Impact of the 'Health on Wheels' (HoW) strategy on COVID-19 vaccination coverage in hard-to-reach communities in Alta Verapaz, Guatemala, 2022.

BACKGROUND: In April 2022, after a year of COVID-19 vaccination, there were large differences in coverage between urban and rural areas in Guatemala. To address barriers in rural communities, the "Health on Wheels" (HoW) strategy was implemented. The strategy deployed mobile brigades with a dedicated team of health workers and a culturally sensitive health promotion plan in selected communities in 15 districts in Alta Verapaz, a health area with low COVID-19 vaccination uptake and a high-level of COVID-19 vaccine hesitancy. This study evaluates the impact of the HoW strategy. METHODS: We measured the relative increase in COVID-19 doses administered prior and during the HoW implementation period in the 190 intervened communities and compared to 188 communities without the intervention. Communities were grouped by health district and the impact analyses were stratified by number of COVID-19 vaccine dose (1st, 2nd, and 3rd doses) and history of vaccine hesitancy. RESULTS: The increase in 1st, 2nd, and 3rd dose-COVID-19 vaccination coverage between before and during HoW implementation was 2.4, 2.2 and 2.6 times higher in intervened communities (20 %, 21 % and 37 % increase in 1st, 2nd and 3rd dose, respectively) than in non-intervened communities (8 %, 10 % and 14 % increase in 1st, 2nd and 3rd dose respectively). For the 1st dose, increase in dose administration was 2.9 times higher in intervened communities (n = 24) with hesitancy (24 % increase) compared to non-intervened communities (n = 188) without hesitancy (8 % increase). CONCLUSION: The deployment of mobile brigades with a dedicated team of vaccinators and culturally sensitive health promotion through the HoW strategy successfully accelerated the increase in COVID-19 vaccination coverage in rural communities in Guatemala.

Early impact of COVID-19 vaccination on older populations in four countries of the Americas, 2021.

Objective: To estimate the early impact of coronavirus disease 2019 (COVID-19) vaccination on cases in older populations in four countries (Chile, Colombia, Guatemala, and the United States of America), and on deaths in Chile and Guatemala. Methods: Data were obtained from national databases of confirmed COVID-19 cases and deaths and vaccinations between 1 July 2020 and 31 August 2021. In each country, pre- and post-vaccination incidence ratios were calculated for COVID-19 cases and deaths in prioritized groups (50-59, 60-69, and ≥70 years) compared with those in the reference group (<50 years). Vaccination effect was calculated as the percentage change in incidence ratios between pre- and post-vaccination periods. Results: The ratio of COVID-19 cases in those aged ≥50 years to those aged <50 years decreased significantly after vaccine implementation by 9.8% (95% CI: 9.5 to 10.1%) in Chile, 22.5% (95% CI: 22.0 to 23.1%) in Colombia, 20.8% (95% CI: 20.6 to 21.1%) in Guatemala, and 7.8% (95% CI: 7.6 to 7.9%) in the USA. Reductions in the ratio were highest in adults aged ≥70 years. The effect of vaccination on deaths, with time lags incorporated, was highest in the age group ≥70 years in both Chile and Guatemala: 14.4% (95% CI: 11.4 to 17.4%) and 37.3% (95% CI: 30.9 to 43.7%), respectively. Conclusions: COVID-19 vaccination significantly reduced morbidity in the early post-vaccination period in targeted groups. In the context of a global pandemic with limited vaccine availability, prioritization strategies are important to reduce the burden of disease in high-risk age groups.

