Next Article in Journal
Awareness, Acceptance, and Associated Factors of Human Papillomavirus Vaccine among Parents of Daughters in Hadiya Zone, Southern Ethiopia: A Cross-Sectional Study
Next Article in Special Issue
Impact of COVID-19 Vaccination on Heart Rate Variability: A Systematic Review
Previous Article in Journal
A Novel Finding of an HLA Allele’s and a Haplotype’s Relationship with SARS-CoV-2 Vaccine-Associated Subacute Thyroiditis
Previous Article in Special Issue
Parental Willingness for COVID-19 Vaccination among Children Aged 5 to 11 Years in Riyadh City, Saudi Arabia: A Cross-Sectional Study
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:

Hospitalization and Mortality by Vaccination Status among COVID-19 Patients Aged ≥ 25 Years in Bangladesh: Results from a Multicenter Cross-Sectional Study

Md. Saydur Rahman
Md. Golam Dostogir Harun
Shariful Amin Sumon
Tahrima Mohsin Mohona
Syed Abul Hassan Md Abdullah
Md. Nazuml Huda Khan
Md. Ismail Gazi
Md. Saiful Islam
7 and
Md. Mahabub Ul Anwar
Department of Administration, DNCC Dedicated COVID-19 Hospital, Dhaka 1212, Bangladesh
Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
Department of Public Health, Daffodil International University, Dhaka 1341, Bangladesh
SafetyNet Bangladesh, Dhaka 1212, Bangladesh
Department of Administration, Kurmitola General Hospital, Dhaka 1206, Bangladesh
Sheikh Russel National Gastroliver Institute and Hospital, Dhaka 1212, Bangladesh
School of Medical Science, University of New South Wales, Sydney 2052, Australia
Office of Health Affairs, West Virginia University, Morgantown, WV 26506, USA
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Vaccines 2022, 10(12), 1987;
Submission received: 27 October 2022 / Revised: 20 November 2022 / Accepted: 21 November 2022 / Published: 23 November 2022
(This article belongs to the Collection COVID-19 Vaccine Hesitancy: Correlates and Interventions)


The COVID-19 pandemic has inflicted a massive disease burden globally, involving 623 million confirmed cases with 6.55 million deaths, and in Bangladesh, over 2.02 million clinically confirmed cases of COVID-19, with 29,371 deaths, have been reported. Evidence showed that vaccines significantly reduced infection, severity, and mortality across a wide age range of populations. This study investigated the hospitalization and mortality by vaccination status among COVID-19 patients in Bangladesh and identified the vaccine’s effectiveness against severe outcomes in real-world settings. Between August and December 2021, we conducted this cross-sectional survey among 783 RT-PCR-confirmed COVID-19 hospitalized patients admitted to three dedicated COVID-19 hospitals in Bangladesh. The study used a semi-structured questionnaire to collect information. We reviewed the patient’s records and gathered COVID-19 immunization status from the study participants or their caregivers. Patients with incomplete or partial data from the record were excluded from enrollment. Logistic regression analyses were performed to determine the association between key variables with a patient’s vaccination status and mortality. The study revealed that overall hospitalization, severity, and morality were significantly high among unvaccinated study participants. Only one-fourth (25%) of hospitalized patients were found COVID-19 vaccinated. Morality among unvaccinated COVID-19 study participants was significantly higher (AOR: 7.17) than the vaccinated (11.17% vs. 1.53%). Severity was found to be seven times higher among unvaccinated patients. Vaccination coverage was higher in urban areas (29.8%) compared to rural parts (20.8%), and vaccine uptake was lower among female study participants (22.7%) than male (27.6%). The study highlighted the importance of COVID-19 vaccines in reducing mortality, hospitalization, and other severe consequences. We found a gap in vaccination coverage between urban and rural settings. The findings would encourage the entire population toward immunization and aid the policymakers in the ground reality so that more initiatives are taken to improve vaccination coverage among the pocket population.

