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

Mark W Tenforde; Manish M Patel; Adit A Ginde; David J Douin; H Keipp Talbot; Jonathan D Casey; Nicholas M Mohr; Anne Zepeski; Manjusha Gaglani; Tresa McNeal; Shekhar Ghamande; Nathan I Shapiro; Kevin W Gibbs; D Clark Files; David N Hager; Arber Shehu; Matthew E Prekker; Heidi L Erickson; Matthew C Exline; Michelle N Gong; Amira Mohamed; Daniel J Henning; Jay S Steingrub; Ithan D Peltan; Samuel M Brown; Emily T Martin; Arnold S Monto; Akram Khan; Catherine L Hough; Laurence W Busse; Caitlin C Ten Lohuis; Abhijit Duggal; Jennifer G Wilson; Alexandra June Gordon; Nida Qadir; Steven Y Chang; Christopher Mallow; Hayley B Gershengorn; Hilary M Babcock; Jennie H Kwon; Natasha Halasa; James D Chappell; Adam S Lauring; Carlos G Grijalva; Todd W Rice; Ian D Jones; William B Stubblefield; Adrienne Baughman; Kelsey N Womack; Christopher J Lindsell; Kimberly W Hart; Yuwei Zhu; Samantha M Olson; Meagan Stephenson; Stephanie J Schrag; Miwako Kobayashi; Jennifer R Verani; Wesley H Self; Influenza and Other Viruses in the Acutely Ill (IVY) Network

doi:10.1093/cid/ciab687

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

Clin Infect Dis. 2022 May 3;74(9):1515-1524. doi: 10.1093/cid/ciab687.

Authors

Mark W Tenforde¹, Manish M Patel¹, Adit A Ginde², David J Douin³, H Keipp Talbot⁴, Jonathan D Casey⁵, Nicholas M Mohr⁶, Anne Zepeski⁶, Manjusha Gaglani⁷, Tresa McNeal⁷, Shekhar Ghamande⁷, Nathan I Shapiro⁸, Kevin W Gibbs⁹, D Clark Files⁹, David N Hager¹⁰, Arber Shehu¹⁰, Matthew E Prekker¹¹, Heidi L Erickson¹², Matthew C Exline¹³, Michelle N Gong¹⁴, Amira Mohamed¹⁵, Daniel J Henning¹⁶, Jay S Steingrub¹⁷, Ithan D Peltan¹⁸, Samuel M Brown¹⁸, Emily T Martin¹⁹, Arnold S Monto¹⁹, Akram Khan²⁰, Catherine L Hough²⁰, Laurence W Busse²¹, Caitlin C Ten Lohuis²², Abhijit Duggal²³, Jennifer G Wilson²⁴, Alexandra June Gordon²⁴, Nida Qadir²⁵, Steven Y Chang²⁵, Christopher Mallow²⁶, Hayley B Gershengorn²⁶, Hilary M Babcock²⁷, Jennie H Kwon²⁷, Natasha Halasa²⁸, James D Chappell²⁸, Adam S Lauring²⁹, Carlos G Grijalva³⁰, Todd W Rice⁵, Ian D Jones³¹, William B Stubblefield³¹, Adrienne Baughman³¹, Kelsey N Womack³², Christopher J Lindsell³³, Kimberly W Hart³³, Yuwei Zhu³³, Samantha M Olson¹, Meagan Stephenson¹, Stephanie J Schrag¹, Miwako Kobayashi¹, Jennifer R Verani¹, Wesley H Self³⁴; Influenza and Other Viruses in the Acutely Ill (IVY) Network

Affiliations

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

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.

Keywords: COVID-19; hospitalized; immunocompromised; mRNA vaccines; vaccine effectiveness.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adult
COVID-19 Vaccines
COVID-19* / epidemiology
COVID-19* / prevention & control
Hospitalization
Humans
Middle Aged
RNA
SARS-CoV-2
United States / epidemiology
mRNA Vaccines

Substances

COVID-19 Vaccines
mRNA Vaccines
RNA

Abstract

Publication types

MeSH terms

Substances

Grants and funding