1887
  1. Home
  2. Eurosurveillance
  3. Volume 31, Issue 15, 16/Apr/2026
  4. Article
Research Open Access
Like 0
Download

2025 theme: Vaccines

Abstract

BACKGROUND

Vaccinations against COVID-19 were integrated into routine care in Germany in April 2023. However, evidence of the impact of seasonal vaccination remains limited.

AIM

To assess the clinical and economic impact of COVID-19 vaccination in routine care during the early SARS-CoV-2-endemic phase in Germany.

METHODS

A retrospective cohort study using statutory health insurance data from two German federal states (Saxony and Thuringia), covering over 3 million individuals, was conducted. Adults aged ≥ 18 years vaccinated against COVID-19 between 1 September and 30 November 2023 were matched 1:1 with unvaccinated individuals using propensity scores. Outcomes during the 4-month follow-up included occurrence of SARS-CoV-2 infection, long COVID, other respiratory infections, hospitalisations, mortality, healthcare costs and indirect costs caused by sick leave. Rate and hazard ratios (RR, HR) with 95% confidence intervals (CI) were calculated. Sensitivity analyses tested robustness.

RESULTS

A total of 146,132 individuals (73,066 per group) were matched. COVID-19 vaccination was associated with reduced rates of long COVID (RR: 0.43; 95% CI: 0.26–0.70), respiratory infections (RR: 0.91; 95% CI: 0.87–0.95) and COVID-19-related hospitalisations (RR: 0.41; 95% CI: 0.31–0.54). All-cause mortality was 25% lower among COVID-19-vaccinated individuals (HR: 0.76; 95% CI: 0.70–0.82). Healthcare costs were lower in the vaccinated cohort, particularly for inpatient care, e.g. EUR 1 million savings in COVID-19-related hospitalisations. Indirect costs caused by sick leave were also reduced by EUR 1.3 million.

CONCLUSION

Seasonal COVID-19 vaccinations in routine care settings were associated with substantial clinical and economic benefits. These real-world findings support continued implementation of national immunisation recommendations during the endemic phase of SARS-CoV-2 circulation.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2026.31.15.2500672
2026-04-16
2026-05-15
/content/10.2807/1560-7917.ES.2026.31.15.2500672
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/31/15/eurosurv-31-15-5.html?itemId=/content/10.2807/1560-7917.ES.2026.31.15.2500672&mimeType=html&fmt=ahah