1. Background

The COVID-19 pandemic has inflicted a massive disease burden globally [1], involving 623 million confirmed cases and 6.55 million deaths as of 4 October 2022. The severity of coronavirus disease 2019 (COVID-19) can range from mild symptoms to serious consequences, especially in the elderly and with comorbidities [2,3]. The disease is highly infectious, having prompt clinical manifestations in cases where the principal transmission route is respiratory, i.e., via droplets and contact routes [4,5,6]. Several infection prevention and control (IPC) measures, including performing regular hand hygiene, maintaining six feet of social distancing, appropriately wearing the face mask, and contact tracing when a positive case is detected, can restrict the viral spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections [7]. However, non-clinical initiatives alone cannot limit the transmission of this deadly virus [8]. Both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) strongly recommend vaccination against COVID-19 as the safest long-term prophylactic approach to containing the pandemic [9,10]. The COVID-19 vaccinations have started, which make a difference and have proven significantly effective at preventing infection with different SARS-CoV-2 variants [11,12]. Vaccines develop the body’s natural defenses and boost the immune system to combat the virus. Several vaccine trials achieved remarkable immunity for the COVID-19 vaccine, which were found to be up to 92% among those previously infected, 87% among hospitalized patients, and 92% among those with severe disease [13,14,15]. The effectiveness of these vaccines among hospitalized patients has been a topic of discussion in different forums.
Evidence showed that vaccines significantly reduced the infection, severity, and mortality across a wide age range of populations in developed and developing countries [13,16]. A recently conducted case-control study in the United States of America (USA) showed that fully vaccinated adults (≥65 years) had 94% effectiveness against COVID infections, whereas partially vaccinated patients had 64% effectiveness against COVID infections and the findings were statistically significant [17]. Another community-based study conducted in Los Angeles showed that fully vaccinated personnel were less likely to be admitted to the hospital, shifted to the intensive care unit (ICU), require mechanical ventilation, and die than partially vaccinated ones due to COVID infections [18]. A similar result was found in other countries as well, such as England and Israel, where vaccinated patients had fewer risks of progressing to a severely diseased state and requiring ventilation in hospitals than those who were non-vaccinated or partially vaccinated [19,20]. In Malaysia, the age-standardized mortality rate for unvaccinated individuals was 43.2 times higher than for individuals fully vaccinated [21]. A study in India reported that mortality was significantly less among the vaccinated population [22].
In Bangladesh, over 2.02 million clinically confirmed cases of COVID-19, with 29,371 deaths, have been reported to WHO thus far [23]. Bangladesh is one of the most densely populated countries where strict social distancing is difficult. Being at high risk of transmission of SARS-CoV-2, the vaccine may be the most effective containment strategy for the country. The Government of Bangladesh commenced the COVID-19 vaccination program on 27 January 2021, with mass immunization in the following months [24]. Acceptance of the COVID-19 vaccine among Bangladeshi inhabitants was reported to be 80%, and the government has announced a target of vaccinating three-fourths of its population by 2022 [25]. However, nearly one-quarter (22.3%) of the population still remains unvaccinated [26]. Yet, no explicit study has been conducted on hospitalization and mortality by vaccination status related to COVID-19 in Bangladesh. This study aims to investigate the hospitalization and mortality by vaccination status among COVID-19 patients in Bangladesh and to identify the vaccine’s effectiveness against severe outcomes in real-world settings. The findings of this study will contribute to the overall success of the vaccination program, tailored tactics, and vaccine promotion campaigns aimed at the general community in Bangladesh.

2. Methods

2.1. Study Setting

We conducted this survey in three COVID-dedicated public hospitals in Bangladesh: Dhaka North City Corporation (DNCC) Dedicated COVID-19 Hospital, Sheikh Russel National Gastroliver Institute and Hospital, and Kurmitola General Hospital. All three hospitals have a central oxygen supply available and, as they are referral hospitals, provide care to the most critical patients, referred from all over Bangladesh. DNCC Dedicated COVID-19 Hospital is the only specialized hospital in Bangladesh for COVID-19 patients built to combat the pandemic. It is the largest COVID hospital, with 1500 beds, including 212 ICU beds and 288 high-dependency units. Sheikh Russel National Gastroliver Institute and Hospital is a 500 bedded specialized hospital with an annual patient turnover of 5000, and Kurmitola General hospital is a 500-bedded general hospital with an annual patient turnover of 9647 in 2021, both of which were announced to be COVID-dedicated hospitals by the government hospital during the pandemic.

2.2. Study Design and Population

This cross-sectional study was carried out among hospitalized patients aged ≥ 25 years with SARS-CoV-2 infection confirmed by reverse transcription–polymerase chain reaction (RT-PCR) test from August to December 2021. We enrolled people aged 25 years and above because at the time the study was conducted, only this group was eligible for the COVID-19 vaccine. Patients or caregivers who were unwilling to participate in the study were excluded.

2.3. Sampling Technique

Patients admitted with confirmed cases of COVID-19 in the study period comprised the study population. Hospital admission records were assessed every day to form a sampling frame. A systematic random sampling method was used to enroll every third patient from the sample frame. If any participant was unwilling to participate, we took the following patient in the sampling frame.

2.4. Data Collection

A semi-structured questionnaire was used to obtain information. We reviewed the patient’s records from the patient file and hospital registry to extract information on COVID-19 hospitalization status as well as the outcome of patients. Both nasopharyngeal or oropharyngeal swabs were collected by a medical technologist specifically instructed and trained in the techniques of real-time PCR and in vitro diagnostic procedures for laboratory testing. National guidelines on the standard procedure for conducting RT-PCR test was followed. In addition, we collected data on patients’ symptoms during hospitalization, and comorbid conditions, including ICU and oxygen requirements.
The study team also gathered COVID-19 immunization status, number of doses, and sociodemographic information from the study participants or their caregivers. The vaccination status of both single and double doses was confirmed by the patient or their caregivers or through a vaccination card authorized and issued by the Government of Bangladesh. The patient’s discharge was determined after the results of the RT-PCR test showed negative status along with clinical recovery. Patients with incomplete or partial data from the record were excluded from enrollment.

2.5. Statistical Analysis

The study used descriptive statistics for continuous and categorical variables with percentages, mean, and standard deviations to illustrate sociodemographic information. We also compared the hospitalization rate and outcome, including deaths among vaccinated and non-vaccinated patients. Additionally, we categorized the severity of patients considering comorbidities, ICU, and oxygen requirements. We conducted logistic regression to determine the association between key variables, patient vaccination status, and mortality. Both adjusted and unadjusted odds ratios within a 95% confidence interval were calculated. We performed all the statistical analysis in STATA software (Stata Corp, College Station, TX, USA, 2013, version 13.0).

