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Observational Study
. 2022 Jul 1;5(7):e2219940.
doi: 10.1001/jamanetworkopen.2022.19940.

Association of BNT162b2 Vaccine Third Dose Receipt With Incidence of SARS-CoV-2 Infection, COVID-19-Related Hospitalization, and Death Among Residents of Long-term Care Facilities, August to October 2021

Khitam Muhsen  1 , Nimrod Maimon  2   3   4 , Amiel Yaron Mizrahi  2 , Baruch Varticovschi  2 , Omri Bodenheimer  2 , Dani Cohen  1 , Ron Dagan  3
Affiliations
Observational Study

Association of BNT162b2 Vaccine Third Dose Receipt With Incidence of SARS-CoV-2 Infection, COVID-19-Related Hospitalization, and Death Among Residents of Long-term Care Facilities, August to October 2021

Khitam Muhsen et al. JAMA Netw Open. .

Abstract

Importance: COVID-19 vaccine might be less immunogenic and effective among residents of long-term care facilities (LTCFs).

Objective: To examine the association of BNT162b2 third dose (first booster dose) with overall SARS-CoV-2 infection, COVID-19 hospitalizations, and mortality among LTCF residents during a nationwide surge of the Delta variant in Israel.

Design, setting, and participants: This observational cohort study conducted nationwide COVID-19 surveillance in LTCFs in Israel between August and October 2021. Participants were residents of LTCFs aged 60 years or older.

Exposures: Vaccination with the third dose of BNT162b2 vaccine vs receipt of 2 doses at least 5 months earlier, based on self-preference and choice.

Main outcomes and measures: The cumulative incidences of reverse transcription-polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection, COVID-19 hospitalizations, and COVID-19-related deaths more than 7 days after vaccination with the third dose were compared between the groups using Kaplan-Meier curves. Hazard ratios (HRs) and 95% CIs were obtained using multivariable Cox regression models.

Results: Among 18 611 residents included in the analysis, 12 715 (68.3%) were female, 463 (2.5%) were from the Arab population, 16 976 (91.2%) were from the general Jewish population, and 618 (3.3%) were from the ultraorthodox Jewish population; the mean (SD) age was 81.1 (9.2) years; 16 082 residents received their first booster dose (third dose) and 2529 were vaccinated with 2 doses at least 5 months earlier. The median (IQR) follow-up durations were 66 (60-70) days among 3-dose recipients and 56 (53-62) days among 2-dose-only recipients; 107 residents had SARS-CoV-2 infection after 7 days following vaccination with the booster dose compared with 185 among the 2-dose only group (cumulative incidence: 0.7% vs 7.5%; adjusted HR, 0.11 [95% CI, 0.07-0.15]). The respective adjusted HRs were 0.07 (95% CI, 0.03-0.14) and 0.10 (95% CI, 0.04-0.24) for the associations of vaccination with the third dose with hospitalization for mild-to-moderate COVID-19 and severe illness. Five COVID-19-related deaths occurred among the third dose vaccinees during the follow-up period compared with 22 among the 2-dose-only vaccinees (cumulative rate: 0.04% vs 0.9%; adjusted HR, 0.04 [95% CI, 0.009-0.16]).

Conclusions and relevance: This cohort study found significant inverse associations between vaccination with the third dose of the BNT162b2 vaccine with overall SARS-CoV-2 infection, COVID-19 hospitalizations, severe disease, and COVID-19-related deaths among LTCF residents during a massive surge caused by the Delta variant in Israel.

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Conflict of interest statement

Conflict of Interest Disclosures: Prof Dagan reported receiving grants from Pfizer, MSD, and MedImmune-AstraZeneca; and personal fees from Pfizer, MSD, MeMed, and BiondVax outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Selection of Participants
Figure 2.
Figure 2.. Cumulative Incidence of Overall SARS-CoV-2 Infection and Mild-to-Moderate COVID-19
Shaded areas represent 95% CIs and crosses on lines indicate censoring.
Figure 3.
Figure 3.. Cumulative Incidence of Severe COVID-19 Hospitalization and COVID-19–Related Death
Shaded areas represent 95% CIs and crosses on lines indicate censoring.
See this image and copyright information in PMC

References

    1. Muhsen K, Cohen D. COVID-19 vaccination in Israel. Clin Microbiol Infect. 2021;27(11):1570-1574. doi:10.1016/j.cmi.2021.07.041 - DOI - PMC - PubMed
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