Protection of Messenger RNA Vaccines Against Hospitalized Coronavirus Disease 2019 in Adults Over the First Year Following Authorization in the United States

Author:

Tenforde Mark W1,Self Wesley H2,Zhu Yuwei2,Naioti Eric A1,Gaglani Manjusha34,Ginde Adit A5,Jensen Kelly5,Talbot H Keipp2,Casey Jonathan D2,Mohr Nicholas M6,Zepeski Anne6,McNeal Tresa34,Ghamande Shekhar34,Gibbs Kevin W7,Files D Clark7,Hager David N8,Shehu Arber8,Prekker Matthew E9,Erickson Heidi L9,Gong Michelle N10,Mohamed Amira10,Johnson Nicholas J11,Srinivasan Vasisht11,Steingrub Jay S12,Peltan Ithan D13,Brown Samuel M13,Martin Emily T14,Monto Arnold S14,Khan Akram15,Hough Catherine L15,Busse Laurence W16,Lohuis Caitlin ten16,Duggal Abhijit17,Wilson Jennifer G18,Qadir Nida19,Chang Steven Y19,Mallow Christopher20,Rivas Carolina20,Babcock Hilary M21,Kwon Jennie H21,Exline Matthew C22,Botros Mena M22,Lauring Adam S23,Shapiro Nathan I24,Halasa Natasha2,Chappell James D2,Grijalva Carlos G2,Rice Todd W2,Jones Ian D2,Stubblefield William B2,Baughman Adrienne2,Womack Kelsey N2,Rhoads Jillian P2,Lindsell Christopher J2,Hart Kimberly W2,Turbyfill Caitlin1,Olson Samantha1,Murray Nancy1,Adams Katherine1,Patel Manish M1,

Affiliation:

1. CDC COVID-19 Response Team , Atlanta, Georgia , USA

2. Vanderbilt University Medical Center , Nashville, Tennessee , USA

3. Baylor Scott & White Health , Temple, Texas , USA

4. Texas A&M University College of Medicine , Temple, Texas , USA

5. University of Colorado School of Medicine , Aurora, Colorado , USA

6. University of Iowa , Iowa City, Iowa , USA

7. Wake Forest University Baptist Medical Center , Winston-Salem, North Carolina , USA

8. Johns Hopkins Hospital , Baltimore, Maryland , USA

9. Hennepin County Medical Center , Minneapolis, Minnesota , USA

10. Montefiore Healthcare Center, Albert Einstein College of Medicine , Bronx, New York , USA

11. University of Washington School of Medicine , Seattle, Washington , USA

12. Baystate Medical Center , Springfield, Massachusetts , USA

13. Intermountain Medical Center and University of Utah , Salt Lake City, Utah , USA

14. University of Michigan School of Public Health , Ann Arbor, Michigan , USA

15. Oregon Health & Science University Hospital , Portland, Oregon , USA

16. Emory University School of Medicine , Atlanta, Georgia , USA

17. Cleveland Clinic , Cleveland, Ohio , USA

18. Stanford University School of Medicine , Palo Alto, California , USA

19. Ronald Reagan-UCLA Medical Center , Los Angeles, California , USA

20. University of Miami , Miami, Florida , USA

21. Washington University , St. Louis, Missouri , USA

22. Ohio State University Wexner Medical Center , Columbus, Ohio , USA

23. University of Michigan School of Medicine , Ann Arbor, Michigan , USA

24. Beth Israel Deaconess Medical Center , Boston, Massachusetts , USA

Abstract

Abstract Background Coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccines were authorized in the United States in December 2020. Although vaccine effectiveness (VE) against mild infection declines markedly after several months, limited understanding exists on the long-term durability of protection against COVID-19–associated hospitalization. Methods Case-control analysis of adults (≥18 years) hospitalized at 21 hospitals in 18 states 11 March–15 December 2021, including COVID-19 case patients and reverse transcriptase-polymerase chain reaction–negative controls. We included adults who were unvaccinated or vaccinated with 2 doses of a mRNA vaccine before the date of illness onset. VE over time was assessed using logistic regression comparing odds of vaccination in cases versus controls, adjusting for confounders. Models included dichotomous time (<180 vs ≥180 days since dose 2) and continuous time modeled using restricted cubic splines. Results A total of 10 078 patients were included, 4906 cases (23% vaccinated) and 5172 controls (62% vaccinated). Median age was 60 years (interquartile range, 46–70), 56% were non-Hispanic White, and 81% had ≥1 medical condition. Among immunocompetent adults, VE <180 days was 90% (95% confidence interval [CI], 88–91) versus 82% (95% CI, 79–85) at ≥180 days (P < .001). VE declined for Pfizer-BioNTech (88% to 79%, P < .001) and Moderna (93% to 87%, P < .001) products, for younger adults (18–64 years) (91% to 87%, P = .005), and for adults ≥65 years of age (87% to 78%, P < .001). In models using restricted cubic splines, similar changes were observed. Conclusions In a period largely predating Omicron variant circulation, effectiveness of 2 mRNA doses against COVID-19–associated hospitalization was largely sustained through 9 months.

Funder

United States Centers for Disease Control and Prevention

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

Reference30 articles.

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