2.6. Ethical Consideration

We collected written permission from the hospital authority to collect clinical information from the patient medical records. Before collecting demographic information, we obtained written informed consent from the patients or the accompanying family caregivers. The study-maintained anonymity and confidentiality strictly. This study was reviewed and approved by the Institutional Review Board (IRB) of Dhaka North City Corporation Dedicated COVID-19 Hospital.

3. Results

3.1. Key Characteristics of Study Participants by Hospitals

We enrolled a total of 783 RT-PCR confirmed COVID-19 hospitalized patients in the study. The median age of the participants was 56.0 years (IQR: 47.0–66.0), and half of them were female. Almost half (51.1%) of the study participants were from rural areas. The study documented that only 25.0% (196/783) of hospitalized patients received the COVID-19 vaccine. Among the vaccinated participants, 63.3% (124/196) took double doses. The study revealed that 71.8% of the enrolled participants had a history of the co-morbid condition. However, the mortality among enrolled hospitalized patients was 7.9% during the study period (Table 1).

3.2. Key Characteristics of Study Participants by Vaccination Status

Table 2 describes the key characteristics of enrolled hospitalized patients based on vaccination status. The overall vaccination coverage was low among the study participants, whereas males had slightly higher (27.6%) vaccination than their counterparts (22.7%). Similarly, patients living in rural areas had a lower vaccination uptake compared to urban patients (20.8% vs. 29.8%). Three-fourths (73.7%) of the study participants had comorbidities. The study documented that oxygen and ICU requirements were significantly higher (76.1% and 75.4%) among unvaccinated patients. In terms of severity, considering patients had comorbidities, oxygen, and ICU requirements, the majority of the participants (73.8%) were not vaccine recipients. Unvaccinated patients had remarkably higher mortality (95.2%) compared to the COVID-19 vaccine recipients (4.8%) during the study period (Table 2).
Figure 1 shows the number of deaths among hospitalized patients by vaccination coverage during the study period. The mortality was found to be higher among COVID-19 unvaccinated patients (10.1%, 59/587) compared to the vaccinated hospitalized patients (1.53%, 3/196) (Figure 1).

3.3. Factors Associated with COVID-19 Mortality of Enrolled Participants

The study found a significant association between receiving the COVID-19 vaccine and a reduction in COVID-19 mortality among hospitalized patients (Table 3). Unvaccinated hospitalized patients were seven times more likely to die from COVID-19 (AOR: 7.17, 95%CI: 2.21–23.27, p-value: 0.001) than vaccinated, hospitalized patients. The adjusted odds of death were found to be 9.98 times higher among unvaccinated COVID patients with co-morbidities compared to vaccinated patients who had co-morbid conditions (AOR: 9.98, 95%CI: 2.39–41.68, p-value: 0.002). Among patients who required oxygen (O2), unvaccinated patients had higher odds of death (AOR: 10.24) than their counterparts (95%CI: 2.46–42.69, p-value: 0.001). We found that unvaccinated, hospitalized patients with ICU requirements were at higher risk for COVID-19-associated mortality (AOR: 7.74, 95%CI: 1.78–33.74, p-value: 0.006) than the vaccinated patients with similar requirements. Considering the severity, the odds of mortality (AOR: 6.98, 95%CI: 1.57–30.92) among unvaccinated patients were statistically significant compared to vaccinated patients (Table 3).

