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

• Authors: Laurence Busse, Emory University; MW Tenforde, CDC COVID 19 Response Team; WH Self, Vanderbilt Univ Sch Med; Y Zhu, Vanderbilt Univ Sch Med; EA Naioti, CDC COVID 19 Response Team; M Gaglani, Baylor Scott & White Hlth; AA Ginde, Univ Colorado; K Jensen, Univ Colorado; HK Talbot, Vanderbilt Univ Sch Med; JD Casey, Vanderbilt Univ Sch Med; NM Mohr, University of Iowa; A Zepeski, University of Iowa; T McNeal, Baylor Scott & White Hlth; S Ghamande, Baylor Scott & White Hlth; KW Gibbs, Wake Forest University; DC Files, Wake Forest University; DN Hager, Johns Hopkins Univ Hosp; A Shehu, Johns Hopkins Univ Hosp; ME Prekker, Hennepin Cty Med Ctr; HL Erickson, Hennepin Cty Med Ctr; MN Gong, Albert Einstein College of Medicine; A Mohamed, Albert Einstein College of Medicine; NJ Johnson, University of Washington; V Srinivasan, University of Washington; JS Steingrub, Baystate Med Ctr; ID Peltan, Intermountain Med Ctr; SM Brown, Intermountain Med Ctr; ET Martin, University of Utah; AS Monto, University of Utah; A Khan, Oregon Hlth & Sci Univ Hosp; CL Hough, Oregon Hlth & Sci Univ Hosp; C ten Lohuis, Emory University; A Duggal, Cleveland Clin; JG Wilson, Stanford University; N Qadir, Ronald Reagan UCLA Med Ctr; SY Chang, Ronald Reagan UCLA Med Ctr; C Mallow, University of Miami; C Rivas, University of Miami; HM Babcock, Washington Univ; JH Kwon, Washington Univ; MC Exline, Ohio State University; MM Botros, Ohio State University; AS Lauring, University of Michigan; N Shapiro, Beth Israel Deaconess Med Ctr; N Halasa, Vanderbilt Univ Sch Med; JD Chappell, Vanderbilt Univ Sch Med; CG Grijalva, Vanderbilt Univ Sch Med; TW Rice, Vanderbilt Univ Sch Med; ID Jones, Vanderbilt Univ Sch Med; WB Stubblefield, Vanderbilt Univ Sch Med; A Baughman, Vanderbilt Univ Sch Med; KN Womack, Vanderbilt Univ Sch Med; JP Rhoads, Vanderbilt Univ Sch Med; CJ Lindsell, Vanderbilt Univ Sch Med; KW Hart, Vanderbilt Univ Sch Med; C Turbyfill, CDC COVID 19 Response Team; S Olson, CDC COVID 19 Response Team; N Murray, CDC COVID 19 Response Team; K Adams, CDC COVID 19 Response Team; MM Patel, CDC COVID 19 Response Team
• Journal Title: CLINICAL INFECTIOUS DISEASES
• Volume: Volume, Number
• Publisher: OXFORD UNIV PRESS INC | 2022-05-17
• Type of Work: Article
• Publisher DOI: http://doi.org/10.1093/cid/ciac381
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Microbiology; COVID-19; duration of protection; waning; vaccine effectiveness; mRNA; COVID-19 VACCINES; SARS-COV-2 INFECTION; VACCINATION; BNT162B2; 2-DOSE

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.