Early impact of COVID-19 vaccination on older populations in four countries of the Americas, 2021

[ABSTRACT]. Objective. To estimate the early impact of coronavirus disease 2019 (COVID-19) vaccination on cases in older populations in four countries (Chile, Colombia, Guatemala, and the United States of America), and on deaths in Chile and Guatemala. Methods. Data were obtained from national databases of confirmed COVID-19 cases and deaths and vac- cinations between 1 July 2020 and 31 August 2021. In each country, pre- and post-vaccination incidence ratios were calculated for COVID-19 cases and deaths in prioritized groups (50–59, 60–69, and ≥70 years) compared with those in the reference group (<50 years). Vaccination effect was calculated as the percentage change in incidence ratios between pre- and post-vaccination periods. Results. The ratio of COVID-19 cases in those aged ≥50 years to those aged <50 years decreased signifi- cantly after vaccine implementation by 9.8% (95% CI: 9.5 to 10.1%) in Chile, 22.5% (95% CI: 22.0 to 23.1%) in Colombia, 20.8% (95% CI: 20.6 to 21.1%) in Guatemala, and 7.8% (95% CI: 7.6 to 7.9%) in the USA. Reduc- tions in the ratio were highest in adults aged ≥70 years. The effect of vaccination on deaths, with time lags incorporated, was highest in the age group ≥70 years in both Chile and Guatemala: 14.4% (95% CI: 11.4 to 17.4%) and 37.3% (95% CI: 30.9 to 43.7%), respectively. Conclusions. COVID-19 vaccination significantly reduced morbidity in the early post-vaccination period in targeted groups. In the context of a global pandemic with limited vaccine availability, prioritization strategies are important to reduce the burden of disease in high-risk age groups.

[RESUMEN]. Objetivo. Estimar el impacto temprano sobre los casos de enfermedad por coronavirus 2019 (COVID-19) obtenido con la vacunación contra la COVID-19 en los grupos poblacionales de edad avanzada en cuatro países (Chile, Colombia, Estados Unidos de América y Guatemala), así como el efecto en la mortalidad en Chile y Guatemala. Métodos. Los datos se obtuvieron a partir de las bases de datos nacionales sobre vacunaciones y sobre casos de COVID-19 y muertes debidas a esta enfermedad entre el 1 de julio del 2020 y el 31 de agosto del 2021. Para cada país, se calcularon las razones de incidencia de casos de COVID-19 y de muertes por COVID-19 anteriores y posteriores a la vacunación en los grupos priorizados (50-59, 60-69 y ≥70 años) en comparación con las del grupo de referencia (<50 años). Se calculó el efecto de la vacunación expresado en forma de variación porcentual de la razón de las incidencias entre el período anterior y el posterior a la vacunación. Resultados. Tras la introducción de la vacuna, la razón de los casos de COVID-19 entre las personas ≥50 años y las <50 disminuyó significativamente en un 9,8% (IC del 95%: 9,5% a 10,1%) en Chile, en un 22,5% (IC del 95%: 22,0% a 23,1%) en Colombia, en un 7,8% (IC del 95%: 7,6% a 7,9%) en Estados Unidos de América y en un 20,8% (IC del 95%: 20,6% a 21,1%) en Guatemala. Las reducciones de la razón fueron máximas en las personas adultas ≥70 años. El efecto de la vacunación sobre las muertes, una vez incorporados los desfases cronológicos, fue máximo en el grupo de personas ≥70 años, tanto en Chile como en Guatemala: 14,4% (IC 95%: 11,4% a 17,4%) y 37,3% (IC 95%: 30,9% a 43,7%), respectivamente. Conclusiones. La vacunación contra la COVID-19 redujo significativamente la morbilidad en el período inmediato posterior a la vacunación en los grupos destinatarios. En el contexto de una pandemia con disponibilidad limitada de vacunas a nivel mundial, las estrategias de asignación de prioridades son un factor importante para reducir la carga de morbilidad en los grupos etarios de alto riesgo.