4. Discussion

This multicenter cross-sectional study evaluated the impact of the COVID-19 vaccine against severity, hospitalization, and mortality among the patients admitted into three dedicated COVID-19 hospitals in Bangladesh. This study revealed that hospitalization, severity, and morality were significantly high among the COVID-19 unvaccinated study participants. Only one-fourth of all hospitalized COVID-19 patients were found to be vaccinated, which is much lower than the global vaccine uptake rates. A study found false claims related to the estimated deaths caused by the COVID-19 vaccine were one of the highest pieces of circulating misinformation [27]. Our study demonstrates vaccination as a protective factor, as unvaccinated hospitalized patients were 7.17 times more likely to die from COVID-19-related complications. These results could be used as supporting data to design evidence-based risk communication and community engagement strategies to promote vaccine uptake.
Hospitalized COVID-19 patients who had received at least one dose of the vaccine had lower incidences of death than unvaccinated patients (Figure 1). This was also observed in a US study where receipt of Pfizer–BioNTech COVID-19 vaccine (BNT162b2 mRNA) and Moderna (mRNA-1273) was associated with a 100% reduction in hospitalizations or mortality [28,29]. In a nationwide retrospective cohort study conducted in Hungary, vaccination prevented all-cause mortality [30]. A study in a low- and middle-income countries (LMIC) setting reported that being fully vaccinated was associated with a 70% reduction in the odds of death among hospitalized COVID patients [22]. As COVID-19 vaccines induce antibodies, it boosts the immune response against the variants of SARS-CoV-2. Vaccines might also elicit the body to produce T-cells which kill COVID-19 infected cells, thus reducing the mortality attributed to COVID-19. The study findings revealed that COVID-19 vaccination was associated with a significant reduction in the severity of COVID-19. We assessed the severity as a condition where patients had co-morbidities and oxygen and ICU requirements. Our study showed that unvaccinated COVID patients with pre-existing co-morbid conditions were ten times more likely to die from COVID-19-associated complications. The results are in line with a previous systematic review which documented that the presence of co-morbidities such as hypertension, diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD) increased the risk of COVID-associated mortality [31]. Our study demonstrated that the requirement for oxygen and ICU support in unvaccinated patients was almost three times more than in those vaccinated prior to hospitalization. The findings correspond to an overall 94% effectiveness of vaccines against hospitalization (mainly for oxygen support) and a reduced need for mechanical ventilation [32,33]. Unvaccinated patients requiring oxygen and ICU support also had significantly greater odds (10.24 and 7.74 times, respectively) of dying. Our findings align with prior studies that reported a 98% and 91% reduction in ICU admission among COVID vaccine recipients [29,33]. This reduction in ICU and oxygen requirement might be due to the IgG antibody response produced by vaccines that fight against the SARS-CoV-2 strains, thus reducing the severity of COVID-19-associated illness.
This analysis also found that old age is associated with increased odds of mortality, as older patients are more susceptible to SARS-CoV-2 [34]. Previously, a USA study comprising a large cohort of elderly patients (n = 20,037) documented that receiving the COVID vaccine in cirrhosis patients was associated with a 100% reduction in COVID-19-related hospitalization or death [28]. Likewise, an Israeli study reported that vaccinated patients had a higher prevalence of risk factors for COVID-19 (older age, co-morbidity) but still showed a lower rate of ICU admission and mortality compared to the unvaccinated controls [32]. COVID-19 vaccine was the only protective factor among those patients. At the same time, vaccination is critical for people of all age groups, yet, the impaired immunity in elderly individuals with co-morbid conditions makes them vulnerable to the inflammation produced by SARS-CoV-2 infection [35]. As the maximum risk of progression to severe COVID-19 cases with pre-existing conditions, vaccines protect these immunocompromised individuals.
Our data revealed a disparity in vaccination coverage between urban and rural areas (29.8% vs. 20.8%). A CDC report documented a lower COVID-19 vaccination coverage in rural areas (58.5%) compared to urban counties (75.4%) across the USA [36]. The government of Bangladesh launched a mass vaccination program to vaccinate 80% (over 130 million) of the country’s total population with vaccines in four different phases [37]. Although more than one hundred ten million people received the COVID-19 vaccine as of 19th September 2022 in Bangladesh, a low turnout has been recorded in rural places as a substantial gap exists concerning receiving vaccines between the two areas of people [37]. The poor IPC situation and overcrowded conditions in hospital settings might create hesitancy among people about taking COVID-19 vaccines, as the vaccination program is mostly carried out in those hospitals [38,39]. Taking the interest of the rural population into account, as approximately 85% were willing to be vaccinated, with a fraction even willing to pay for the vaccine [37], the Government of Bangladesh needs to take more initiative to increase vaccination coverage in those areas. Ensuring higher vaccination coverage is of particular importance as the majority of the population lives in rural areas.
Amidst the unrest caused by SARS-CoV-2, researchers have been trying to find a solution to put this global health menace to a stop [40]. Additionally, as a clear majority of people across developing countries still remain vulnerable to COVID-19 [41], vaccination seems to be the only effective clinical approach to reducing the mounting burden of this outbreak. Vaccines not only work as impactful barriers against the spread of preventable infectious diseases, but also assure routine healthcare service provision [42,43] and, therefore, should be vehemently promoted.
We conducted this survey in the three dedicated COVID-19 hospitals. We collected data from patients’ records and hospital registries, so recall bias is not an issue. However, we could not collect data on individual co-morbidities and types of COVID-19 vaccine, as this information was not available in their medical files. All the study hospitals were from Dhaka, so lack of generalization could be an issue. This is also reflected in the large confidence interval, which suggests that the sample may not provide an adequate representation of the population mean. Secondly, due to the cross-sectional study design, causation could not be measured.

5. Conclusions

Our study investigated the effectiveness of the COVID-19 vaccine against severe associated outcomes. Our findings highlighted the importance of COVID-19 vaccines in reducing mortality, hospitalization, and other severe consequences. Our results also highlighted the gap in vaccination coverage between urban and rural settings. The findings would inform the policymakers about the ground reality so that more initiatives are taken to improve vaccination coverage among the pocket population.

Author Contributions

Conceptualization, M.S.R., M.G.D.H., M.S.I., S.A.H.M.A. and M.M.U.A.; methodology, M.S.R., M.G.D.H., S.A.H.M.A., M.M.U.A., M.I.G. and M.S.I.; validation, S.A.S., M.S.I., M.N.H.K. and T.M.M.; formal analysis, M.G.D.H., S.A.S., M.M.U.A., M.S.R. and M.S.I.; data collection supervision, M.I.G., M.N.H.K., M.S.R. and T.M.M.; writing—original draft preparation, S.A.S., M.S.R., M.G.D.H. and T.M.M.; writing—review and editing; all authors wrote, reviewed and edited the manuscript. All authors have read and agreed to the published version of the manuscript.


The authors received no specific funding for this work.

Institutional Review Board Statement

This study was reviewed and approved by the Institutional Review Board (IRB) of Dhaka North City Corporation (DNCC) Dedicated COVID-19 Hospital. Respective authorities of the study site were contacted before the beginning of the data collection and necessary approvals were taken.

Informed Consent Statement

Written informed consent was taken from the respondents before the study. The goals and objectives of the study were coherently mentioned in the consent paper. The respondents were assured of their anonymity and the privacy and confidentiality of the data they would provide. They had also been informed about the voluntary pattern of participation, and they were at liberty to leave the survey at any time if they found it inconvenient to go forward. No monetary incentives were provided to the respondents.

Data Availability Statement

The authors are responsible for the data described in this manuscript. The datasets generated and analyzed are available from the corresponding author upon request. Data Can also be available from the DNCC hospital authority at upon request.


