Epidemiology of COVID-19 outbreaks in aged care facilities during postvaccine period: a systematic review and meta-analysis.

Publication date: Mar 14, 2024

We aimed to define the epidemiology of COVID-19 outbreaks in aged care facilities (ACFs) during the postvaccine period, including vaccine effectiveness (VE) for this high-risk group. Systematic review and meta-analysis. Ovid Medline, Ovid Embase, Scopus, Web of Science and Cochrane databases were searched through 1 September 2023. Any original observational studies and trials reporting data on COVID-19 outbreaks among the partially/fully vaccinated residents from ACFs during or after the worldwide implementation of vaccine roll-out. We estimated the attack rate, case fatality rate, mortality rate and VE during postvaccine period. Random effect model was adopted for meta-analysis. Quality assessment on all included studies was performed using the Meta Quality Appraisal Tool. 38 articles were included from 12 countries reporting 79 outbreaks with 1708 confirmed cases of COVID-19 from 78 ACFs. The pooled attack rate was 28% (95% CI 20% to 37%) among the fully vaccinated residents. Two-thirds (62. 5%) of the index cases were unvaccinated healthcare professionals (eg, physicians, nurses) and caregivers. Unvaccinated residents had a significantly higher rates (12%) (95% CI 7% to 19%) of mortality compared with the vaccinated residents (2%) (95% CI% 1 to 4%) and the post-COVID-19 vaccine estimates for case fatality rate (13% vs 23%) and hospitalisation rate (17% vs 37%) were substantially lower. VE in preventing disease among residents in ACFs was 73% (95% CI 49% to 86). Overall, the included studies were heterogeneous in nature, however, the risk of bias was low to moderate. Our study reaffirmed the impact of vaccination as a key public health measure to minimise the burden of COVID-19 in ACFs. Facilities with higher crowding indexes should be prioritised for vaccination and should advocate for higher vaccination targets among staff and residents as a critical intervention strategy to minimise disease burden in this vulnerable population.

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Concepts Keywords
Attack Aged
Epidemiology COVID-19
Vaccines Public health
Systematic Review


Type Source Name
disease MESH COVID-19
disease VO vaccine effectiveness
disease VO vaccinated
disease VO vaccine
disease IDO quality
disease VO unvaccinated
disease VO COVID-19 vaccine
disease VO vaccination
drug DRUGBANK Etoperidone
disease IDO intervention
disease VO population
disease MESH morbidity
disease MESH infection
disease MESH death
disease VO Canada
disease IDO country
disease IDO facility
disease IDO virulence
drug DRUGBANK Coenzyme M
disease VO protocol
disease VO vaccine dose
disease VO dose
disease IDO process
disease VO USA
disease VO frequency

Original Article

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