The added effect of non-pharmaceutical interventions and lifestyle behaviors on vaccine effectiveness against severe COVID-19 in Chile: A matched case-double control study

Cinthya Urquidi; Emilio Santelices; Anne J. Lagomarcino; María Teresa Valenzuela; Nicolás Larrañaga; Emilio Gonzalez; Axel Pavez; Amanda Wosiack; Marcela Maturana; Paulina Moller; Juan Pablo Torres; Sergio Muñoz; Miguel O'Ryan G

doi:10.1016/j.vaccine.2023.03.060

The added effect of non-pharmaceutical interventions and lifestyle behaviors on vaccine effectiveness against severe COVID-19 in Chile: A matched case-double control study

Cinthya Urquidi, Emilio Santelices, Anne J. Lagomarcino, María Teresa Valenzuela, Nicolás Larrañaga, Emilio Gonzalez, Axel Pavez, Amanda Wosiack, Marcela Maturana, Paulina Moller, Juan Pablo Torres, Sergio Muñoz, Miguel O'Ryan G^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: World Health Organization approved vaccines have demonstrated relatively high protection against moderate to severe COVID-19. Prospective vaccine effectiveness (VE) designs with first-hand data and population-based controls are nevertheless rare. Neighborhood compared to hospitalized controls, may differ in compliance to non-pharmacuetical interventions (NPI) compliance, which may influence VE results in real-world settings. We aimed to determine VE against COVID-19 intensive-care-unit (ICU) admission using hospital and community-matched controls in a prospective design. Methods: We conducted a multicenter, observational study of matched cases and controls (1:3) in adults ≧18 years of age from May to July 2021. For each case, a hospital control and two community controls were matched by age, gender, and hospital admission date or neighborhood of residence. Conditional logistic regression models were built, including interaction terms between NPIs, lifestyle behaviors, and vaccination status; the model's β coefficients represent the added effect these terms had on COVID-19 VE. Results: Cases and controls differed in several factors including education level, obesity prevalence, and behaviors such as compliance with routine vaccinations, use of facemasks, and routine handwashing. VE was 98·2% for full primary vaccination and 85·6% for partial vaccination when compared to community controls, and somewhat lower, albeit not significantly, compared to hospital controls. A significant added effect to vaccination in reducing COVID-19 ICU admission was regular facemask use and VE was higher among individuals non-compliant with the national vaccine program, and/or tonroutine medical visits during the prior year. Conclusion: VE against COVID-19 ICU admission in this stringent prospective case-double control study reached 98% two weeks after full primary vaccination, confirming the high effectiveness provided by earlier studies. Face mask use and hand washing were independent protective factors, the former adding additional benefit to VE. VE was significantly higher in subjects with increased risk behaviors.

Original language	English
Journal	Vaccine
DOIs	https://doi.org/10.1016/j.vaccine.2023.03.060
State	Published - 2023

Bibliographical note

Funding Information:
We would like to thank the following medical students from the Universidad de los Andes and the Universidad de Chile for their work recruiting and interviewing study participants: Almendra Fernanda Gómez Berrios, Diego Ignacio Muñoz Salamanca, Ximena Aguilera, Andrés Ignacio Rojas Liberona, Nayareth de los Angeles Negrón Monr, Javiera Carstens Taub, Sofia Barros Correia Mendes, Cristóbal Edwards Latorre, Macarena Shejade Sirhan, Martín Eduardo Tolosa Titichoca, and Álvaro Kompatzki. We would like to thank Manuel Diaz and Sebastian Sepulveda from the Servicio de Salud Metropolitano Central for their support in georeferencing the residences of cases and their possible community controls. Finally, we would like to express our gratitude to the Servicio de Salud Metropolitano Central, the municipal corporations of Maipu and Santiago, Hospital de Urgencia Asistencia Pública, and Hospital El Carmen Dr. Luis Valentín Ferrada for their support of the study. The study received funding support from the Confederación de la Producción y el Comercio (CPC) to help support staff. The study database is available from the authors upon reasonable request and with the permission of Cinthya Urquidi, the first author of the study.

Publisher Copyright:
© 2023 Elsevier Ltd

Keywords

COVID-19
Non-pharmacological intervention
Risk factors
SARS-Cov-2
Vaccine effectiveness

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.vaccine.2023.03.060

Cite this

Urquidi, C., Santelices, E., Lagomarcino, A. J., Teresa Valenzuela, M., Larrañaga, N., Gonzalez, E., Pavez, A., Wosiack, A., Maturana, M., Moller, P., Pablo Torres, J., Muñoz, S., & O'Ryan G, M. (2023). The added effect of non-pharmaceutical interventions and lifestyle behaviors on vaccine effectiveness against severe COVID-19 in Chile: A matched case-double control study. Vaccine. https://doi.org/10.1016/j.vaccine.2023.03.060