We are grateful to the study hospitals for providing administrative and technical support. We gratefully acknowledge our gratitude to all study participants and their caregivers for participating in this study.

Conflicts of Interest

The authors declare no conflict of interest.


  1. Fauci, A.S.; Lane, H.C.; Redfield, R.R. COVID-19—Navigating the Uncharted. N. Engl. J. Med. 2020, 382, 1268–1269. [Google Scholar] [CrossRef]
  2. Verity, R.; Okell, L.C.; Dorigatti, I.; Winskill, P.; Whittaker, C.; Imai, N.; Cuomo-Dannenburg, G.; Thompson, H.; Walker, P.G.T.; Fu, H.; et al. Estimates of the severity of coronavirus disease 2019: A model-based analysis. Lancet Infect. Dis. 2020, 20, 669–677. [Google Scholar] [CrossRef]
  3. Guan, W.J.; Ni, Z.Y.; Hu, Y.; Liang, W.H.; Qu, C.Q.; He, J.X.; Liu, L.; Shan, H.; Lei, C.L.; Hui, D.S.C.; et al. Clinical Characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 2020, 382, 1708–1720. [Google Scholar] [CrossRef] [PubMed]
  4. Chi, H.; Chiu, N.-C.; Tai, Y.-L.; Chang, H.-Y.; Lin, C.-H.; Sung, Y.-H.; Tseng, C.-Y.; Liu, L.Y.-M.; Lin, C.-Y. Clinical features of neonates born to mothers with coronavirus disease-2019: A systematic review of 105 neonates. J. Microbiol. Immunol. Infect. 2021, 54, 69–76. [Google Scholar] [CrossRef] [PubMed]
  5. Chi, H.; Chiu, N.-C.; Peng, C.-C.; Lin, C.-H.; Tai, Y.-L.; Lee, M.-D.; Cheng, Y.-J.; Tan, B.F.; Lin, C.-Y. One-Seventh of Patients with COVID-19 Had Olfactory and Gustatory Abnormalities as Their Initial Symptoms: A Systematic Review and Meta-Analysis. Life 2020, 10, 158. [Google Scholar] [CrossRef] [PubMed]
  6. World Health Organization. Advice on the Use of Masks in the Context of COVID-19: Interim Guidance, 5 June 2020; WHO: Geneva, Switzerland, 2020; Available online: (accessed on 15 October 2022).
  7. Walker, P.G.T.; Whittaker, C.; Watson, O.J.; Baguelin, M.; Winskill, P.; Hamlet, A.; Djafaara, B.A.; Cucunubá, Z.; Mesa, D.O.; Green, W.; et al. The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries. Science 2020, 369, 413–422. [Google Scholar] [CrossRef]
  8. Schroter, R.C. Social distancing for COVID-19: Is 2 metres far enough? BMJ 2020, 369, m2010. [Google Scholar] [CrossRef]
  9. Cui, X.; Wang, P.; Wei, Z. Emergency use of COVID-19 vaccines recommended by the World Health Organization (WHO) as of June 2021. Drug Discov. Ther. 2021, 15, 222–224. [Google Scholar] [CrossRef]
  10. Centers for Disease Control Prevention. Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination; Centers for Disease Control and Prevention: Atlanta, GA, USA, 2021. [Google Scholar]
  11. Tenforde, M.W.; Patel, M.M.; Ginde, A.A.; Douin, D.J.; Talbot, H.K.; Casey, J.D.; Mohr, N.M.; Zepeski, A.; Gaglani, M.; McNeal, T.; et al. Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing COVID-19 Hospitalizations in the United States. medRxiv 2021. [Google Scholar] [CrossRef]
  12. Vasileiou, E.; Simpson, C.R.; Shi, T.; Kerr, S.; Agrawal, U.; Akbari, A.; Bedston, S.; Beggs, J.; Bradley, D.; Chuter, A.; et al. Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: A national prospective cohort study. Lancet 2021, 397, 1646–1657. [Google Scholar] [CrossRef]
  13. Polack, F.P.; Thomas, S.J.; Kitchin, N.; Absalon, J.; Gurtman, A.; Lockhart, S.; Perez, J.L.; Pérez Marc, G.; Moreira, E.D.; Zerbini, C.; et al. Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine. N. Engl. J. Med. 2020, 383, 2603–2615. [Google Scholar] [CrossRef] [PubMed]
  14. Baden, L.R.; El Sahly, H.M.; Essink, B.; Kotloff, K.; Frey, S.; Novak, R.; Diemert, D.; Spector, S.A.; Rouphael, N.; Creech, C.B.; et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N. Engl. J. Med. 2021, 384, 403–416. [Google Scholar] [CrossRef] [PubMed]
  15. Saadat, S.; Tehrani, Z.R.; Logue, J.; Newman, M.; Frieman, M.B.; Harris, A.D.; Sajadi, M.M. Binding and Neutralization Antibody Titers After a Single Vaccine Dose in Health Care Workers Previously Infected With SARS-CoV-2. JAMA 2021, 325, 1467. [Google Scholar] [CrossRef] [PubMed]