References

  1. World Health Organization (WHO). Statement on the fifteenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic. Geneva: WHO; 2023. Available from: https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic
  2. Katz MA, Cohuet S, Bino S, Tarkhan-Mouravi O, Kryeziu B, Otorbaeva D, et al. COVID-19 vaccine effectiveness against SARS-CoV-2-confirmed hospitalisation in the eastern part of the WHO European Region (2022-2023): a test-negative case-control study from the EuroSAVE network. Lancet Reg Health Eur. 2024;47:101095.  https://doi.org/10.1016/j.lanepe.2024.101095  PMID: 39726724 
  3. Tolksdorf K, Goerlitz L, Gvaladze T, Haas W, Buda S. SARI-Hospitalisierungsinzidenz. [SARI hospitalization incidence]. Berlin: Zenodo. [Accessed: 28 Jul 2025]. German. Available from: https://zenodo.org/records/15421898
  4. World Health Organization Regional Office for Europe (WHO/Europe). Guidance on developing national COVID-19 vaccination policy and integrating COVID-19 vaccination into national immunization programmes and broader health care delivery mechanisms in the WHO European Region. Copenhagen: WHO/Europe; 2023. Available from: https://www.who.int/europe/publications/i/item/WHO-EURO-2023-7892-47660-70230
  5. Robert Koch Institute (RKI). Empfehlungen der Ständigen Impfkommission (STIKO) beim Robert Koch-Institut 2025. [Recommendations of the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute 2025]. Berlin: RKI; 2025. German. Available from: https://www.rki.de/DE/Aktuelles/Publikationen/Epidemiologisches-Bulletin/2025/04_25.pdf?__blob=publicationFile&v=7
  6. Koch J, Piechotta V, Berner R, Bogdan C, Burchard G, Heininger U, et al. Empfehlung der STIKO zur Implementierung der COVID-19-Impfung in die Empfehlungen der STIKO 2023 und die dazugehörige wissenschaftliche Begründung. [STIKO recommendation for integrating COVID-19 vaccination into the STIKO recommendations 2023 and the associated scientific rationale.] Berlin: Robert Koch-Institut; 2023. German. Available from: https://www.rki.de/DE/Aktuelles/Publikationen/Epidemiologisches-Bulletin/2023/21_23.pdf?__blob=publicationFile&v=3
  7. Robert Koch Institute (RKI). VacMap – Dashboard zum Impfgeschehen in Deutschland. [VacMap – Dashboard on vaccination activity in Germany]. Berlin: RKI. [Accessed: 28 Jul 2025]. German. Available from: https://www.rki.de/DE/Themen/Infektionskrankheiten/Impfen/Impfquoten/VacMap/vacmap.html
  8. European Centre for Disease Prevention and Control (ECDC). COVID-19 vaccination coverage in the EU/EEA during the 2023-24 season campaigns. Stockholm: ECDC; 2024. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/covid19-vaccination-coverage-2023-2024.pdf
  9. European Medicines Agency (EMA). Comirnaty: EMA recommends approval of adapted COVID-19 vaccine targeting Omicron XBB.1.5. Amsterdam: EMA. [Accessed: 28 Jul 2025]. Available from: https://www.ema.europa.eu/en/news/comirnaty-ema-recommends-approval-adapted-covid-19-vaccine-targeting-omicron-xbb15
  10. European Medicines Agency (EMA). Spikevax: EMA recommends approval of adapted COVID-19 vaccine targeting Omicron XBB.1.5. Amsterdam: EMA. [Accessed: 28 Jul 2025]. Available from: https://www.ema.europa.eu/en/news/spikevax-ema-recommends-approval-adapted-covid-19-vaccine-targeting-omicron-xbb15
  11. Robert Koch Institute (RKI). Digitales Impfquotenmonitoring zur COVID-19-Impfung (bis 30.6.2024). [Digital vaccination coverage monitoring for COVID-19 vaccination (until 30 June 2024).]. Berlin: RKI. [Accessed: 28 Jul 2025]. German. Available from: https://www.rki.de/DE/Themen/Infektionskrankheiten/Impfen/Impfungen-A-Z/COVID-19/Impfquoten/Impfquoten-Tab.html
  12. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine. Boston. N Engl J Med. 2020;383(27):2603-15.  https://doi.org/10.1056/NEJMoa2034577  PMID: 33301246 
  13. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. Boston. N Engl J Med. 2021;384(5):403-16.  https://doi.org/10.1056/NEJMoa2035389  PMID: 33378609 
  14. Müller S, Schmetz A, Knaul JK, Wilke T, Yang J, Dornig S, et al. COVID-19 disease burden in the Omicron variant-dominated endemic phase: insights from the ROUTINE-COV19 study using real-world German statutory health insurance data. Basel. Viruses. 2025;17(3):424.  https://doi.org/10.3390/v17030424  PMID: 40143351 
