Understanding COVID-19 vaccine effectiveness (VE) in preventing severe disease is critical to inform vaccine policy. We used the test-negative design to estimate VE against SARS-CoV-2-confirmed hospitalisation in adults ≥18 years in the eastern WHO European Region. We included patients hospitalised for severe acute respiratory infection (SARI) at sentinel surveillance sites in Albania, Georgia, Kyrgyzstan, North Macedonia, Serbia, and in Kosovo. We collected demographic information, COVID-19 vaccination history, and tested respiratory samples for SARS-CoV-2 by RT-PCR. We calculated VE of any vaccine dose received within 12 months (Annual VE) as [(1 − adjusted Odds Ratio) x 100%] using a one-stage pooled analysis. The reference group included unvaccinated individuals and those who received their last vaccine >12 months before symptom onset. During 1 January 1, 2022–November 20, 2023, of 5162 patients, 57.0% (2942) were unvaccinated, 2.5% (129) received only one dose, 26.0% (1340) received only two doses (originally considered a primary series vaccine (PS)), 13.2% (683) received three doses only, and 1.3% (68) received four doses. Most PS vaccines and boosters were BNT162b2 (46.4% (622/1340) and 64.9% (443/683), respectively) and CoronaVac (23.0% (309/1340) and 18.3% (125/683)). No patients received Ad26.COV2.S (Johnson and Johnson) vaccines. Overall, 1009/5162 (19.5%) patients were SARS-CoV-2-positive. VE was 60.1% (95% Confidence Interval (CI) 12.4–81.8) for last vaccine received 14–89 days before symptom onset, 60.0% (95% CI 32.2–76.4) for 90–179 days, 7.0% (95% CI −28.5 to 32.7) for 180–269 days, and −5.4% (95% CI −43.8 to 22.8) for 270–365 days.) During nearly two years of Omicron circulation in the eastern WHO European Region, COVID-19 vaccination reduced the risk of hospitalisations by more than half for 6 months following vaccination. This study was funded by the World Health Organization, Regional Office for Europe through a cooperative agreement with the 10.13039/100000030 U.S. Centers for Disease Control and Prevention .

Background—Non-communicable diseases (NCDs) affect a growing share of the population in Kosovo. The country faces challenges with NCDs management, specifically detecting, screening, and treating people with NCDs. Objective—To assess the management of NCDs, including the inputs that influence the provision of NCDs and outcomes of NCD management. Eligibility criteria—Studies had to report NCD management in Kosovo. Sources of evidence—We systematically searched Google Scholar, PubMed, Scopus, and Web of Science. Charting methods—The data were charted by two researchers. We extracted data on general study details and design and information on the management and outcomes of NCDs in Kosovo. Synthesis of results—For the mix of studies that were included in the review, thematic narrative synthesis was used. We developed a conceptual framework based on health production core components to analyze the data. Results—Kosovo’s health care system is available to provide basic care for patients with NCDs. However, there are serious limitations in the availability of key inputs providing care, i.e., funding, medicines, supplies, and medical staff. Additionally, in terms of the management of NCDs, there are areas for improvement, such as limited application of clinical pathways and guidelines and issues with referrals of patients among levels and sectors of care. Finally, it is worth noting that there is overall limited information on NCD management and outcomes. Conclusions—Kosovo provides only basic services and treatment of NCDs. The data reporting the existing situation on NCD management are limited. The inputs from this review are helpful for existing policy efforts by the government aimed to enhance NCD care in Kosovo. Funding—This study is part of the research done for a World Bank review of the state of NCDs in Kosovo and was funded through the Access Accelerated Trust Fund (P170638).

Acute myocardial infarction (AMI) remains a major global health problem, being the leading cause of both morbidity and mortality. We aim to present the temporal trends, demographic, clinical characteristics and risk factors of AMI in Kosovo. We conducted a retrospective, single-center observational study at the Clinic of Cardiology, University Clinical Center of Kosovo, having analyzed all patients admitted with AMI between January 2014 and December 2024. STEMI and NSTEMI cases were diagnosed according to ESC criteria. Patient’s risk factors, biomarkers, PCI, and outcome data were extracted from hospital clinical records. Latent class analysis identified patient subgroups based on risk profiles. Temporal trends and projections of AMI incidence (per 100,000 population) were analyzed using polynomial and Joinpoint regression models. Statistical comparisons employed Chi-squared, t-tests, or Mann-Whitney U tests. Over the course of 11 years, 13,099 AMI patients (mean age 63.8 years; 29% female) were admitted; 55% had STEMI and 45% NSTEMI. Annual Age-standardized incidence increased from 23.5 to 86.4 per 100,000 (2014–2021) then fell to 71.3 in 2024. Hypertension (66%), smoking (47%), diabetes (34%) and dyslipidemia were highly prevalent. Latent class analysis identified four distinct patient clusters with varying combinations of smoking, diabetes, hypertension and family history of cardiovascular disease (CVD) (p < 0.001). STEMI patients were younger, more often male and smokers, while NSTEMI patients were older with higher rates of diabetes, hypertension and prior LBBB. In-hospital mortality was 9.15%, higher for STEMI (~12%) than NSTEMI (~6%), and declined markedly over time (19.3% in 2014 vs 7–10% in 2022, p < 0.001). In a developing country, Kosovo, STEMI was more frequent than NSTEMI, affecting younger male patients. The leading risk factors included arterial hypertension, smoking, diabetes mellitus, and a family history of CVD. The decline in acute MI related mortality over recent years, can be explained by the increasing use of myocardial reperfusion procedures. Furthermore, the rates of acute MI related complications are not different from neighboring countries.