  16. Mohammed, I.; Nauman, A.; Paul, P.; Ganesan, S.; Chen, K.-H.; Jalil, S.M.S.; Jaouni, S.H.; Kawas, H.; Khan, W.A.; Vattoth, A.L.; et al. The efficacy and effectiveness of the COVID-19 vaccines in reducing infection, severity, hospitalization, and mortality: A systematic review. Hum. Vaccines Immunother. 2022, 18, 2027160. [Google Scholar] [CrossRef] [PubMed]
  17. Tenforde, M.W.; Olson, S.M.; Self, W.H.; Talbot, H.K.; Lindsell, C.J.; Steingrub, J.S.; Shapiro, N.I.; Ginde, A.A.; Douin, D.J.; Prekker, M.E.; et al. Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged ≥65 Years—United States, January–March 2021. MMWR. Morb. Mortal. Wkly. Rep. 2021, 70, 674–679. [Google Scholar] [CrossRef]
  18. Griffin, J.B.; Haddix, M.; Danza, P.; Fisher, R.; Koo, T.H.; Traub, E.; Gounder, P.; Jarashow, C.; Balter, S. SARS-CoV-2 Infections and Hospitalizations Among Persons Aged ≥16 Years, by Vaccination Status—Los Angeles County, California, May 1–July 25, 2021. MMWR. Morb. Mortal. Wkly. Rep. 2021, 70, 1170–1176. [Google Scholar] [CrossRef]
  19. Rinott, E.; Youngster, I.; Lewis, Y.E. Reduction in COVID-19 Patients Requiring Mechanical Ventilation Following Implementation of a National COVID-19 Vaccination Program—Israel, December 2020–February 2021. MMWR. Morb. Mortal. Wkly. Rep. 2021, 70, 326–328. [Google Scholar] [CrossRef]
  20. Bernal, J.L.; Andrews, N.; Gower, C.; Robertson, C.; Stowe, J.; Tessier, E.; Simmons, R.; Cottrell, S.; Roberts, R.; O’Doherty, M.; et al. Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on COVID-19 related symptoms, hospital admissions, and mortality in older adults in England: Test negative case-control study. BMJ 2021, 373, n1088. [Google Scholar] [CrossRef]
  21. Taib, N.A.A.; Raja, D.B.; Teo, A.K.J.; Kamarulzaman, A.; William, T.; Hs, A.-S.; Mokhtar, S.A.; Ting, C.-Y.; Yap, W.A.; Kim, M.C.Y.; et al. Characterisation of COVID-19 deaths by vaccination types and status in Malaysia between February and September 2021. Lancet Reg. Health-West. Pac. 2022, 18, 100354. [Google Scholar] [CrossRef]
  22. Muthukrishnan, J.; Vardhan, V.; Mangalesh, S.; Koley, M.; Shankar, S.; Yadav, A.K.; Khera, A. Vaccination status and COVID-19 related mortality: A hospital based cross sectional study. Med. J. Armed Forces India 2021, 77, S278–S282. [Google Scholar] [CrossRef]
  23. Word Health Organization. Bangladesh—WHO Coronavirus (COVID-19) Dashboard. Available online: (accessed on 26 September 2022).
  24. Abedin, M.; Islam, M.A.; Rahman, F.N.; Reza, H.M.; Hossain, M.Z.; Arefin, A.; Hossain, A. Willingness to vaccinate against COVID-19 among Bangladeshi adults: Understanding the strategies to optimize vaccination coverage. PLoS ONE 2021, 16, e0250495. [Google Scholar] [CrossRef] [PubMed]
  25. Haque, M.M.A.; Rahman, M.L.; Hossian, M.; Matin, K.F.; Nabi, M.H.; Saha, S.; Hasan, M.; Manna, R.M.; Barsha, S.Y.; Hasan, S.; et al. Acceptance of COVID-19 vaccine and its determinants: Evidence from a large sample study in Bangladesh. Heliyon 2021, 7, e07376. [Google Scholar] [CrossRef] [PubMed]
  26. Our World in Data. Coronavirus (COVID-19) Vaccinations. Available online: (accessed on 26 September 2022).
  27. Islam, S.; Kamal, A.-H.M.; Kabir, A.; Southern, D.L.; Khan, S.H.; Hasan, S.M.M.; Sarkar, T.; Sharmin, S.; Das, S.; Roy, T.; et al. COVID-19 vaccine rumors and conspiracy theories: The need for cognitive inoculation against misinformation to improve vaccine adherence. PLoS ONE 2021, 16, e0251605. [Google Scholar] [CrossRef] [PubMed]
  28. John, B.V.; Deng, Y.; Scheinberg, A.; Mahmud, N.; Taddei, T.H.; Kaplan, D.; Labrada, M.; Baracco, G.; Dahman, B. Association of BNT162b2 mRNA and mRNA-1273 Vaccines With COVID-19 Infection and Hospitalization Among Patients With Cirrhosis. JAMA Intern. Med. 2021, 181, 1306–1314. [Google Scholar] [CrossRef] [PubMed]
  29. Olson, S.M.; Newhams, M.M.; Halasa, N.B.; Price, A.M.; Boom, J.A.; Sahni, L.C.; Pannaraj, P.S.; Irby, K.; Walker, T.C.; Schwartz, S.P.; et al. Effectiveness of BNT162b2 Vaccine against Critical COVID-19 in Adolescents. N. Engl. J. Med. 2022, 386, 713–723. [Google Scholar] [CrossRef]
