Sociobehavioural factors associated with SARS-CoV-2 infection and COVID-19 vaccine effectiveness against medically attended, symptomatic SARS-CoV-2 infection in the Philippines: a prospective case-control study (FASCINATE-P study).

Abstract

Objective: We examined sociobehavioural factors associated with SARS-CoV-2 infection and estimated COVID-19 vaccine effectiveness against symptomatic SARS-CoV-2 infection in the Philippines. Such studies are limited in low- and middle-income countries, especially in Asia and the Pacific.

Methods: A case-control study was conducted in two hospitals in Manila, Philippines, from March 2022 to June 2023. Sociobehavioural factors and vaccination history were collected. PCR-positive individuals were cases, while PCR-negative individuals were controls. Adjusted odds ratios (aORs) were calculated to examine associations between sociobehavioural factors/vaccination and medically attended SARS-CoV-2 infection.

Results: The analysis included 2489 individuals (574 positive cases, 23.1%; 1915 controls, 76.9%; median age [interquartile range]: 35 [27-51] years). Although education and household income were not associated with infection, being a health-care worker was (aOR: 1.45; 95% confidence interval [CI]: 1.03-2.06). The odds of infection were higher among individuals who attended gatherings of five or more people compared to those who attended smaller gatherings (aOR: 2.58; 95% CI: 1.14-5.83). Absolute vaccine effectiveness for vaccination status was not estimated due to a high risk of bias, for example, unascertained prior infection. Moderate relative vaccine effectiveness for the first booster (32%; 95% CI: -120-79) and the second booster (48%; 95% CI: -23-78) were observed (both with wide CI), albeit with a waning trend after half a year.

Discussion: The higher odds of infection among health-care workers emphasize the importance of infection prevention and control measures. Moderate relative vaccine effectiveness with a waning trend reiterates the need for more efficacious vaccines against symptomatic infection caused by circulating variants and with longer duration of protection.