Introduction: The COVID-19 pandemic has had an extensive impact on public health worldwide. However, in many countries burden of disease indicators for COVID-19 have not yet been calculated or used for monitoring. The present study protocol describes an approach developed in the project “The Burden of Disease due to COVID-19. Towards a harmonization of population health metrics for the surveillance of dynamic outbreaks” (BoCO-19). The process of data collection and aggregation across 14 different countries and sub-national regions in Southern and Eastern Europe and Central Asia is described, as well as the methodological approaches used. Materials and methods: The study implemented in BoCO-19 is a secondary data analysis, using information from national surveillance systems as part of mandatory reporting on notifiable diseases. A customized data collection template is used to gather aggregated data on population size as well as COVID-19 cases and deaths. Years of life lost (YLL), as one component of the number of Disability Adjusted Life Years (DALY), are calculated as described in a recently proposed COVID-19 disease model (the ‘Burden-EU’ model) for the calculation of DALY. All-cause mortality data are collected for excess mortality sensitivity analyses. For the calculation of Years lived with disability (YLD), the Burden-EU model is adapted based on recent evidence. Because Covid-19 cases vary in terms of disease severity, the possibility and suitability of applying a uniform severity distribution of cases across all countries and sub-national regions will be explored. An approach recently developed for the Global Burden of Disease Study, that considers post-acute consequences of COVID-19, is likely to be adopted. Findings will be compared to explore the quality and usability of the existing data, to identify trends across age-groups and sexes and to formulate recommendations concerning potential improvements in data availability and quality. Discussion: BoCO-19 serves as a collaborative platform in order to build international capacity for the calculation of burden of disease indicators, and to support national experts in the analysis and interpretation of country-specific data, including their strengths and weaknesses. Challenges include inherent differences in data collection and reporting systems between countries, as well as assumptions that have to be made during the calculation process.

Background: Updated regional data on COVID‐19 epidemiology and vaccination can inform vaccine policies and implementation strategies.Methods: We used surveillance data on patients hospitalized from the European SARI Vaccine Effectiveness (EuroSAVE) network to describe COVID‐19 epidemiology and COVID‐19 vaccine uptake among adults hospitalized with severe acute respiratory infection (SARI) in six middle‐income countries and areas (CAs) in the WHO European region during 2022–2024. For SARI patients, we collected data on demographics, comorbidities, vaccination status, and hospital course, and a respiratory specimen, which was tested for SARS‐CoV‐2 by RT‐PCR. In October 2024, we surveyed national public health institute staff on national COVID‐19 vaccine guidelines and availability.Results: Of SARI patients, 833/3982 (20.9%) and 367/3752 (9.8%) tested positive for SARS‐CoV‐2 during May 2022–April 2023 and May 2023–April 2024, respectively. Of COVID‐19 patients, 857 (71.4%) were ≥60 years old and 713 (59.4%) had ≥1 comorbidity. A higher proportion of COVID‐19 patients required mechanical ventilation (30 [8.2%] vs. 23 [2.8%], p <0.001) and intensive care (70 [8.4%] vs. 48 [13.1%], p =0.016) during May 2023–April 2024 compared to May 2022–April 2023. COVID‐19 vaccination in the last 12 months decreased from 25% in 2022–2023 to 3% in 2023–2024. Most CAs had not updated their COVID‐19 vaccination guidelines to recommend annual vaccination, and only two had vaccines available.Conclusions: Although COVID‐19 was associated with severe disease among SARI patients, COVID‐19 vaccination uptake was low among priority populations recommended for vaccination by WHO guidance. Continued efforts to understand reasons for low vaccine uptake and improve vaccine access will help protect those at greatest risk for COVID‐19‐associated morbidity and mortality.

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.