Imunização contra covid-19 e mortalidade em pacientes hospitalizados: coorte retrospectiva
DOI:
https://doi.org/10.11606/s1518-8787.2024058005476Palavras-chave:
Covid-19, Estudos de Coorte, Estudos Observacional, Mortalidade, Vacinas contra Covid-19Resumo
OBJETIVO: Avaliar a efetividade das vacinas desenvolvidas contra a covid-19 na redução da mortalidade em pessoas internadas com síndrome respiratória aguda grave (SRAG) causada pelo SARS-CoV-2.
MÉTODOS: Trata-se de uma coorte retrospectiva que avaliou fatores de riscos e a efetividade do esquema vacinal com duas doses na redução da mortalidade de pessoas internadas por covid-19 no estado da Paraíba entre fevereiro e novembro de 2021. As variáveis explicativas foram situação vacinal, presença de comorbidades, características socioeconômicas e demográficas. Foram realizadas análises descritivas e regressão logística bivariada e multivariável. RESULTADOS: A maior parte das internações e óbitos ocorreram até maio de 2021. O percentual de pacientes com esquema vacinal completo foi similar entre pacientes internados em hospitais públicos e privados e superior em residentes de municípios com menor desenvolvimento. A análise multivariável demonstrou que mulheres (OR = 0,896; IC95% 0,830–0,967) e pessoas internadas em hospitais privados (OR = 0,756; IC95% 0,679–0,842) apresentaram menor chance de morte. A presença de alguma comorbidade (OR = 1,627; IC95% 1,500–1,765) e idade ≥ 80 anos (OR = 7,426; IC95% 6,309–8,741) foram fatores de risco de óbito. Pacientes com esquema vacinal completo no momento da internação apresentaram uma chance 41,7% menor de morte (OR = 0,583; IC95% 0,501–0,679) por covid-19 na análise ajustada, quando comparados com pacientes não vacinados.
CONCLUSÕES: O estudo revela que a imunização foi efetiva na redução da chance de óbito por covid-19. Os resultados sugerem que uma maior cobertura vacinal no primeiro semestre de 2021 evitaria milhares de mortes no país.
Referências
World Health Organization. Weekly epidemiological update on COVID-19. Jan 2023 [citado 2 mar 2023]. Disponível em: https://www.who.int/publications/m/item/weeklyepidemiological-update-on-covid-19---4-january-2023
Ministério da Saúde (BR). Painel Coronavírus. 2023 [citado 2 mar 2023]. Disponível em: https://covid.saude.gov.br/
Victora PC, Castro PM, Gurzenda S, Medeiros AC, França GV, Barros PA. Estimating the early impact of vaccination against COVID-19 on deaths among elderly people in Brazil: analyses of routinely-collected data on vaccine coverage and mortality. EClinicalMedicine.
Aug;38:101036. https://doi.org/10.1016/j.eclinm.2021.101036
Grapsa E, Adamos G, Andrianopoulos I, Tsolaki V, Giannakoulis VG, Karavidas N, et al. Association between vaccination status and mortality among intubated patients with COVID-19-Related Acute Respiratory Distress Syndrome. JAMA Netw Open. 2022 Oct;5(10):e2235219. https://doi.org/10.1001/jamanetworkopen.2022.35219
Cook TM, Roberts JV. Impact of vaccination by priority group on UK deaths, hospital admissions and intensive care admissions from COVID-19. Anaesthesia. 2021 May;76(5):608-16. https://doi.org/10.1111/anae.15442
Chowdhury R, Luhar S, Khan N, Choudhury SR, Matin I, Franco OH. Long-term strategies to control COVID-19 in low and middle-income countries: an options overview of communitybased, non-pharmacological interventions. Eur J Epidemiol. 2020 Aug;35(8):743-8.
https://doi.org/10.1007/s10654-020-00660-1
Cowling BJ, Ali ST, Ng TW, Tsang TK, Li JC, Fong MW, et al. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health. 2020 May;5(5):e279-88.
https://doi.org/10.1016/S2468-2667(20)30090-6
Fernandez M. Uso de evidências científicas para a tomada de decisão diante da pandemia de covid-19: uma aproximação à atuação do Ministério da Saúde In: Koga NM, Palotti PLM, Mello J, Pinheiro MMS. Políticas públicas e usos de evidências no Brasil: conceitos, métodos, contextos e práticas. Brasília, DF: Instituto de Pesquisa Econômica Aplicada; 2022. Cap. 20.
Lurie N, Saville M, Hatchett R, Halton J. Developing Covid-19 Vaccines at Pandemic Speed. N Engl J Med. 2020 May;382(21):1969-73. https://doi.org/10.1056/NEJMp2005630
Lima EJ, Almeida AM, Kfouri RA. Vacinas para COVID-19: o estado da arte. Rev Bras Saúde Mater Infant. 2021 Feb;21 Suppl 1:13-9. https://doi.org/10.1590/1806-9304202100s100002
Ministério da Saúde (BR). Plano nacional de operacionalização da vacinação contra a COVID-19. Brasília, DF: Ministério da Saúde; ano [citado 20 nov 2022]. Disponível em: https://www.gov.br/saude/pt-br/coronavirus/publicacoes-tecnicas/guias-e-planos/plano-nacionalde-vacinacao-covid-19/view
Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med. 2020 Dec;383(27):2603-15. https://doi.org/10.1056/NEJMoa2034577
Voysey M, Clemens SA, Madhi SA, Weckx LY, Folegatti PM, Aley PK, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet.
