Determinants of severe COVID-19 in vaccinated adults: a study from southern Brazil (2021-2023)

Despite the effectiveness of vaccination in preventing severe COVID-19, some individuals remain at risk. The study goal was to determine risk factors for COVID-19 requiring hospital admission. A case-control study was conducted in Porto Alegre, Brazil. Vaccinated adults with confirmed SARS-CoV-2 infection from February 2021 to March 2023 were eligible. Hospitalized patients (cases) and outpatients with non-severe infections (control group) were time-matched in a 1:1 ratio. Moreover, we followed hospitalized patients (cases) to evaluate factors related to 30-day mortality and/or ventilation support. We included 364 patients: 182 cases and 182 controls. Age > 60 years (odds ratio [OR] 3.98 [95% confidence interval{CI} 2.23-7.19]), male sex (OR 3.07 [95%CI 1.78-5.40]), diabetes mellitus (OR 4.61 [95% CI 2.08-11.08]), cardiovascular disease (OR 4.07 [95%CI 1.73-10.64]), lung disease (OR 3.06 [95%CI 1.39-6.94]), obesity (OR 3.39 [95%CI 1.29-9.73]), and previous infection (OR 0.19 [95%CI 0.06-0.51]) were independently related to COVID-19 hospital admission. In the arm of hospitalized patients, the number of vaccine doses (OR 0.53 [95%CI 0.39-0.73]) was a protective factor against 30-day mortality and/or ventilation support, whereas obesity (OR1.62 [95%CI 1.19-2.20]) was a risk factor. Health policies should consider focusing on these risk populations for targeted interventions, such as additional boosters, early treatment and prophylaxis.