[RESUMO]. Objetivo. Estimar o impacto inicial da vacinação contra a doença pelo coronavírus 2019 (COVID-19) nos casos em populações idosas de quatro países (Chile, Colômbia, Guatemala e Estados Unidos da América) e nas mortes no Chile e na Guatemala. Métodos. Os dados foram obtidos de bancos de dados nacionais de casos e mortes confirmados por COVID-19 e de vacinações entre 1º de julho de 2020 e 31 de agosto de 2021. Em cada país, foram calculadas taxas de incidência pré e pós-vacinação de casos e mortes por COVID-19 em grupos priorizados (50 a 59, 60 a 69 e ≥70 anos) em comparação com o grupo de referência (<50 anos). O efeito da vacinação foi calculado como a mudança percentual nas taxas de incidência entre os períodos pré e pós-vacinação. Resultados. A incidência de casos de COVID-19 em pessoas com idade ≥50 anos em relação às com idade <50 anos diminuiu significativamente após a implementação da vacina, em 9,8% (IC 95%: 9,5 a 10,1%) no Chile, 22,5% (IC 95%: 22,0 a 23,1%) na Colômbia, 20,8% (IC 95%: 20,6 a 21,1%) na Guatemala e 7,8% (IC 95%: 7,6 a 7,9%) nos EUA. As reduções na incidência foram maiores em adultos com idade ≥70 anos. O efeito da vacinação sobre as mortes, com defasagens temporais incorporadas, foi maior na faixa etária ≥70 anos no Chile e na Guatemala, 14,4% (IC de 95%: 11,4 a 17,4%) e 37,3% (IC de 95%: 30,9 a 43,7%), respectivamente. Conclusões. A vacinação contra a COVID-19 reduziu significativamente a morbidade no início do período pós-vacinação nos grupos-alvo. No contexto de uma pandemia mundial com disponibilidade limitada de vacinas, estratégias de priorização são importantes para reduzir a carga de doença em grupos etários de alto risco.

Early impact of COVID-19 vaccination on older populations in four countries of the Americas, 2021 / Impacto temprano de la vacunación contra la COVID-19 en adultos mayores en cuatro países de las Américas, 2021 / Impacto inicial da vacinação contra a COVID-19 em populações idosas em quatro países das Américas, 2021

ABSTRACT Objective. To estimate the early impact of coronavirus disease 2019 (COVID-19) vaccination on cases in older populations in four countries (Chile, Colombia, Guatemala, and the United States of America), and on deaths in Chile and Guatemala. Methods. Data were obtained from national databases of confirmed COVID-19 cases and deaths and vaccinations between 1 July 2020 and 31 August 2021. In each country, pre- and post-vaccination incidence ratios were calculated for COVID-19 cases and deaths in prioritized groups (50-59, 60-69, and ≥70 years) compared with those in the reference group (<50 years). Vaccination effect was calculated as the percentage change in incidence ratios between pre- and post-vaccination periods. Results. The ratio of COVID-19 cases in those aged ≥50 years to those aged <50 years decreased significantly after vaccine implementation by 9.8% (95% CI: 9.5 to 10.1%) in Chile, 22.5% (95% CI: 22.0 to 23.1%) in Colombia, 20.8% (95% CI: 20.6 to 21.1%) in Guatemala, and 7.8% (95% CI: 7.6 to 7.9%) in the USA. Reductions in the ratio were highest in adults aged ≥70 years. The effect of vaccination on deaths, with time lags incorporated, was highest in the age group ≥70 years in both Chile and Guatemala: 14.4% (95% CI: 11.4 to 17.4%) and 37.3% (95% CI: 30.9 to 43.7%), respectively. Conclusions. COVID-19 vaccination significantly reduced morbidity in the early post-vaccination period in targeted groups. In the context of a global pandemic with limited vaccine availability, prioritization strategies are important to reduce the burden of disease in high-risk age groups.

