COVID-19 Mortality and Vaccination Coverage Among Older Adults in Tunisia, 2020–2022: A National Descriptive and Ecological Study

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Abstract
Background: Older adults experienced a disproportionate burden of COVID-19 mortality, but national evidence is limited. We described COVID-19 mortality among adults aged ≥65 years (March 2020–December 2022) and vaccination coverage among adults aged ≥60 years (March 2021–December 2022). Methods: We conducted a retrospective national descriptive and ecological study using ONMNE mortality surveillance and aggregated EVAX vaccination data. We calculated mortality, age-standardized, and proportional mortality rates; vaccination coverage; dropout proportions; and no-show rates. Results: Of 29,306 COVID-19 deaths, 20,467 (69.8%) occurred among adults aged ≥65 years; 8,725 (42.6%) were aged ≥80 years and 11,463 (56.0%) were male. Cumulative mortality was 1,809.9 per 100,000, with the highest period-specific rate during Delta predominance (750.1 per 100,000). Coverage among adults aged ≥60 years was 95.4% for at least one dose, 88.3% for primary-schedule completion, and 38.4% for a third dose; cumulative uptake was 215.1 doses per 100. Coverage varied by governorate; no-show rates increased in 2022. Conclusions: Mortality was concentrated among the oldest-old and during Delta predominance. Coverage was high nationally but uneven geographically, and booster uptake and attendance declined. Targeted outreach and equitable access remain priorities.

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