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title = "The added effect of non-pharmaceutical interventions and lifestyle behaviors on vaccine effectiveness against severe COVID-19 in Chile: A matched case-double control study",

abstract = "Background: World Health Organization approved vaccines have demonstrated relatively high protection against moderate to severe COVID-19. Prospective vaccine effectiveness (VE) designs with first-hand data and population-based controls are nevertheless rare. Neighborhood compared to hospitalized controls, may differ in compliance to non-pharmacuetical interventions (NPI) compliance, which may influence VE results in real-world settings. We aimed to determine VE against COVID-19 intensive-care-unit (ICU) admission using hospital and community-matched controls in a prospective design. Methods: We conducted a multicenter, observational study of matched cases and controls (1:3) in adults ≧18 years of age from May to July 2021. For each case, a hospital control and two community controls were matched by age, gender, and hospital admission date or neighborhood of residence. Conditional logistic regression models were built, including interaction terms between NPIs, lifestyle behaviors, and vaccination status; the model's β coefficients represent the added effect these terms had on COVID-19 VE. Results: Cases and controls differed in several factors including education level, obesity prevalence, and behaviors such as compliance with routine vaccinations, use of facemasks, and routine handwashing. VE was 98·2% for full primary vaccination and 85·6% for partial vaccination when compared to community controls, and somewhat lower, albeit not significantly, compared to hospital controls. A significant added effect to vaccination in reducing COVID-19 ICU admission was regular facemask use and VE was higher among individuals non-compliant with the national vaccine program, and/or tonroutine medical visits during the prior year. Conclusion: VE against COVID-19 ICU admission in this stringent prospective case-double control study reached 98% two weeks after full primary vaccination, confirming the high effectiveness provided by earlier studies. Face mask use and hand washing were independent protective factors, the former adding additional benefit to VE. VE was significantly higher in subjects with increased risk behaviors.",

keywords = "COVID-19, Non-pharmacological intervention, Risk factors, SARS-Cov-2, Vaccine effectiveness",

author = "Cinthya Urquidi and Emilio Santelices and Lagomarcino, {Anne J.} and {Teresa Valenzuela}, Mar{\'i}a and Nicol{\'a}s Larra{\~n}aga and Emilio Gonzalez and Axel Pavez and Amanda Wosiack and Marcela Maturana and Paulina Moller and {Pablo Torres}, Juan and Sergio Mu{\~n}oz and {O'Ryan G}, Miguel",

note = "Funding Information: We would like to thank the following medical students from the Universidad de los Andes and the Universidad de Chile for their work recruiting and interviewing study participants: Almendra Fernanda G{\'o}mez Berrios, Diego Ignacio Mu{\~n}oz Salamanca, Ximena Aguilera, Andr{\'e}s Ignacio Rojas Liberona, Nayareth de los Angeles Negr{\'o}n Monr, Javiera Carstens Taub, Sofia Barros Correia Mendes, Crist{\'o}bal Edwards Latorre, Macarena Shejade Sirhan, Mart{\'i}n Eduardo Tolosa Titichoca, and {\'A}lvaro Kompatzki. We would like to thank Manuel Diaz and Sebastian Sepulveda from the Servicio de Salud Metropolitano Central for their support in georeferencing the residences of cases and their possible community controls. Finally, we would like to express our gratitude to the Servicio de Salud Metropolitano Central, the municipal corporations of Maipu and Santiago, Hospital de Urgencia Asistencia P{\'u}blica, and Hospital El Carmen Dr. Luis Valent{\'i}n Ferrada for their support of the study. The study received funding support from the Confederaci{\'o}n de la Producci{\'o}n y el Comercio (CPC) to help support staff. The study database is available from the authors upon reasonable request and with the permission of Cinthya Urquidi, the first author of the study. Publisher Copyright: {\textcopyright} 2023 Elsevier Ltd",

year = "2023",

doi = "10.1016/j.vaccine.2023.03.060",

language = "English",

journal = "Vaccine",

issn = "0264-410X",

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Urquidi, C, Santelices, E, Lagomarcino, AJ, Teresa Valenzuela, M, Larrañaga, N, Gonzalez, E, Pavez, A, Wosiack, A, Maturana, M, Moller, P, Pablo Torres, J, Muñoz, S & O'Ryan G, M 2023, 'The added effect of non-pharmaceutical interventions and lifestyle behaviors on vaccine effectiveness against severe COVID-19 in Chile: A matched case-double control study', Vaccine. https://doi.org/10.1016/j.vaccine.2023.03.060

TY - JOUR

T1 - The added effect of non-pharmaceutical interventions and lifestyle behaviors on vaccine effectiveness against severe COVID-19 in Chile

T2 - A matched case-double control study

AU - Urquidi, Cinthya

AU - Santelices, Emilio

AU - Lagomarcino, Anne J.

