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Research ArticleOriginal Article
Open Access

Impact of vaccination on morbidity and mortality in adults hospitalized with COVID-19 during the omicron wave in the Jazan Region, Saudi Arabia

Mohammed Y. Elamin, Yahya A. Maslamani, Feras A. Alsheikh, Mohsen A. Sailah, Mussab A. Samm, Ahmed M. Motanbk, Yehya M. Hejri, Anwar A. Alameer, Osama H. Khalid, Abdu A. Dahlan and Ibrahim M. Gosadi
Saudi Medical Journal February 2024, 45 (2) 179-187; DOI: https://doi.org/10.15537/smj.2024.45.2.20230530
Mohammed Y. Elamin
From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
DTM&H, MCTM
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Yahya A. Maslamani
From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
DFE, SBCM
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Feras A. Alsheikh
From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
BSPH
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Mohsen A. Sailah
From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
MSN, BSN
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Mussab A. Samm
From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
BSN
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Ahmed M. Motanbk
From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
MSN
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Yehya M. Hejri
From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
MPH
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Anwar A. Alameer
From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
SBCM, JBCM
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Osama H. Khalid
From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
MPH, MD
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Abdu A. Dahlan
From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
DFE
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Ibrahim M. Gosadi
From the Public Health Administration (Elamin, Maslamani, Alsheikh, Sailah, Hejri, Alameer, Khalid, Dahlan); from the Command and Control Center (Samm); from the Emergency Administration (Motanbk), Jazan Health Directorate, and from the Department of Family and Community Medicine (Gosadi), Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
MPH, PhD
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  • ORCID record for Ibrahim M. Gosadi
  • For correspondence: [email protected]
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    - Flow diagram of the study subjects.

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    Table 1

    - The outcomes characteristics of adult patients hospitalized with coronavirus disease-19 from January to June 2022 according to their immunity (n=634).

    CharacteristicsAll (n=634)Not immunized (n=215)Partially immunized (n=125)Fully immunized (n=294)P-values
    Entry to hospital
    Emergency room486 (76.7)153 (71.1)106 (84.8)227 (77.2)0.078
    In patients99 (15.6)42 (19.5)12 (9.6)45 (15.3)
    Referral49 (7.7)20 (9.3)7 (5.6)22 (7.5)
    Admission department
    Ward490 (77.8)151 (70.2)99 (79.2)240 (81.6)0.010
    Emergency room13 (2.1)5 (2.3)5 (4.0)3 (1.0)
    ICU131 (20.7)59 (27.4)21 (16.5)51 (17.3)
    Length of hospital stay in days, median (IQR)5.0 (3.0-8.0)6.0 (4.0-10.0)5.0 (3.0-6.0)5.0 (3.0-7.0)0.001
    Oxygen therapy and ventilation
    No oxygen292 (46.1)81 (37.7)60 (48.0)151 (51.4)0.006
    Mask/cannula180 (28.4)66 (30.4)38 (30.4)76 (25.9)
    Non-invasive66 (10.4)20 (9.3)14 (11.2)32 (10.9)
    Mechanical96 (15.1)48 (22.3)13 (10.4)35 (11.9)
    World Health Organization classification for covid-19 severity
    Mild/moderate292 (46.1)81 (37.7)60 (48.0)151 (51.4)0.002
    Severe246 (38.8)86 (40.0)52 (41.6)108 (36.7)
    Critical96 (15.1)48 (22.3)13 (10.4)35 (11.9)
    Clinical outcomes
    Cure506 (79.8)147 (68.4)102 (81.6)257 (87.4)<0.001
    Death128 (20.2)69 (31.6)23 (18.4)37 (12.6)

    Values are presented as numbers and precentages (%) or median and interquartile range (IQR). ICU: intensive care unit

      • View popup
      Table 2

      - Demographic and clinical characteristics of adult patients hospitalized with coronavirus disease-19 from January to June 2022 according to their outcomes (n=634).

