. 2024 Apr 11;42(10):2543-2552.

doi: 10.1016/j.vaccine.2023.10.072. Epub 2023 Nov 14.

Effectiveness of a bivalent mRNA vaccine dose against symptomatic SARS-CoV-2 infection among U.S. Healthcare personnel, September 2022-May 2023

Ian D Plumb¹, Melissa Briggs Hagen², Ryan Wiegand², Ghinwa Dumyati³, Christopher Myers³, Karisa K Harland⁴, Anusha Krishnadasan⁵, Jade James Gist², Glen Abedi², Katherine E Fleming-Dutra², Nora Chea⁶, Jane E Lee⁷, Melissa Kellogg⁸, Alexandra Edmundson⁹, Amber Britton¹⁰, Lucy E Wilson¹¹, Sara A Lovett¹², Valerie Ocampo¹³, Tiffanie M Markus¹⁴, Howard A Smithline¹⁵, Peter C Hou¹⁶, Lilly C Lee¹⁷, William Mower¹⁸, Fernand Rwamwejo¹⁹, Mark T Steele²⁰, Stephen C Lim²¹, Walter A Schrading²², Brian Chinnock²³, David G Beiser²⁴, Brett Faine⁴, John P Haran²⁵, Utsav Nandi²⁶, Anne K Chipman²⁷, Frank LoVecchio²⁸, Stephanie Eucker²⁹, Jon Femling³⁰, Matthew Fuller³¹, Richard E Rothman³², Marcel E Curlin³³, David A Talan¹⁸, Nicholas M Mohr⁴; Vaccine Effectiveness among Healthcare Personnel Study Team

Affiliations

¹ National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA. Electronic address: iplumb@cdc.gov.
² National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA.
³ University of Rochester Medical Center, Rochester, NY, USA.
⁴ University of Iowa, Iowa City, IA, USA.
⁵ Olive View- UCLA Education and Research Institute, CA, USA.
⁶ National Center for Emerging and Zoonotic Diseases, Centers for Disease Control & Prevention, USA.
⁷ California Emerging Infections Program, Oakland, CA, USA.
⁸ Colorado Department of Public Health & Environment, CO, USA.
⁹ Connecticut Emerging Infections Program, Yale School of Public Health, CT, USA.
¹⁰ Georgia Emerging Infections Program and Emory University School of Medicine, Atlanta, GA, USA.
¹¹ Maryland Emerging Infections Program, Maryland Department of Health and University of Maryland, Baltimore, MD, USA.
¹² Minnesota Department of Health, MN, USA.
¹³ Public Health Division, Oregon Health Authority, OR, USA.
¹⁴ Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁵ Baystate Medical Center, Springfield, MA, USA.
¹⁶ Brigham and Women's Hospital, Boston, MA, USA.
¹⁷ Jackson Memorial Hospital, Miami, FL, USA.
¹⁸ David Geffen School of Medicine, UCLA, CA, USA.
¹⁹ Thomas Jefferson University Hospital, Philadelphia, PA, USA.
²⁰ University of Missouri-Kansas City, Kansas City, MO, USA.
²¹ University Medical Center New Orleans, LSU Health Sciences Center, New Orleans, LA, USA.
²² University of Alabama at Birmingham, Birmingham, AL, USA.
²³ University of California San Francisco, Fresno, CA, USA.
²⁴ University of Chicago, Chicago, IL, USA.
²⁵ University of Massachusetts Chan Medical School, Worcester, MA, USA.
²⁶ University of Mississippi Medical Center, Jackson, MS, USA.
²⁷ University of Washington, Seattle, WA, USA.
²⁸ Valleywise Health Medical Center, Phoenix, AZ, USA.
²⁹ Duke University School of Medicine, NC, USA.
³⁰ University of New Mexico Health Science Center, USA.
³¹ University of Utah School of Medicine, USA.
³² Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.
³³ Oregon Health and Sciences University, USA.