  15. Federal Institute for Drugs and Medical Devices (BfArM). ICD-10-GM. International Statistical Classification of Diseases. German modification. 10th revision. Bonn/Köln: BfArM; 2021. Available from: https://www.bfarm.de/EN/Code-systems/Classifications/ICD/ICD-10-GM/_node.html
  16. Chae JW, Song CS, Kim H, Lee KB, Seo BS, Kim DI. Prediction of mortality in patients undergoing maintenance hemodialysis by Charlson Comorbidity Index using ICD-10 database. Nephron Clin Pract. 2011;117(4):c379-84.  https://doi.org/10.1159/000321525  PMID: 21071962 
  17. van Walraven C, Austin PC, Jennings A, Quan H, Forster AJ. A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data. Med Care. 2009;47(6):626-33.  https://doi.org/10.1097/MLR.0b013e31819432e5  PMID: 19433995 
  18. van den Ham HA, Klungel OH, Singer DE, Leufkens HGM, van Staa TP, van den HH, et al. Comparative performance of ATRIA, CHADS2, and CHA2DS2-VASc risk scores predicting stroke in patients with atrial fibrillation: results from a national primary care database. J Am Coll Cardiol. 2015;66(17):1851-9.  https://doi.org/10.1016/j.jacc.2015.08.033  PMID: 26493655 
  19. Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (BAuA). Volkswirtschaftliche Kosten durch Arbeitsunfähigkeit. [Federal Institute for Occupational Safety and Health. Economic costs due to work incapacity.]. Berlin: BAuA. [Accessed: 1 Oct 2024]. German. Available from: https://www.baua.de/DE/Themen/Monitoring-Evaluation/Zahlen-Daten-Fakten/Kosten-der-Arbeitsunfaehigkeit
  20. Piechotta V, Koch J, Berner R, Bogdan C, Burchard G, Heininger U, et al. Aktualisierung der COVID-19-Impfempfehlung in den allgemeinen Empfehlungen der STIKO 2024 und die dazugehörige wissenschaftliche Begründung. [Update of the COVID-19 vaccination recommendation within the general STIKO recommendations 2024 and the associated scientific rationale.]. Berlin: Robert Koch Institute; 2024. German. Available from: https://edoc.rki.de/handle/176904/11455
  21. Robert Koch Institute (RKI). Long COVID. Berlin: RKI. [Accessed: 29 Jul 2025]. German. Available from: https://www.rki.de/SharedDocs/FAQs/DE/COVID-19/Long-COVID/FAQ_Liste_Gesundheitliche_Langzeitfolgen.html
  22. Tesch F, Ehm F, Loser F, Bechmann L, Vivirito A, Wende D, et al. Post-viral symptoms and conditions are more frequent in COVID-19 than influenza, but not more persistent. BMC Infect Dis. 2024;24(1):1126.  https://doi.org/10.1186/s12879-024-10059-y  PMID: 39385128 
  23. Wulf Hanson S, Abbafati C, Aerts JG, Al-Aly Z, Ashbaugh C, Ballouz T, et al. Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA. 2022;328(16):1604-15.  https://doi.org/10.1001/jama.2022.18931  PMID: 36215063 
  24. Jackson LA, Jackson ML, Nelson JC, Neuzil KM, Weiss NS. Evidence of bias in estimates of influenza vaccine effectiveness in seniors. Int J Epidemiol. 2006;35(2):337-44.  https://doi.org/10.1093/ije/dyi274  PMID: 16368725 
  25. Simonsen L, Taylor RJ, Viboud C, Miller MA, Jackson LA. Mortality benefits of influenza vaccination in elderly people: an ongoing controversy. Lancet Infect Dis. 2007;7(10):658-66.  https://doi.org/10.1016/S1473-3099(07)70236-0  PMID: 17897608 
  26. Stoliaroff-Pepin A, Peine C, Herath T, Lachmann J, Hellenbrand W, Perriat D, et al. Vaccine effectiveness against severe COVID-19 during the Omicron wave in Germany: results from the COViK study. Infection. 2023;51(4):1093-102.  https://doi.org/10.1007/s15010-023-02012-z  PMID: 36913112 
  27. European Centre for Disease Prevention and Control (ECDC). COVID-19 vaccination coverage in the EU/EEA during the 2023-24 season campaigns. Stockholm: ECDC; 2024. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/covid19-vaccination-coverage-2023-2024.pdf
  28. Matveeva O, Shabalina SA. Comparison of vaccination and booster rates and their impact on excess mortality during the COVID-19 pandemic in European countries. Front Immunol. 2023;14:1151311.  https://doi.org/10.3389/fimmu.2023.1151311  PMID: 37483606 
  29. Ikeokwu AE, Adeniran OF, Marwizi FM, Kolade-Ernest OJ, Solomon RO, Ogedengbe W, et al. A meta-analysis to ascertain the effectiveness of COVID-19 vaccines on clinical outcomes in North America. San Francisco. Cureus. 2023;15(6):e41053. PMID: 37519527 