      CharacteristicsAll (n=634)Cure (n=506)Deceased (n=128)P-values
      Age (years), mean±SD62.4±22.859.6±23.573.4±16.2<0.001
      <60246 (38.8)224 (44.3)22 (17.2)<0.001
      ≥60388 (61.2)282 (55.7)106 (82.8)
      Gender
      Female317 (50.0)262 (51.38)55 (43.0)0.075
      Male317 (50.0)244 (48.2)73 (57.0)
      Nationality
      Saudi560 (88.3)447 (88.3)113 (88.3)0.985
      Non-Saudi74 (11.7)59 (11.7)15 (11.7)
      Past history of COVID-19
      No594 (93.7)467 (92.3)127 (99.2)0.004
      Yes40 (6.3)39 (7.7)1 (0.8)
      Comorbidities (underline chronic diseases)
      No360 (56.8)328 (64.8)32 (25.0)<0.001
      Yes274 (43.2)178 (35.2)96 (75.0)
      Diabetes mellitus
      No458 (72.2)398 (78.7)60 (46.9)<0.001
      Yes176 (27.8)108 (21.3)68 (53.1)
      Hypertension
      No445 (70.2)387 (76.5)58 (45.3)<0.001
      Yes189 (29.8)119 (23.5)70 (54.7)
      Chronic heart disease
      No610 (96.2)490 (96.8)120 (93.7)0.089
      Yes24 (3.8)16 (3.2)8 (6.3)
      Asthma
      No617 (97.3)496 (98.0)121 (94.5)0.075
      Yes17 (2.7)10 (2.0)7 (5.5)
      Chronic kidney disease
      No619 (97.6)500 (98.8)119 (93.0)0.001
      Yes15 (2.4)6 (1.2)9 (7.0)
      Other comorbidities (SCA, obesity, immunosuppression, malignancies, and others)
      No612 (96.1)487 (96.0)125 (96.1)0.608
      Yes25 (3.9)20 (4.0)5 (3.9)
      Vaccination status
      1 dose87 (13.7)69 (13.6)18 (14.1)<0.001
      2 doses244 (38.5)210 (41.5)34 (26.6)
      3 doses88 (13.9)80 (15.8)8 (6.3)
      Not vaccinated215 (33.9)147 (29.1)68 (53.1)
      Entry to hospital
      ER486 (76.7)421 (83.2)65 (50.8)<0.001
      In patients99 (15.6)69 (13.6)30 (23.4)
      Referral49 (7.7)16 (3.2)33 (25.8)
      Admission department
      Word493 (77.8)464 (91.7)26 (20.3)<0.001
      ER13 (2.1)11 (2.2)2 (1.6)
      ICU128 (20.2)31 (6.1)100 (78.1)
      Admission after infection with COVID-19 in days, median (IQR)0.0 (0.0-2.0)0.0 (0.0-2.0)0.5 (0.0-2.5)0.221
      Length of hospital stay in days, median (IQR)5.0 (3.0-8.0)5.0 (3.0-7.0)7.0 (4.0-13.5)<0.001
      Oxygen therapy and ventilation
      No oxygen292 (46.1)286 (56.5)6 (4.7)<0.001
      Mask/cannula180 (28.4)158 (31.2)22 (17.2)
      Non-invasive66 (10.4)55 (10.9)11 (8.6)
      Mechanical96 (15.1)7 (1.4)89 (69.5)
      World Health Organization classification for COVID-19 severity
      Mild/moderate292 (46.1)286 (56.5)6 (4.7)<0.001
      Severe246 (38.8)213 (42.1)33 (25.8)
      Critical96 (15.1)7 (1.4)89 (69.5)

      Values are presented as numbers and precentages (%), mean ± standard deviation (SD), or median and interquartile range (IQR).

      SCA: sickle cell anemia, ER: emergency room, ICU: intensive care unit, COVID-19: coronavirus disease-19

        • View popup
        Table 3

        - Multivariate analysis of the variables predicting morbidity and mortality in adult patients hospitalized with coronavirus disease-19 from January to June 2022 (n=634).