RESUMEN Objetivo. Estimar el impacto temprano sobre los casos de enfermedad por coronavirus 2019 (COVID-19) obtenido con la vacunación contra la COVID-19 en los grupos poblacionales de edad avanzada en cuatro países (Chile, Colombia, Estados Unidos de América y Guatemala), así como el efecto en la mortalidad en Chile y Guatemala. Métodos. Los datos se obtuvieron a partir de las bases de datos nacionales sobre vacunaciones y sobre casos de COVID-19 y muertes debidas a esta enfermedad entre el 1 de julio del 2020 y el 31 de agosto del 2021. Para cada país, se calcularon las razones de incidencia de casos de COVID-19 y de muertes por COVID-19 anteriores y posteriores a la vacunación en los grupos priorizados (50-59, 60-69 y ≥70 años) en comparación con las del grupo de referencia (<50 años). Se calculó el efecto de la vacunación expresado en forma de variación porcentual de la razón de las incidencias entre el período anterior y el posterior a la vacunación. Resultados. Tras la introducción de la vacuna, la razón de los casos de COVID-19 entre las personas ≥50 años y las <50 disminuyó significativamente en un 9,8% (IC del 95%: 9,5% a 10,1%) en Chile, en un 22,5% (IC del 95%: 22,0% a 23,1%) en Colombia, en un 7,8% (IC del 95%: 7,6% a 7,9%) en Estados Unidos de América y en un 20,8% (IC del 95%: 20,6% a 21,1%) en Guatemala. Las reducciones de la razón fueron máximas en las personas adultas ≥70 años. El efecto de la vacunación sobre las muertes, una vez incorporados los desfases cronológicos, fue máximo en el grupo de personas ≥70 años, tanto en Chile como en Guatemala: 14,4% (IC 95%: 11,4% a 17,4%) y 37,3% (IC 95%: 30,9% a 43,7%), respectivamente. Conclusiones. La vacunación contra la COVID-19 redujo significativamente la morbilidad en el período inmediato posterior a la vacunación en los grupos destinatarios. En el contexto de una pandemia con disponibilidad limitada de vacunas a nivel mundial, las estrategias de asignación de prioridades son un factor importante para reducir la carga de morbilidad en los grupos etarios de alto riesgo.

RESUMO Objetivo. Estimar o impacto inicial da vacinação contra a doença pelo coronavírus 2019 (COVID-19) nos casos em populações idosas de quatro países (Chile, Colômbia, Guatemala e Estados Unidos da América) e nas mortes no Chile e na Guatemala. Métodos. Os dados foram obtidos de bancos de dados nacionais de casos e mortes confirmados por COVID-19 e de vacinações entre 1º de julho de 2020 e 31 de agosto de 2021. Em cada país, foram calculadas taxas de incidência pré e pós-vacinação de casos e mortes por COVID-19 em grupos priorizados (50 a 59, 60 a 69 e ≥70 anos) em comparação com o grupo de referência (<50 anos). O efeito da vacinação foi calculado como a mudança percentual nas taxas de incidência entre os períodos pré e pós-vacinação. Resultados. A incidência de casos de COVID-19 em pessoas com idade ≥50 anos em relação às com idade <50 anos diminuiu significativamente após a implementação da vacina, em 9,8% (IC 95%: 9,5 a 10,1%) no Chile, 22,5% (IC 95%: 22,0 a 23,1%) na Colômbia, 20,8% (IC 95%: 20,6 a 21,1%) na Guatemala e 7,8% (IC 95%: 7,6 a 7,9%) nos EUA. As reduções na incidência foram maiores em adultos com idade ≥70 anos. O efeito da vacinação sobre as mortes, com defasagens temporais incorporadas, foi maior na faixa etária ≥70 anos no Chile e na Guatemala, 14,4% (IC de 95%: 11,4 a 17,4%) e 37,3% (IC de 95%: 30,9 a 43,7%), respectivamente. Conclusões. A vacinação contra a COVID-19 reduziu significativamente a morbidade no início do período pós-vacinação nos grupos-alvo. No contexto de uma pandemia mundial com disponibilidade limitada de vacinas, estratégias de priorização são importantes para reduzir a carga de doença em grupos etários de alto risco.