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

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.

PMID: 34358310
PMCID: PMC8436392
DOI: 10.1093/cid/ciab687

Multicenter Study

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

Mark W Tenforde et al. Clin Infect Dis. 2022.

. 2022 May 3;74(9):1515-1524.

doi: 10.1093/cid/ciab687.

Authors

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.

PMID: 34358310
PMCID: PMC8436392
DOI: 10.1093/cid/ciab687

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.

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Update of

Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing Covid-19 Hospitalizations in the United States.
Tenforde MW, Patel MM, Ginde AA, Douin DJ, Talbot HK, Casey JD, Mohr NM, Zepeski A, Gaglani M, McNeal T, Ghamande S, Shapiro NI, Gibbs KW, Files DC, Hager DN, Shehu A, Prekker ME, Erickson HL, Exline MC, Gong MN, Mohamed A, Henning DJ, Steingrub JS, Peltan ID, Brown SM, Martin ET, Monto AS, Khan A, Hough CT, Busse L, Lohuis CCT, Duggal A, Wilson JG, Gordon AJ, Qadir N, Chang SY, Mallow C, Gershengorn HB, Babcock HM, Kwon JH, Halasa N, Chappell JD, Lauring AS, Grijalva CG, Rice TW, Jones ID, Stubblefield WB, Baughman A, Womack KN, Lindsell CJ, Hart KW, Zhu Y, Olson SM, Stephenson M, Schrag SJ, Kobayashi M, Verani JR, Self WH; Influenza and Other Viruses in the Acutely Ill (IVY) Network. Tenforde MW, et al. medRxiv [Preprint]. 2021 Jul 8:2021.07.08.21259776. doi: 10.1101/2021.07.08.21259776. medRxiv. 2021. Update in: Clin Infect Dis. 2022 May 3;74(9):1515-1524. doi: 10.1093/cid/ciab687. PMID: 34268515 Free PMC article. Updated. Preprint.

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

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

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