  30. Solanki G, Cleary S, Little F. Impact of COVID-19 vaccination on hospitalization, hospital utilization and expenditure for COVID-19: A retrospective cohort analysis of a South African private health insured population. PLoS One. 2025;20(1):e0317686.  https://doi.org/10.1371/journal.pone.0317686  PMID: 39854537 
  31. Whittaker R, Bråthen Kristofferson A, Valcarcel Salamanca B, Seppälä E, Golestani K, Kvåle R, et al. Length of hospital stay and risk of intensive care admission and in-hospital death among COVID-19 patients in Norway. Amsterdam. Clin Microbiol Infect. 2022;28(6):871-8.  https://doi.org/10.1016/j.cmi.2022.01.033  PMID: 35219807 
  32. Parenica J, Benesova K, Radvan M, Sanca O, Hlasensky J, Lokaj P, et al. COVID-19 vaccine booster significantly decreases ICU hospitalization risk in heart failure patients during Omicron. Lausanne. Front Cardiovasc Med. 2022;9:998842.  https://doi.org/10.3389/fcvm.2022.998842  PMID: 36337877 
  33. Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-90.  https://doi.org/10.1038/s41591-022-01689-3  PMID: 35132265 
  34. Heidecker B, Libby P, Vassiliou VS, Roubille F, Vardeny O, Hassager C, et al. Vaccination as a new form of cardiovascular prevention: ESC clinical consensus statement. Eur Heart J. 2025;46(36):3518-3531.  https://doi.org/10.1093/eurheartj/ehaf384  PMID: 40582710 
  35. Wissenschaftliches Institut der AOK (WidO). Fehltage 2024. [Sick leave days 2024.]. Berlin: WIdO. [Accessed: 29 Jul 2025]. German. Available from: https://www.wido.de/news-presse/pressemitteilungen/2025/40-prozent-aller-fehltage-2024-wegen-langzeit-erkrankungen
  36. Teerawattananon Y, Anothaisintawee T, Pheerapanyawaranun C, Botwright S, Akksilp K, Sirichumroonwit N, et al. A systematic review of methodological approaches for evaluating real-world effectiveness of COVID-19 vaccines: Advising resource-constrained settings. PLoS One. 2022;17(1):e0261930.  https://doi.org/10.1371/journal.pone.0261930  PMID: 35015761 
  37. Lund JL, Horváth-Puhó E, Komjáthiné Szépligeti S, Sørensen HT, Pedersen L, Ehrenstein V, et al. Conditioning on future exposure to define study cohorts can induce bias: the case of low-dose acetylsalicylic acid and risk of major bleeding. Clin Epidemiol. 2017;9:611-26.  https://doi.org/10.2147/CLEP.S147175  PMID: 29200891 
  38. Lustig RH. Hypothalamic obesity after craniopharyngioma: mechanisms, diagnosis, and treatment. Front Endocrinol (Lausanne). 2011;2:60.  https://doi.org/10.3389/fendo.2011.00060  PMID: 22654817 
  39. Swart E, Gothe H, Geyer S, Jaunzeme J, Maier B, Grobe TG, et al. [Good Practice of Secondary Data Analysis (GPS): guidelines and recommendations]. Gesundheitswesen. 2015;77(2):120-6. German. https://doi.org/10.1055/s-0034-1396815  PMID: 25622207 
Clinical and economic benefits of seasonal COVID-19 vaccination in Germany: results from the ROUTINE-COV19 Study, September 2022 to March 2024
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Andrea+Schmetz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schmetz Andrea</a>, <a href="/search?value1=Julia+Knaul&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Knaul Julia</a>, <a href="/search?value1=Sabrina+M%C3%BCller&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Müller Sabrina</a>, <a href="/search?value1=Thomas+Wilke&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wilke Thomas</a>, <a href="/search?value1=Jingyan+Yang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Yang Jingyan</a>, <a href="/search?value1=Christoph+Spinner&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Spinner Christoph</a>, <a href="/search?value1=Clara+Lehmann&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lehmann Clara</a></span>. Clinical and economic benefits of seasonal COVID-19 vaccination in Germany: results from the ROUTINE-COV19 Study, September 2022 to March 2024. <a href="/content/ecdc">Euro Surveill.</a> 2026;31(15):pii=2500672. <a href="https://doi.org/10.2807/1560-7917.ES.2026.31.15.2500672" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2026.31.15.2500672</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 29 Aug 2025;&nbsp;&nbsp; <span class="generated">Accepted</span>: 02 Dec 2025 </span> </p>
/content/10.2807/1560-7917.ES.2026.31.15.2500672
/content/10.2807/1560-7917.ES.2026.31.15.2500672
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error