Effectiveness of Severe Acute Respiratory Syndrome Coronavirus 2 Messenger RNA Vaccines for Preventing Coronavirus Disease 2019 Hospitalizations in the United States

Author:

Tenforde Mark W1,Patel Manish M1,Ginde Adit A2,Douin David J3,Talbot H Keipp4,Casey Jonathan D5,Mohr Nicholas M6,Zepeski Anne6,Gaglani Manjusha7,McNeal Tresa7,Ghamande Shekhar7,Shapiro Nathan I8,Gibbs Kevin W9,Files D Clark9,Hager David N10,Shehu Arber10,Prekker Matthew E11,Erickson Heidi L12,Exline Matthew C13,Gong Michelle N14,Mohamed Amira15,Henning Daniel J16,Steingrub Jay S17,Peltan Ithan D18,Brown Samuel M18,Martin Emily T19,Monto Arnold S19,Khan Akram20,Hough Catherine L20,Busse Laurence W21,ten Lohuis Caitlin C22,Duggal Abhijit23,Wilson Jennifer G24,Gordon Alexandra June24,Qadir Nida25,Chang Steven Y25,Mallow Christopher26,Gershengorn Hayley B26,Babcock Hilary M27,Kwon Jennie H27,Halasa Natasha28,Chappell James D28,Lauring Adam S29,Grijalva Carlos G30,Rice Todd W5,Jones Ian D31,Stubblefield William B31,Baughman Adrienne31,Womack Kelsey N32,Lindsell Christopher J33,Hart Kimberly W33,Zhu Yuwei33,Olson Samantha M1,Stephenson Meagan1,Schrag Stephanie J1,Kobayashi Miwako1,Verani Jennifer R1,Self Wesley H34,

Affiliation:

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

2. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA

3. Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA

4. Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA

5. Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA

6. Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA

7. Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA

8. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

9. Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA

10. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

11. Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA

12. Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA

13. Department of Medicine, The Ohio State University, Columbus, Ohio, USA

14. Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA

15. Department of Medicine, Montefiore Medical Center, Bronx, New York, USA

16. Department of Emergency Medicine, University of Washington, Seattle, Washington, USA

17. Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA

18. Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah, USA

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

20. Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, USA

21. Department of Medicine, Emory University, Atlanta, Georgia, USA

22. Emory Critical Care Center, Emory Healthcare, Atlanta, Georgia, USA

23. Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA

24. Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA

25. Department of Medicine, University of California-Los Angeles, Los Angeles, California, USA

26. Department of Medicine, University of Miami, Miami, Florida, USA

27. Department of Medicine, Washington University, St. Louis, Missouri, USA

28. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA

29. Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, USA

30. Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA

31. Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA

32. Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA

33. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA

34. Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Abstract

Abstract Background As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination coverage increases in the United States, there is a need to understand the real-world effectiveness against severe coronavirus disease 2019 (COVID-19) and among people at increased risk for poor outcomes. Methods In a multicenter case-control analysis of US adults hospitalized March 11–May 5, 2021, we evaluated vaccine effectiveness to prevent COVID-19 hospitalizations by comparing odds of prior vaccination with a messenger RNA (mRNA) vaccine (Pfizer-BioNTech or Moderna) between cases hospitalized with COVID-19 and hospital-based controls who tested negative for SARS-CoV-2. Results Among 1212 participants, including 593 cases and 619 controls, median age was 58 years, 22.8% were Black, 13.9% were Hispanic, and 21.0% had immunosuppression. SARS-CoV-2 lineage B0.1.1.7 (Alpha) was the most common variant (67.9% of viruses with lineage determined). Full vaccination (receipt of 2 vaccine doses ≥14 days before illness onset) had been received by 8.2% of cases and 36.4% of controls. Overall vaccine effectiveness was 87.1% (95% confidence interval [CI], 80.7–91.3). Vaccine effectiveness was similar for Pfizer-BioNTech and Moderna vaccines, and highest in adults aged 18–49 years (97.4%; 95% CI, 79.3–9.7). Among 45 patients with vaccine-breakthrough COVID hospitalizations, 44 (97.8%) were ≥50 years old and 20 (44.4%) had immunosuppression. Vaccine effectiveness was lower among patients with immunosuppression (62.9%; 95% CI,20.8–82.6) than without immunosuppression (91.3%; 95% CI, 85.6–94.8). Conclusion During March–May 2021, SARS-CoV-2 mRNA vaccines were highly effective for preventing COVID-19 hospitalizations among US adults. SARS-CoV-2 vaccination was beneficial for patients with immunosuppression, but effectiveness was lower in the immunosuppressed population.

Funder

US Centers for Disease Control and Prevention

Clinical and Translational Science

National Institute of Allergy And Infectious Diseases, National Institutes of Health

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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