        CharacteristicsDeathICU AdmissionMechanical ventilationLength of hospital stay exceeding 5 days
        OR (95% CI)P-valuesOR (95% CI)P-valuesOR (95% CI)P-valuesOR (95% CI)P-values
        Not immunized3.03 (1.85-4.98)<0.0011.91 (1.17-3.11)0.0092.11 (1.25-3.56)0.0051.79 (1.24-2.59)0.002
        Partially immunized1.75 (0.98-3.15)0.0591.69 (0.91-3.15)0.0992.33 (1.15-4.72)0.0191.80 (1.14-2.84)0.011
        Age (≥60 years)2.20 (1.25-3.86)0.0060.78 (0.46-1.32)0.3611.20 (0.67-2.16)0.5381.20 (0.84-1.74)0.309
        Gender (male)1.29 (0.83-2.00)0.2631.77 (1.13-2.76)0.0121.58 (0.97-2.58)0.0660.83 (0.60-1.15)0.268
        Past history of COVID-19 (yes)0.11 (0.01-0.86)0.0360.00 (0.00-0.00)0.9970.00 (0.00-0.00)0.9971.22 (0.63-2.37)0.543
        Comorbidities (yes)3.35 (1.55-7.20)0.0025.07 (2.40-10.67)<0.0014.76 (2.11-10.77)<0.0011.17 (0.63-2.15)0.611
        Diabetes mellitus (yes)1.46 (0.80-2.65)0.2211.12 (0.63-1.96)0.7071.29 (0.69-2.41)0.4210.85 (0.55-1.45)0.551
        hypertension (yes)1.04 (0.55-1.98)0.8991.62 (0.88-2.99)0.1241.02 (0.53-1.96)0.9620.35 (0.77-2.36)0.293
        Asthma (yes)1.85 (0.57-5.99)0.3040.87 (0.26-2.90)0.8230.00 (0.00-0.00)0.9981.04 (0.36-3.02)0.947
        Chronic heart disease (yes)0.76 (0.28-1.98)0.5690.68 (0.27-1.74)0.4191.07 (0.41-2.74)0.8950.50 (0.20-1.26)0.142
        Chronic kidney disease (yes)3.06 (0.99-9.49)0.0533.98 (1.17-13.47)0.0272.12 (0.68-6.61)0.1963.58 (1.05-12.18)0.041

        Values are presented as odds ratio (OR) and 95% confidence interval (CI). References: fully vaccinated, age <60 years, gender (female), past history of COVID (no), comorbidities (no), diabetes mellitus (no), hypertension (no), asthma (no), chronic heart disease (no), and chronic kidney disease (no). COVID-19: coronavirus disease-19, ICU: intensive care unit

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        Impact of vaccination on morbidity and mortality in adults hospitalized with COVID-19 during the omicron wave in the Jazan Region, Saudi Arabia
        Mohammed Y. Elamin, Yahya A. Maslamani, Feras A. Alsheikh, Mohsen A. Sailah, Mussab A. Samm, Ahmed M. Motanbk, Yehya M. Hejri, Anwar A. Alameer, Osama H. Khalid, Abdu A. Dahlan, Ibrahim M. Gosadi
        Saudi Medical Journal Feb 2024, 45 (2) 179-187; DOI: 10.15537/smj.2024.45.2.20230530

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        Impact of vaccination on morbidity and mortality in adults hospitalized with COVID-19 during the omicron wave in the Jazan Region, Saudi Arabia
        Mohammed Y. Elamin, Yahya A. Maslamani, Feras A. Alsheikh, Mohsen A. Sailah, Mussab A. Samm, Ahmed M. Motanbk, Yehya M. Hejri, Anwar A. Alameer, Osama H. Khalid, Abdu A. Dahlan, Ibrahim M. Gosadi
        Saudi Medical Journal Feb 2024, 45 (2) 179-187; DOI: 10.15537/smj.2024.45.2.20230530
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