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Influenza Other Respir Viruses
. 2025 Sep;19(9):e70152.
doi: 10.1111/irv.70152. COVID-19 Vaccine Effectiveness Against Hospitalizations and Severe Outcomes in Kosovo, 2022-2024: A Test-Negative Case-Control Study
Besfort Kryeziu 1 2 3 , Sandra Cohuet 4 , Ariana Kalaveshi-Osmani 1 3 , Zana Kaçaniku-Deva 1 , Pranvera Kaçaniku-Gunga 1 , Iris Finci 5 , Miguel Angel Sanchez 4 , James Humphreys 4 , Naser Ramadani 1 3 , Edita Haxhiu 3 , Kostas Danis 2 , Angela M C Rose 4 , Isme Humolli 3 6 , Mark A Katz 5
Affiliations
Background: Few studies have evaluated COVID-19 vaccine effectiveness (VE) in middle-income countries, particularly in eastern Europe. We aimed to estimate COVID-19 VE against SARS-CoV-2-confirmed hospitalizations and severe outcomes in Kosovo.
Methods: We conducted a test-negative case-control study using data from Kosovo's severe acute respiratory infection (SARI) sentinel surveillance system from January 2022 to June 2024. We enrolled adult patients aged ≥ 18 years hospitalized with SARI. From all patients, we collected clinical data, vaccination history, and a nasopharyngeal specimen, which was tested for SARS-CoV-2 using RT-PCR. SARS-CoV-2-positive patients were cases; those testing negative were controls. We estimated VE overall and against severe outcomes (requiring oxygen, intensive care admission, or in-hospital death) using logistic regression, adjusting for age, sex, and comorbidities, calculating VE as (1-adjusted odds ratio) × 100.
Results: We included 564 SARI patients; 218 (39%) tested positive for SARS-CoV-2. Overall, 24% of SARI patients had received at least one COVID-19 vaccine dose in the previous 12 months. VE against SARS-CoV-2-confirmed SARI hospitalization among all adults was 72% (95% CI: 30%-89%) at 14-179-day postvaccination, and 26% (95% CI: -33%-59%) at 180-364 days. In adults ≥ 60 years, VE was 52% (95% CI:-31%-82%) at 14-179-day postvaccination, and -36% (95% CI: -190%-36%) at 180-364 days. VE against severe outcomes was 67% (95% CI: -14%-91%) at 14-179 days, and 17% (95% CI:-111%-67%) at 180-364 days.
Conclusions: Our findings suggest that COVID-19 vaccination in Kosovo offered substantial protection against hospitalization and severe outcomes within 6 months, though confidence intervals were wide for some subgroups. Effectiveness waned after 6 months, highlighting the need for periodic booster doses.
Keywords: COVID‐19; Kosovo; hospitalization; severe outcomes; vaccine effectiveness.
. 2025 Sep;19(9):e70152.
doi: 10.1111/irv.70152. COVID-19 Vaccine Effectiveness Against Hospitalizations and Severe Outcomes in Kosovo, 2022-2024: A Test-Negative Case-Control Study
Besfort Kryeziu 1 2 3 , Sandra Cohuet 4 , Ariana Kalaveshi-Osmani 1 3 , Zana Kaçaniku-Deva 1 , Pranvera Kaçaniku-Gunga 1 , Iris Finci 5 , Miguel Angel Sanchez 4 , James Humphreys 4 , Naser Ramadani 1 3 , Edita Haxhiu 3 , Kostas Danis 2 , Angela M C Rose 4 , Isme Humolli 3 6 , Mark A Katz 5
Affiliations
- PMID: 40922048
- PMCID: PMC12417103
- DOI: 10.1111/irv.70152
Background: Few studies have evaluated COVID-19 vaccine effectiveness (VE) in middle-income countries, particularly in eastern Europe. We aimed to estimate COVID-19 VE against SARS-CoV-2-confirmed hospitalizations and severe outcomes in Kosovo.
Methods: We conducted a test-negative case-control study using data from Kosovo's severe acute respiratory infection (SARI) sentinel surveillance system from January 2022 to June 2024. We enrolled adult patients aged ≥ 18 years hospitalized with SARI. From all patients, we collected clinical data, vaccination history, and a nasopharyngeal specimen, which was tested for SARS-CoV-2 using RT-PCR. SARS-CoV-2-positive patients were cases; those testing negative were controls. We estimated VE overall and against severe outcomes (requiring oxygen, intensive care admission, or in-hospital death) using logistic regression, adjusting for age, sex, and comorbidities, calculating VE as (1-adjusted odds ratio) × 100.
Results: We included 564 SARI patients; 218 (39%) tested positive for SARS-CoV-2. Overall, 24% of SARI patients had received at least one COVID-19 vaccine dose in the previous 12 months. VE against SARS-CoV-2-confirmed SARI hospitalization among all adults was 72% (95% CI: 30%-89%) at 14-179-day postvaccination, and 26% (95% CI: -33%-59%) at 180-364 days. In adults ≥ 60 years, VE was 52% (95% CI:-31%-82%) at 14-179-day postvaccination, and -36% (95% CI: -190%-36%) at 180-364 days. VE against severe outcomes was 67% (95% CI: -14%-91%) at 14-179 days, and 17% (95% CI:-111%-67%) at 180-364 days.
Conclusions: Our findings suggest that COVID-19 vaccination in Kosovo offered substantial protection against hospitalization and severe outcomes within 6 months, though confidence intervals were wide for some subgroups. Effectiveness waned after 6 months, highlighting the need for periodic booster doses.
Keywords: COVID‐19; Kosovo; hospitalization; severe outcomes; vaccine effectiveness.