  30. Pálinkás, A.; Sándor, J. Effectiveness of COVID-19 Vaccination in Preventing All-Cause Mortality among Adults during the Third Wave of the Epidemic in Hungary: Nationwide Retrospective Cohort Study. Vaccines 2022, 10, 1009. [Google Scholar] [CrossRef]
  31. Singh, A.K.; Gillies, C.L.; Singh, R.; Singh, A.; Chudasama, Y.; Coles, B.; Seidu, S.; Zaccardi, F.; Davies, M.J.; Khunti, K. Prevalence of co-morbidities and their association with mortality in patients with COVID-19: A systematic review and meta-analysis. Diabetes Obes. Metab. 2020, 22, 1915–1924. [Google Scholar] [CrossRef]
  32. Freund, O.; Tau, L.; Weiss, T.E.; Zornitzki, L.; Frydman, S.; Jacob, G.; Bornstein, G. Associations of vaccine status with characteristics and outcomes of hospitalized severe COVID-19 patients in the booster era. PLoS ONE 2022, 17, e0268050. [Google Scholar] [CrossRef]
  33. Thompson, M.G.; Stenehjem, E.; Grannis, S.; Ball, S.W.; Naleway, A.L.; Ong, T.C.; DeSilva, M.B.; Natarajan, K.; Bozio, C.H.; Lewis, N.; et al. Effectiveness of COVID-19 Vaccines in Ambulatory and Inpatient Care Settings. N. Engl. J. Med. 2021, 385, 1355–1371. [Google Scholar] [CrossRef]
  34. Landi, F.; Barillaro, C.; Bellieni, A.; Brandi, V.; Carfì, A.; D’Angelo, M.; Fusco, D.; Landi, G.; Monaco, R.L.; Martone, A.M.; et al. The New Challenge of Geriatrics: Saving Frail Older People from the SARS-COV-2 Pandemic Infection. J. Nutr. Health Aging 2020, 24, 466–470. [Google Scholar] [CrossRef]
  35. Barek, A.; Aziz, A.; Islam, M.S. Impact of age, sex, comorbidities and clinical symptoms on the severity of COVID-19 cases: A meta-analysis with 55 studies and 10014 cases. Heliyon 2020, 6, e05684. [Google Scholar] [CrossRef] [PubMed]
  36. Saelee, R.; Zell, E.; Murthy, B.P.; Castro-Roman, P.; Fast, H.; Meng, L.; Shaw, L.; Gibbs-Scharf, L.; Chorba, T.; Harris, L.Q.; et al. Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties—United States, December 14, 2020–January 31, 2022. MMWR. Morb. Mortal. Wkly. Rep. 2022, 71, 335–340. [Google Scholar] [CrossRef]
  37. Roy, D.N.; Huda, N.; Azam, S. Factors influencing COVID-19 vaccine acceptance and hesitancy among rural community in Bangladesh: A cross-sectional survey based study. Hum. Vaccines Immunother. 2022, 18, 2064685. [Google Scholar] [CrossRef]
  38. Harun, G.D.; Anwar, M.U.; Sumon, S.A.; Hassan, Z.; Haque, T.; Mah-E-Muneer, S.; Rahman, A.; Abdullah, S.A.H.M.; Islam, S.; Styczynski, A.R.; et al. Infection prevention and control in tertiary care hospitals of Bangladesh: Results from WHO infection prevention and control assessment framework (IPCAF). Antimicrob. Resist. Infect. Control. 2022, 11, 125. [Google Scholar] [CrossRef] [PubMed]
  39. Harun, G.D.; Anwar, M.U.; Sumon, S.A.; Hassan, Z.; Mohona, T.M.; Rahman, A.; Abdullah, S.A.H.M.; Islam, S.; Kaydos-Daniels, S.C.; Styczynski, A.R. Rationale and guidance for strengthening infection prevention and control measures and antimicrobial stewardship programs in Bangladesh: A study protocol. BMC Health Serv. Res. 2022, 22, 1239. [Google Scholar] [CrossRef] [PubMed]
  40. Halim, M.; Halim, A.; Tjhin, Y. COVID-19 vaccination efficacy and safety literature review. J. Clin. Med. Res. 2021, 3, 1–10. [Google Scholar] [CrossRef] [PubMed]
  41. Tagoe, E.T.; Sheikh, N.; Morton, A.; Nonvignon, J.; Sarker, A.R.; Williams, L.; Megiddo, I. COVID-19 Vaccination in Lower-Middle Income Countries: National Stakeholder Views on Challenges, Barriers, and Potential Solutions. Front. Public Health 2021, 9, 709127. [Google Scholar] [CrossRef]
  42. Galanakis, E.; Jansen, A.; Lopalco, P.L.; Giesecke, J. Ethics of mandatory vaccination for healthcare workers. Euro. Surveill. 2013, 18, 20627. [Google Scholar] [CrossRef] [Green Version]
  43. Maltezou, H.C.; Poland, G.A. Immunization of Health-Care Providers: Necessity and Public Health Policies. Healthcare 2016, 4, 47. [Google Scholar] [CrossRef]
Figure 1. Morality by COVID-19 vaccination status among hospitalized patients.
Figure 1. Morality by COVID-19 vaccination status among hospitalized patients.
