Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing Covid-19 Hospitalizations in the United States.

• Type of Material: Article
• Authors: Mark W Tenforde, CDC COVID-19 Response Team, Atlanta, Georgia.; Manish M Patel, CDC COVID-19 Response Team, Atlanta, Georgia.; Adit A Ginde, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado.; David J Douin, Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado.; Keipp H Talbot, Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.; Jonathan D Casey, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.; Nicholas M Mohr, Department of Emergency Medicine, University of Iowa, Iowa City, Iowa.; Anne Zepeski, Department of Emergency Medicine, University of Iowa, Iowa City, Iowa.; Manjusha Gaglani, Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas.; Tresa McNeal, Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas.; Shekhar Ghamande, Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas.; Nathan I Shapiro, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.; Kevin W Gibbs, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.; Clark D Files, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.; David N Hager, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Arber Shehu, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Matthew E Prekker, Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.; Heidi L Erickson, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.; Matthew C Exline, Department of Medicine, The Ohio State University, Columbus, Ohio.; Michelle N Gong, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York.; Amira Mohamed, Department of Medicine, Montefiore Medical Center, Bronx, New York.; Daniel J Henning, Department of Emergency Medicine, University of Washington, Seattle, Washington.; Ithan D Peltan, Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah.; Samuel M Brown, Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah.; Emily T Martin, School of Public Health, University of Michigan, Ann Arbor, Michigan.; Arnold S Monto, School of Public Health, University of Michigan, Ann Arbor, Michigan.; Akram Khan, Department of Medicine, Oregon Health and Sciences University, Portland, Oregon.; Terri C Hough, Department of Medicine, Oregon Health and Sciences University, Portland, Oregon.; Laurence Busse, Emory University; Caitlin ten C Lohuis, Emory Critical Care Center, Emory Healthcare, Atlanta, Georgia.; Abhijit Duggal, Department of Medicine, Cleveland Clinic, Cleveland, Ohio.; Jennifer G Wilson, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California.; Alexandra June Gordon, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California.; Nida Qadir, Department of Medicine, University of California-Los Angeles, Los Angeles, California.; Steven Y Chang, Department of Medicine, University of California-Los Angeles, Los Angeles, California.; Christopher Mallow, Department of Medicine, University of Miami, Miami, Florida.; Hayley B Gershengorn, Department of Medicine, University of Miami, Miami, Florida.; Hilary M Babcock, Department of Medicine, Washington University, St. Louis, Missouri.; Jennie H Kwon, Department of Medicine, Washington University, St. Louis, Missouri.; Natasha Halasa, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.; James D Chappell, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.; Adam S Lauring, Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan.; Carlos G Grijalva, Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.; Todd W Rice, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.; Ian D Jones, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.; William B Stubblefield, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.; Adrienne Baughman, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.; Kelsey N Womack, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee.; Christopher J Lindsell, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.; Kimberly W Hart, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.; Yuwei Zhu, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.; Samantha M Olson, CDC COVID-19 Response Team, Atlanta, Georgia.; Meagan Stephenson, CDC COVID-19 Response Team, Atlanta, Georgia.; Stephanie J Schrag, CDC COVID-19 Response Team, Atlanta, Georgia.; Miwako Kobayashi, CDC COVID-19 Response Team, Atlanta, Georgia.; Jennifer Verani, Emory University; Wesley H Self, Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee.
• Language: English
• Date: 2021-07-08
• Publisher: Oxford University Press for the Infectious Diseases Society of America
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [e-mail].
• Final Published Version (URL): http://dx.doi.org/10.1101/2021.07.08.21259776
• Title of Journal or Parent Work: medRxiv
• Keywords: United States; Covid-19; SARS-CoV-2; Hospitalizations; mRNA Vaccines
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Biostatistics

Abstract

BACKGROUND: As SARS-CoV-2 vaccination coverage increases in the United States (US), there is a need to understand the real-world effectiveness against severe 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 an 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 1210 participants, median age was 58 years, 22.8% were Black, 13.8% were Hispanic, and 20.6% had immunosuppression. SARS-CoV-2 lineage B.1.1.7 was most common variant (59.7% of sequenced viruses). Full vaccination (receipt of two vaccine doses ≥14 days before illness onset) had been received by 45/590 (7.6%) cases and 215/620 (34.7%) controls. Overall vaccine effectiveness was 86.9% (95% CI: 80.4 to 91.2%). Vaccine effectiveness was similar for Pfizer-BioNTech and Moderna vaccines, and highest in adults aged 18-49 years (97.3%; 95% CI: 78.9 to 99.7%). 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 (59.2%; 95% CI: 11.9 to 81.1%) than without immunosuppression (91.3%; 95% CI: 85.5 to 94.7%). 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.