital in the Philippines during the pre-Omicron and Omicron periods. To elucidate factors associated with in-hospital death, 1782 COVID-19 patients were assessed. To estimate absolute VE for various severe outcomes, 1059 patients were assessed (869 [82.1%] COVID-19 cases; 190 [17.9%] controls). Factors associated with in-hospital death included older age, tuberculosis (adjusted odds ratio [aOR] 2.45 [95% confidence interval {95% CI} 1.69-3.57]), HIV (aOR 3.30 [95% CI 2.03-5.37]), and current smokers (aOR 2.65 [95% CI 1.72-4.10]). Pre-Omicron, the primary series provided high protection within a median of 2 months (hospitalization: 85.4% [95% CI 35.9-96.7%]; oxygen requirement: 91.0% [95% CI 49.4-98.4%]; invasive mechanical ventilation (IMV): 97.0% [95% CI 65.7-99.7%]; death: 96.5% [95% CI 67.1-99.6%]). During Omicron, the primary series provided moderate-high protection within a median of 6-9 months (hospitalization: 70.2% [95% CI 27.0-87.8%]; oxygen requirement: 71.4% [95% CI 29.3-88.4%]; IMV: 72.7% [95% CI -11.6-93.3%]; death: 58.9% [95% CI -82.8-90.8%]). Primary series VE against severe COVID-19 outcomes was consistently high for both pre-Omicron and Omicron in a setting where approximately half of the vaccinees received inactivated vaccines.

Keywords: Philippines; SARS-CoV-2 variants; coronavirus disease (COVID-19); epidemiological study; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); vaccine effectiveness.

Figure 1.

Epidemic curves of the number of reported COVID-19 cases and vaccine rollout in the Philippines. The data are likely underestimated due to reporting constraints, testing/reporting intensity varied substantially over time, and COVID-19 vaccination data are up to 9 March 2023. Source: Our World in Data (https://ourworldindata.org).

Figure 2.

Flow diagram of the study participants.