Association of mRNA Vaccination With Clinical and Virologic Features of COVID-19 Among US Essential and Frontline Workers
Author:
, Joseph Gregory1, Barnes John1, Azziz-Baumgartner Eduardo1, Arvay Melissa1, Fry Alicia1, Hall Aron1, Kutty Preeta1, MacNeil Adam1, Donald L. Clifford1, Reynolds Sue1, Schrag Stephan1, Shang Nong1, Slaughter Robert1, Thornburg Natalie1, Verani Jennife1, Wang Rose1, Hunt Danielle R.1, Sokol Brian1, Bloodworth Robin1, Douglas Claire1, Gerber Isaiah1, Hadden Louise1, Harder Jenna1, McGarry Nancy1, Pickett Steve1, Poe Brandon P.1, Shea Meghan1, Thacker John1, Zheng Pearl1, Mistry Peenaz1, Patlan Kelly1, Flores Jessica1, Duque Jazmin1, Edwards Laura J.1, Etolue Jini1, LeClair Lindsay1, Prather Khaila1, Smith Michael E.1, Murthy Kempapura1, Calhoun Nicole1, Hoffman Eric1, Zayed Martha1, Blais Joel1, Ettlinger Jason1, Settele Natalie1, Patel Rupande1, Priest Elisa1, Thomas Jennifer1, Jatla Muralidhar1, Beeram Madhava1, Arroliga Alejandro1, Prado Yolanda1, Sapp Daniel S.1, Lee Mi1, Hornbrook Matt1, Bialobok Kristin1, Alaspa Jennifer1, Stafki Daniel1, Robinson Mary1, Dolezilek Jill1, Hoffman Leia1, Connor Tyna1, Luzio Catherine1, Kendrick Samantha1, Cowling Hannah1, Healy Olivia1, Tovar Gavin1, Jarrah Meccah1, Nsengiyunva Assumpta1, Slocum Alison1, Steffen Lili1, Smidt Saskia1, Coleman Alissa1, Deal Carly1, Hanson Hanna1, Trejo Italia1, Makar Jeremy1, Grijalva Sofia1, Jovel Krystal1, Sharma Priyanka1, Sun Xiaoxiao1, Nikolich-Žugich Janko 1, Gerald Joe K.1, Fisher Juli1, Krupp Karl1, Gerald Lynn1, Littau Sally1, Ramadan Ferris1, Woods Erin1, Miiro Flavia1, Arani Gayatri1, Tang Nicholas1, Baccam Nora1, Lowe Ashley1, Lobos Amelia1, Yingst April1, Stea Danielle1, Mayhew Natalya1, Nava Raul1, Porter Cynthia1, Carmona Andrea1, strong Ariyah1, Flangos Ashlyn1, Klinck Caroline1, Pikowski Celia1, Hendrix Chloe1, Perez Cielo1, Morris Cierra1, Goebert Erika1, Taylor Gianna1, Sowell Jayla1, Scott Jen1, Mirabito Joe1, Baker Jordan1, Naff Kaitlyn1, Carson Karysa1, Obrien Kennedy1, Earley Kiara1, Mevises Kristisha1, Martinez Mayra1, Pena Mya1, Hilyard Raven1, Islam Rezwana1, Perlman Riley1, Murray Sarah1, Capell Shelby1, Bigler Sienna1, Thomas Ta’Nya1, Butcher Tatum1, Graham Taylor1, Rojas Christian1, Jones John1, Astor Brandon1, Lee Ian A.1, Desai Meghal S.1, Gomez Victoria1, Reyes Rachael1, Gallimore-Wilson Damena1, Noriega Roger1, Reyes Annabel1, Madan Brigitte1, Cruz Alexandra1, Carrera Olga1, Suarez Nathaly1, Feliciano Paola1, Garibaldi Johanna1, Green Aimee1, Testoff Addison1, Brown Rachel T.1, Schaefer Camie1, Arteaga Arlyne1, Bruner Matthew1, Dawson Daniel1, Eden Emilee1, Praggastis Jenna1, Stanford Joseph1, Mayer Jeanma1, Stucki Marcus1, Campbell Riley1, Tran Kathy1, Smith Madele1, Black Braydon1, Pick Christina1, Tallman Madison1, Cox Chapman1, Wong Derrick1, Langston Michael1, Fugal Adriel1, Tsang Fiona1, Wheeler Maya1, Maughan Gretchen1, Wilson Megan1, Stinson Pasha1, Williams Jesse1, Smith Taryn1, Reed Seon1, Mao Jinyi1, allacher Nikki1, Chatard Kendal1, Vo Jenna1, Luong Katie1, Jordin Ryder1, Stewart Grace1, Bourdelle Brock1, Powaukee Timina1, Minoughan Max1, Whiting Hannah1, Souza Anika1, Arlington Ian1, Anderson Lauren1, Stubbs Trevor1, Park Katherine1, Jones Talesha1, Thompson Mark G.2, Yoon Sarang K.3, Naleway Allison L.4, Meece Jennifer5, Fabrizio Thomas P.6, Caban-Martinez Alberto J.7, Burgess Jefferey L.8, Gaglani Manjusha910, Olsho Lauren E.W.11, Bateman Allen12, Lundgren Jessica13, Grant Lauren2, Phillips Andrew L.3, Groom Holly C.4, Stefanski Elisha5, Solle Natasha Schaefer7, Ellingson Katherine8, Lutrick Karen14, Dunnigan Kayan9, Wesley Meredith G.11, Guenther Kyley12, Hunt Angela13, Mak Josephine2, Hegmann Kurt T.3, Kuntz Jennifer L.4, Bissonnette Adam5, Hollister James8, Rose Spencer9, Morrill Tyler C.11, Respet Karley13, Fowlkes Ashley L.2, Thiese Matthew S.3, Rivers Patrick14, Herring Meghan K.11, Odean Marilyn J.15, Yoo Young M.2, Brunner Matthew3, Bedrick Edward J.8, Fleary Deanna E.11, Jones John T.2, Praggastis Jenna3, Romine James8, Dickerson Monica2, Khan Sana M.8, Lamberte Julie Mayo2, Beitel Shawn8, Webby Richard J.6, Tyner Harmony L.13
Affiliation:
1. The HEROES-RECOVER Network 2. Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia 3. Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah 4. Kaiser Permanente Northwest Center for Health Research, Portland, Oregon 5. Marshfield Clinic Research Institute, Marshfield, Wisconsin 6. St Jude Children's Research Hospital, Memphis, Tennessee 7. Leonard M. Miller School of Medicine, University of Miami, Miami, Florida 8. Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona 9. Baylor Scott and White Health, Temple, Texas 10. Texas A&M University College of Medicine, Temple 11. Abt Associates Inc, Rockville, Maryland 12. Wisconsin State Laboratory of Hygiene, Madison 13. St Luke’s Regional Health Care System, Duluth, Minnesota 14. College of Medicine - Tucson, University of Arizona, Tucson 15. Whiteside Institute for Clinical Research, St Luke’s, Duluth, Minnesota
Abstract
ImportanceData on the epidemiology of mild to moderately severe COVID-19 are needed to inform public health guidance.ObjectiveTo evaluate associations between 2 or 3 doses of mRNA COVID-19 vaccine and attenuation of symptoms and viral RNA load across SARS-CoV-2 viral lineages.Design, Setting, and ParticipantsA prospective cohort study of essential and frontline workers in Arizona, Florida, Minnesota, Oregon, Texas, and Utah with COVID-19 infection confirmed by reverse transcriptase–polymerase chain reaction testing and lineage classified by whole genome sequencing of specimens self-collected weekly and at COVID-19 illness symptom onset. This analysis was conducted among 1199 participants with SARS-CoV-2 from December 14, 2020, to April 19, 2022, with follow-up until May 9, 2022, reported.ExposuresSARS-CoV-2 lineage (origin strain, Delta variant, Omicron variant) and COVID-19 vaccination status.Main Outcomes and MeasuresClinical outcomes included presence of symptoms, specific symptoms (including fever or chills), illness duration, and medical care seeking. Virologic outcomes included viral load by quantitative reverse transcriptase–polymerase chain reaction testing along with viral viability.ResultsAmong 1199 participants with COVID-19 infection (714 [59.5%] women; median age, 41 years), 14.0% were infected with the origin strain, 24.0% with the Delta variant, and 62.0% with the Omicron variant. Participants vaccinated with the second vaccine dose 14 to 149 days before Delta infection were significantly less likely to be symptomatic compared with unvaccinated participants (21/27 [77.8%] vs 74/77 [96.1%]; OR, 0.13 [95% CI, 0-0.6]) and, when symptomatic, those vaccinated with the third dose 7 to 149 days before infection were significantly less likely to report fever or chills (5/13 [38.5%] vs 62/73 [84.9%]; OR, 0.07 [95% CI, 0.0-0.3]) and reported significantly fewer days of symptoms (10.2 vs 16.4; difference, −6.1 [95% CI, −11.8 to −0.4] days). Among those with Omicron infection, the risk of symptomatic infection did not differ significantly for the 2-dose vaccination status vs unvaccinated status and was significantly higher for the 3-dose recipients vs those who were unvaccinated (327/370 [88.4%] vs 85/107 [79.4%]; OR, 2.0 [95% CI, 1.1-3.5]). Among symptomatic Omicron infections, those vaccinated with the third dose 7 to 149 days before infection compared with those who were unvaccinated were significantly less likely to report fever or chills (160/311 [51.5%] vs 64/81 [79.0%]; OR, 0.25 [95% CI, 0.1-0.5]) or seek medical care (45/308 [14.6%] vs 20/81 [24.7%]; OR, 0.45 [95% CI, 0.2-0.9]). Participants with Delta and Omicron infections who received the second dose 14 to 149 days before infection had a significantly lower mean viral load compared with unvaccinated participants (3 vs 4.1 log10 copies/μL; difference, −1.0 [95% CI, −1.7 to −0.2] for Delta and 2.8 vs 3.5 log10 copies/μL, difference, −1.0 [95% CI, −1.7 to −0.3] for Omicron).Conclusions and RelevanceIn a cohort of US essential and frontline workers with SARS-CoV-2 infections, recent vaccination with 2 or 3 mRNA vaccine doses less than 150 days before infection with Delta or Omicron variants, compared with being unvaccinated, was associated with attenuated symptoms, duration of illness, medical care seeking, or viral load for some comparisons, although the precision and statistical significance of specific estimates varied.
Publisher
American Medical Association (AMA)
Cited by
19 articles.
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