Background: Understanding COVID-19 vaccine effectiveness (VE) in preventing severe disease is critical to inform vaccine policy. We used the test-negative design to estimate VE against SARS-CoV-2-confirmed hospitalisation in adults ≥18 years in the eastern WHO European Region.
Methods: We included patients hospitalised for severe acute respiratory infection (SARI) at sentinel surveillance sites in Albania, Georgia, Kyrgyzstan, North Macedonia, Serbia, and in Kosovo. We collected demographic information, COVID-19 vaccination history, and tested respiratory samples for SARS-CoV-2 by RT-PCR. We calculated VE of any vaccine dose received within 12 months (Annual VE) as [(1 - adjusted Odds Ratio) x 100%] using a one-stage pooled analysis. The reference group included unvaccinated individuals and those who received their last vaccine >12 months before symptom onset.
Findings: During 1 January 1, 2022-November 20, 2023, of 5162 patients, 57.0% (2942) were unvaccinated, 2.5% (129) received only one dose, 26.0% (1340) received only two doses (originally considered a primary series vaccine (PS)), 13.2% (683) received three doses only, and 1.3% (68) received four doses. Most PS vaccines and boosters were BNT162b2 (46.4% (622/1340) and 64.9% (443/683), respectively) and CoronaVac (23.0% (309/1340) and 18.3% (125/683)). No patients received Ad26.COV2.S (Johnson and Johnson) vaccines. Overall, 1009/5162 (19.5%) patients were SARS-CoV-2-positive. VE was 60.1% (95% Confidence Interval (CI) 12.4-81.8) for last vaccine received 14-89 days before symptom onset, 60.0% (95% CI 32.2-76.4) for 90-179 days, 7.0% (95% CI -28.5 to 32.7) for 180-269 days, and -5.4% (95% CI -43.8 to 22.8) for 270-365 days.).
Interpretation: During nearly two years of Omicron circulation in the eastern WHO European Region, COVID-19 vaccination reduced the risk of hospitalisations by more than half for 6 months following vaccination.
Funding: This study was funded by the World Health Organization, Regional Office for Europe through a cooperative agreement with the U.S. Centers for Disease Control and Prevention.
Background: Limited studies exist on sex differences in incidence rates of psychiatric disorders across the lifespan. This study aims to analyze sex differences in the incidence rates of clinically diagnosed psychiatric disorders over the lifespan.
Methods: We conducted a nationwide register-based cohort study, including all individuals who were born in Sweden and lived in Sweden between 2003 and 2019, including 4,818,071 females and 4,837,829 males. We calculated sex- and age-specific standardized incidence rates for any and 10 major types of psychiatric disorders. Multivariable-adjusted incidence rate differences (IRDs) for diagnosed psychiatric disorders between females and males were estimated.
Findings: During a follow-up of 119,420,908 person-years, males showed a higher incidence rate of any diagnosed psychiatric disorder than females at age 5-9 (IRD = -8.93; 95% CI: -9.08 to -8.79; per 1000 person-years), whereas females showed a higher rate than males at age 15-19 (IRD = 9.33; 95% CI: 9.12-9.54) and onwards (except age 60-69). Specifically, among females, excess rates were apparent for depressive, anxiety, eating, stress-related and bipolar disorders at age 10-54, whereas among males, excess rates were pronounced for autism and attention deficit hyperactivity disorders before age 14, drug use disorders at age 15-54, and alcohol use disorders in adulthood. For schizophrenia, the male excess at age 15-49 shifted to female excess at age 60-79. The magnitude of IRDs were greater in recent years and individuals with lower socioeconomic status.
Interpretation: Knowledge about the lifespan and socioeconomic variations in the sex differences in rates of diagnosed psychiatric disorders may inform targeted screening/intervention strategies.
Funding: Vetenskapsrådet, FORTE, Karolinska Institutet Strategic Research Area in Epidemiology and Biostatistics, and Icelandic Research Fund.