Jan;397(10269):99-111. https://doi.org/10.1016/S0140-6736(20)32661-1
Stephenson KE, Le Gars M, Sadoff J, Groot AM, Heerwegh D, Truyers C, et al. Immunogenicity of the Ad26.COV2.S Vaccine for COVID-19. JAMA. 2021 Apr;325(15):1535-44. https://doi.org/10.1001/jama.2021.3645
Lopez Bernal J, Andrews N, Gower C, Robertson C, Stowe J, Tessier E, et al. Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study. BMJ. 2021 May;373(1088):n1088. https://doi.org/10.1136/bmj.n1088
Haas EJ, Angulo FJ, McLaughlin JM, Anis E, Singer SR, Khan F, et al. Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel:
an observational study using national surveillance data. Lancet. 2021 May;397(10287):1819-29. https://doi.org/10.1016/S0140-6736(21)00947-8
Jara A, Undurraga EA, González C, Paredes F, Fontecilla T, Jara G, et al. Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile. N Engl J Med. 2021 Sep;385(10):875-84. https://doi.org/10.1056/NEJMoa2107715
Giovanella L, Bousquat A, Schenkman S, Almeida PF, Sardinha LM, Vieira ML. The Family Health Strategy coverage in Brazil: what reveal the 2013 and 2019 National Health Surveys. Cien Saude Colet. 2021 Jun;26 suppl 1:2543-56. https://doi.org/10.1590/1413-81232021266.1.43952020
Ministério da Saúde (BR). Datasus. Leitos de internação. Brasília, DF; 2023 [citado 2 fev 2023]. Disponível em: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?cnes/cnv/leiintbr.def
Wickham, Averick M, Bryan J, Chang W, McGowan L, François R, et al. Welcome to the tidyverse. J Open Source Softw. 2019;4(43):1686. https://doi.org/10.21105/joss.01686
United Nations. Human Development Reports. Technical notes: calculating the human development indices; graphical presentation. 2021-2022 [citado 3 jan 2023]. Disponível em: https://hdr.undp.org/sites/default/files/2021-22_HDR/hdr2021-22_technical_notes.pdf
Governo da Paraíba. Atualização Covid-19, 21/05/2021. João Pessoa; 2021 [citado 3 jan 2023].
Libotte GB, Anjos L, Almeida RCC, Malta SMC, Medronho RA. Impacts of a delayed and slow-paced vaccination on cases and deaths during the COVID-19 pandemic: a modelling study. J R Soc Interface. 2022 May;19(190):20220275. https://doi.org/10.1098/rsif.2022.0275
Ranzani OT, Bastos LS, Gelli JG, Marchesi JF, Baião F, Hamacher S, et al. Characterisation of the first 250,000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data. Lancet Respir Med. 2021 Apr;9(4):407-18. https://doi.org/10.1016/S2213-2600(20)30560-9
Dessie ZG, Zewotir T. Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients. BMC Infect Dis. 2021 Aug;21(1):855. https://doi.org/10.1186/s12879-021-06536-3
Izcovich A, Ragusa MA, Tortosa F, Lavena Marzio MA, Agnoletti C, Bengolea A, et al. Prognostic factors for severity and mortality in patients infected with COVID-19: a systematic review. PLoS One. 2020 Nov;15(11):e0241955. https://doi.org/10.1371/journal.pone.0241955
Instituto Brasileiro de Geografia e Estatística. Desigualdades sociais por cor ou raça no Brasil. Rio de Janeiro; 2023 [citado 3 jan 2023]. Disponível em: https://www.ibge.gov.br/estatisticas/sociais/populacao/25844-desigualdades-sociais-por-cor-ou-raca.
html?edicao=35440&t=resultados
Rentsch CT, Kidwai-Khan F, Tate JP, Park LS, King JT Jr, Skanderson M, et al. Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: a nationwide cohort study. PLoS Med. 2020 Sep;17(9):e1003379. https://doi.org/10.1371/journal.pmed.1003379
Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and mortality among black patients and white patients with Covid-19. N Engl J Med. 2020 Jun;382(26):2534-43. https://doi.org/10.1056/NEJMsa2011686
McGowan VJ, Bambra C. COVID-19 mortality and deprivation: pandemic, syndemic, and endemic health inequalities. Lancet Public Health. 2022 Nov;7(11):e966-75. https://doi.org/10.1016/S2468-2667(22)00223-7
Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med. 2021 Feb;384(8):693-704. https://doi.org/10.1056/NEJMoa2021436
Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of Covid-19: final report. N Engl J Med. 2020 Nov;383(19):1813-26. https://doi.org/10.1056/NEJMoa2007764
Ader F, Bouscambert-Duchamp M, Hites M, Peiffer-Smadja N, Poissy J, Belhadi D, et al. Remdesivir plus standard of care versus standard of care alone for the treatment of patients admitted to hospital with COVID-19 (DisCoVeRy): a phase 3, randomised, controlled, open-label trial. Lancet Infect Dis. 2022 Feb;22(2):209-21. https://doi.org/10.1016/S1473-3099(21)00485-0
Cerqueira-Silva T, Andrews JR, Boaventura VS, Ranzani OT, Oliveira VA, Paixão ES, et al. Effectiveness of CoronaVac, ChAdOx1 nCoV-19, BNT162b2, and Ad26.COV2.S among individuals with previous SARS-CoV-2 infection in Brazil: a test-negative, case-control study.
Lancet Infect Dis. 2022 Jun;22(6):791-801. https://doi.org/10.1016/S1473-3099(22)00140-2
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2024 Michelle Fernandez, Alexandre Medeiros de Figueiredo, Adriano Massuda, Agostinho Hermes de Medeiros Neto, Marcus Carvalho
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