Vaccines 10 01987 g001
Table 1. Key characteristics of study participants by hospital.
Table 1. Key characteristics of study participants by hospital.
[N = 783]
Hospital 1
[N = 344]
Hospital 2
[N = 322]
Hospital 3
[N = 117]
n/N (%)
Age (in years)
Median (IQR)56.0 [47.0–66.0]58.5 [50.0–58.5]54.0 [44.0–66.0]60.0 [50.0–68.0]
25–40109 (13.9)47 (13.7)57 (17.7)5 (4.3)
41–50157 (20.0)69 (20.1)58 (18.0)30 (25.6)
51–60208 (26.6)82 (23.8)90 (27.9)36 (30.8)
61–70173 (22.1)92 (26.7)55 (17.1)26 (22.2)
>70136 (17.4)54 (15.7)62 (19.3)20 (17.1)
Sex: Male391 (50.0)179 (52.0)147 (45.6)65 (55.6)
Religion: Muslim726 (92.7)321 (93.3)296 (91.9)109 (93.2)
Day labor24 (3.1)15 (4.4)3 (1.0)6 (5.1)
Business170 (21.7)82 (23.8)34 (10.5)54 (46.1)
Service153 (19.5)84 (24.4)38 (11.8)31 (26.5)
Housewife291 (37.2)118 (34.3)169 (52.5)4 (3.4)
Agriculture40 (5.1)9 (2.6)12 (3.7)19 (16.2)
No employment105 (13.4)30 (8.7)66 (20.5)3 (2.6)
Living place
Rural400 (51.1)197 (57.3)148 (46.0)55 (47.0)
Urban383 (48.9)147 (42.7)174 (54.0)62 (53.0)
Had comorbidities652 (71.8)216 (62.8)256 (79.5)90 (76.9)
Hospitalization status, by vaccine
Unvaccinated587 (75.0)255 (74.1)301 (93.5)31 (26.5)
Vaccinated (any dose)196 (25.0)89 (25.9)21 (6.5)86 (73.5)
COVID-19 Vaccination status
Double doses124 (15.8)37 (10.8)19 (5.9)68 (58.1)
Single doses72 (9.2)52 (15.1)2 (0.6)18 (15.4)
Final Outcome
Recovered and discharged721 (92.1)313 (91.0)294 (91.3)112 (95.7)
Died62 (7.9)29 (8.4)28 (8.7)5 (4.3)
Table 2. Key Characteristics of study participants by vaccination status.
Table 2. Key Characteristics of study participants by vaccination status.
Hospitalized Patients, by Vaccine
n (%)
n (%)
Male391283 (72.4)108 (27.6)
Female392303 (77.3)89 (22.7)
Living area
Urban383269 (70.2)114 (29.8)
Rural400317 (79.2)83 (20.8)
Had comorbidities562414 (73.7)148 (26.3)
O2 required634477 (75.2)157 (24.8)
ICU required244184 (75.4)60 (24.6)
Severity187138 (73.8)49 (26.2)
Died6259 (95.2)3 (4.8)
Table 3. Associated factors with mortality of enrolled participants.
Table 3. Associated factors with mortality of enrolled participants.
UOR (95%CI)p-ValueAOR (95%CI)p-Value
25–40ref ref
41–501.29 (0.46–3.61)0.6231.61 (0.55–4.73)0.388
51–600.69 (0.23–2.03)0.4970.67 (0.22–2.11)0.512
61–701.63 (0.61–4.34)0.3281.44 (0.51–4.02)0.488
>703.31 (1.29–8.49)0.0133.16 (1.16–8.58)0.024
Hospitalization by vaccine
Vaccinatedref ref
Unvaccinated7.19 (2.28–23.20)0.0017.17 (2.21–23.27)0.001
Had Comorbidities
Unvaccinated10.72 (2.57–44.55)0.0019.98 (2.39–41.68)0.002
O2 required
Vaccinatedref ref
Unvaccinated10.31 (2.49–42.75)0.00110.25 (2.46–42.69)0.001
ICU required
Vaccinatedref ref
Unvaccinated6.81 (1.59–29.24)0.0107.74 (1.78–33.74)0.006
Vaccinatedref ref
Unvaccinated6.53 (1.50–28.4)0.0126.98 (1.57–30.92)0.011
UOR = unadjusted odds ratio, AOR = adjusted odds ratio; (only variables with p values < 0.25 on univariate were put into multivariate regression model).
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Rahman, M.S.; Harun, M.G.D.; Sumon, S.A.; Mohona, T.M.; Abdullah, S.A.H.M.; Khan, M.N.H.; Gazi, M.I.; Islam, M.S.; Anwar, M.M.U. Hospitalization and Mortality by Vaccination Status among COVID-19 Patients Aged ≥ 25 Years in Bangladesh: Results from a Multicenter Cross-Sectional Study. Vaccines 2022, 10, 1987.

AMA Style

Rahman MS, Harun MGD, Sumon SA, Mohona TM, Abdullah SAHM, Khan MNH, Gazi MI, Islam MS, Anwar MMU. Hospitalization and Mortality by Vaccination Status among COVID-19 Patients Aged ≥ 25 Years in Bangladesh: Results from a Multicenter Cross-Sectional Study. Vaccines. 2022; 10(12):1987.

Chicago/Turabian Style

Rahman, Md. Saydur, Md. Golam Dostogir Harun, Shariful Amin Sumon, Tahrima Mohsin Mohona, Syed Abul Hassan Md Abdullah, Md. Nazuml Huda Khan, Md. Ismail Gazi, Md. Saiful Islam, and Md. Mahabub Ul Anwar. 2022. "Hospitalization and Mortality by Vaccination Status among COVID-19 Patients Aged ≥ 25 Years in Bangladesh: Results from a Multicenter Cross-Sectional Study" Vaccines 10, no. 12: 1987.

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop