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

• Type of Material: Article
• Authors: Mark W Tenforde, CDC COVID 19 Response Team; Wesley H Self, Vanderbilt University; Yuwei Zhu, Vanderbilt Univ Sch Med; Eric A Naioti, CDC COVID 19 Response Team; Manjusha Gaglani, Baylor Scott & White Health, Temple; Adit A Ginde, University of Colorado, Aurora; Kelly Jensen, University of Colorado, Aurora; Keipp H Talbot, Vanderbilt University; Jonathan D Casey, Vanderbilt University; Nicholas M Mohr, University of Iowa; Anne Zepeski, University of Iowa; Tresa McNeal, Baylor Scott & White Health, Temple; Shekhar Ghamande, Baylor Scott & White Health, Temple; Kevin W Gibbs, Wake Forest University; Clark D Files, Wake Forest University; David N Hager, Johns Hopkins Hospital; Arber Shehu, Johns Hopkins Hospital; Matthew E Prekker, Hennepin County Medical Center, Minneapolis; Heidi L Erickson, Hennepin County Medical Center, Minneapolis; Michelle N Gong, Albert Einstein College of Medicine; Amira Mohamed, Albert Einstein College of Medicine; Nicholas J Johnson, University of Washington; Vasisht Srinivasan, University of Washington; Jay S Steingrub, Baystate Medical Center; Ithan D Peltan, Intermountain Medical Center; Samuel M Brown, Intermountain Medical Center; Emily T Martin, University of Utah; Arnold S Monto, University of Utah; Akram Khan, Oregon Health & Science University Hospital; Catherine L Hough, Oregon Health & Science University Hospital; Laurence Busse, Emory University; Caitilin ten Lohuis, Emory University; Abhijit Duggal, Cleveland Clinic; Jennifer G Wilson, Stanford University; Nida Qadir, Ronald Reagan-UCLA Medical Center; Steven Y Chang, Ronald Reagan-UCLA Medical Center; Christopher Mallow, University of Miami; Carolina Rivas, University of Miami; Hilary M Babcock, Washington University, St. Louis; Jennie H Kwon, Washington University, St. Louis; Matthew C Exline, Ohio State University; Mena M Botros, Ohio State University; Adam S Lauring, University of Michigan; Nathan Shapiro, Beth Israel Deaconess Medical Center; Natasha Halasa, Vanderbilt University Medical Center; James D Chappell, Vanderbilt University Medical Center; Carlos G Grijalva, Vanderbilt University Medical Center; Todd W Rice, Vanderbilt University Medical Center; Ian D Jones, Vanderbilt University Medical Center; William B Stubblefield, Vanderbilt University Medical Center; Adrienne Baughman, Vanderbilt University Medical Center; Kesley N Womack, Vanderbilt University Medical Center; Jillian P Rhoads, Vanderbilt University Medical Center; Christopher J Lindsell, Vanderbilt University Medical Center; Kimberly W Hart, Vanderbilt University Medical Center; Caitlin Turbyfill, CDC COVID 19 Response Team; Samantha Olson, CDC COVID 19 Response Team; Nancy Murray, CDC COVID 19 Response Team; Katherine Adams, CDC COVID 19 Response Team; Manish M Patel, CDC COVID 19 Response Team
• Language: English
• Date: 2022-05-17
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022, Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2022.
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciac381
• Title of Journal or Parent Work: CLINICAL INFECTIOUS DISEASES
• Keywords: Science & Technology; duration of protection; Microbiology; Life Sciences & Biomedicine; waning; VACCINATION; COVID-19; BNT162B2; Infectious Diseases; vaccine effectiveness; mRNA; 2-DOSE; SARS-COV-2 INFECTION; Immunology; COVID-19 VACCINES

Abstract

BACKGROUND: COVID-19 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 March 11 - December 15, 2021, including COVID-19 case patients and RT-PCR-negative controls. We included adults who were unvaccinated or vaccinated with two 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 two) and continuous time modeled using restricted cubic splines. RESULTS: 10,078 patients were included, 4906 cases (23% vaccinated) and 5172 controls (62% vaccinated). Median age was 60 years (IQR 46-70), 56% were non-Hispanic White, and 81% had ≥1 medical condition. Among immunocompetent adults, VE <180 days was 90% (95%CI: 88-91) vs 82% (95%CI: 79-85) at ≥180 days (p < 0.001). VE declined for Pfizer-BioNTech (88% to 79%, p < 0.001) and Moderna (93% to 87%, p < 0.001) products, for younger adults (18-64 years) [91% to 87%, p = 0.005], and for adults ≥65 years of age (87% to 78%, p < 0.001). In models using restricted cubic splines, similar changes were observed. CONCLUSION: In a period largely pre-dating Omicron variant circulation, effectiveness of two mRNA doses against COVID-19-associated hospitalization was largely sustained through 9 months.