AU - Teresa Valenzuela, María

AU - Larrañaga, Nicolás

AU - Gonzalez, Emilio

AU - Pavez, Axel

AU - Wosiack, Amanda

AU - Maturana, Marcela

AU - Moller, Paulina

AU - Pablo Torres, Juan

AU - Muñoz, Sergio

AU - O'Ryan G, Miguel

N1 - Funding Information: We would like to thank the following medical students from the Universidad de los Andes and the Universidad de Chile for their work recruiting and interviewing study participants: Almendra Fernanda Gómez Berrios, Diego Ignacio Muñoz Salamanca, Ximena Aguilera, Andrés Ignacio Rojas Liberona, Nayareth de los Angeles Negrón Monr, Javiera Carstens Taub, Sofia Barros Correia Mendes, Cristóbal Edwards Latorre, Macarena Shejade Sirhan, Martín Eduardo Tolosa Titichoca, and Álvaro Kompatzki. We would like to thank Manuel Diaz and Sebastian Sepulveda from the Servicio de Salud Metropolitano Central for their support in georeferencing the residences of cases and their possible community controls. Finally, we would like to express our gratitude to the Servicio de Salud Metropolitano Central, the municipal corporations of Maipu and Santiago, Hospital de Urgencia Asistencia Pública, and Hospital El Carmen Dr. Luis Valentín Ferrada for their support of the study. The study received funding support from the Confederación de la Producción y el Comercio (CPC) to help support staff. The study database is available from the authors upon reasonable request and with the permission of Cinthya Urquidi, the first author of the study. Publisher Copyright: © 2023 Elsevier Ltd

PY - 2023

Y1 - 2023

N2 - Background: World Health Organization approved vaccines have demonstrated relatively high protection against moderate to severe COVID-19. Prospective vaccine effectiveness (VE) designs with first-hand data and population-based controls are nevertheless rare. Neighborhood compared to hospitalized controls, may differ in compliance to non-pharmacuetical interventions (NPI) compliance, which may influence VE results in real-world settings. We aimed to determine VE against COVID-19 intensive-care-unit (ICU) admission using hospital and community-matched controls in a prospective design. Methods: We conducted a multicenter, observational study of matched cases and controls (1:3) in adults ≧18 years of age from May to July 2021. For each case, a hospital control and two community controls were matched by age, gender, and hospital admission date or neighborhood of residence. Conditional logistic regression models were built, including interaction terms between NPIs, lifestyle behaviors, and vaccination status; the model's β coefficients represent the added effect these terms had on COVID-19 VE. Results: Cases and controls differed in several factors including education level, obesity prevalence, and behaviors such as compliance with routine vaccinations, use of facemasks, and routine handwashing. VE was 98·2% for full primary vaccination and 85·6% for partial vaccination when compared to community controls, and somewhat lower, albeit not significantly, compared to hospital controls. A significant added effect to vaccination in reducing COVID-19 ICU admission was regular facemask use and VE was higher among individuals non-compliant with the national vaccine program, and/or tonroutine medical visits during the prior year. Conclusion: VE against COVID-19 ICU admission in this stringent prospective case-double control study reached 98% two weeks after full primary vaccination, confirming the high effectiveness provided by earlier studies. Face mask use and hand washing were independent protective factors, the former adding additional benefit to VE. VE was significantly higher in subjects with increased risk behaviors.

AB - Background: World Health Organization approved vaccines have demonstrated relatively high protection against moderate to severe COVID-19. Prospective vaccine effectiveness (VE) designs with first-hand data and population-based controls are nevertheless rare. Neighborhood compared to hospitalized controls, may differ in compliance to non-pharmacuetical interventions (NPI) compliance, which may influence VE results in real-world settings. We aimed to determine VE against COVID-19 intensive-care-unit (ICU) admission using hospital and community-matched controls in a prospective design. Methods: We conducted a multicenter, observational study of matched cases and controls (1:3) in adults ≧18 years of age from May to July 2021. For each case, a hospital control and two community controls were matched by age, gender, and hospital admission date or neighborhood of residence. Conditional logistic regression models were built, including interaction terms between NPIs, lifestyle behaviors, and vaccination status; the model's β coefficients represent the added effect these terms had on COVID-19 VE. Results: Cases and controls differed in several factors including education level, obesity prevalence, and behaviors such as compliance with routine vaccinations, use of facemasks, and routine handwashing. VE was 98·2% for full primary vaccination and 85·6% for partial vaccination when compared to community controls, and somewhat lower, albeit not significantly, compared to hospital controls. A significant added effect to vaccination in reducing COVID-19 ICU admission was regular facemask use and VE was higher among individuals non-compliant with the national vaccine program, and/or tonroutine medical visits during the prior year. Conclusion: VE against COVID-19 ICU admission in this stringent prospective case-double control study reached 98% two weeks after full primary vaccination, confirming the high effectiveness provided by earlier studies. Face mask use and hand washing were independent protective factors, the former adding additional benefit to VE. VE was significantly higher in subjects with increased risk behaviors.

KW - COVID-19

KW - Non-pharmacological intervention

KW - Risk factors

KW - SARS-Cov-2

KW - Vaccine effectiveness

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DO - 10.1016/j.vaccine.2023.03.060

M3 - Article

AN - SCOPUS:85151754841

SN - 0264-410X

JO - Vaccine

JF - Vaccine

ER -

The added effect of non-pharmaceutical interventions and lifestyle behaviors on vaccine effectiveness against severe COVID-19 in Chile: A matched case-double control study

Abstract

Bibliographical note

Keywords

UN SDGs

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