PMID: 37973512
PMCID: PMC10994739
DOI: 10.1016/j.vaccine.2023.10.072

Effectiveness of a bivalent mRNA vaccine dose against symptomatic SARS-CoV-2 infection among U.S. Healthcare personnel, September 2022-May 2023

Ian D Plumb et al. Vaccine. 2024.

. 2024 Apr 11;42(10):2543-2552.

doi: 10.1016/j.vaccine.2023.10.072. Epub 2023 Nov 14.

Authors

Affiliations

¹ National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA. Electronic address: iplumb@cdc.gov.
² National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA.
³ University of Rochester Medical Center, Rochester, NY, USA.
⁴ University of Iowa, Iowa City, IA, USA.
⁵ Olive View- UCLA Education and Research Institute, CA, USA.
⁶ National Center for Emerging and Zoonotic Diseases, Centers for Disease Control & Prevention, USA.
⁷ California Emerging Infections Program, Oakland, CA, USA.
⁸ Colorado Department of Public Health & Environment, CO, USA.
⁹ Connecticut Emerging Infections Program, Yale School of Public Health, CT, USA.
¹⁰ Georgia Emerging Infections Program and Emory University School of Medicine, Atlanta, GA, USA.
¹¹ Maryland Emerging Infections Program, Maryland Department of Health and University of Maryland, Baltimore, MD, USA.
¹² Minnesota Department of Health, MN, USA.
¹³ Public Health Division, Oregon Health Authority, OR, USA.
¹⁴ Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁵ Baystate Medical Center, Springfield, MA, USA.
¹⁶ Brigham and Women's Hospital, Boston, MA, USA.
¹⁷ Jackson Memorial Hospital, Miami, FL, USA.
¹⁸ David Geffen School of Medicine, UCLA, CA, USA.
¹⁹ Thomas Jefferson University Hospital, Philadelphia, PA, USA.
²⁰ University of Missouri-Kansas City, Kansas City, MO, USA.
²¹ University Medical Center New Orleans, LSU Health Sciences Center, New Orleans, LA, USA.
²² University of Alabama at Birmingham, Birmingham, AL, USA.
²³ University of California San Francisco, Fresno, CA, USA.
²⁴ University of Chicago, Chicago, IL, USA.
²⁵ University of Massachusetts Chan Medical School, Worcester, MA, USA.
²⁶ University of Mississippi Medical Center, Jackson, MS, USA.
²⁷ University of Washington, Seattle, WA, USA.
²⁸ Valleywise Health Medical Center, Phoenix, AZ, USA.
²⁹ Duke University School of Medicine, NC, USA.
³⁰ University of New Mexico Health Science Center, USA.
³¹ University of Utah School of Medicine, USA.
³² Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.
³³ Oregon Health and Sciences University, USA.

PMID: 37973512
PMCID: PMC10994739
DOI: 10.1016/j.vaccine.2023.10.072

Abstract

Background: Bivalent mRNA vaccines were recommended since September 2022. However, coverage with a recent vaccine dose has been limited, and there are few robust estimates of bivalent VE against symptomatic SARS-CoV-2 infection (COVID-19). We estimated VE of a bivalent mRNA vaccine dose against COVID-19 among eligible U.S. healthcare personnel who had previously received monovalent mRNA vaccine doses.

Methods: We conducted a case-control study in 22 U.S. states, and enrolled healthcare personnel with COVID-19 (case-participants) or without COVID-19 (control-participants) during September 2022-May 2023. Participants were considered eligible for a bivalent mRNA dose if they had received 2-4 monovalent (ancestral-strain) mRNA vaccine doses, and were ≥67 days after the most recent vaccine dose. We estimated VE of a bivalent mRNA dose using conditional logistic regression, accounting for matching by region and four-week calendar period. We adjusted estimates for age group, sex, race and ethnicity, educational level, underlying health conditions, community COVID-19 exposure, prior SARS-CoV-2 infection, and days since the last monovalent mRNA dose.

Results: Among 3,647 healthcare personnel, 1,528 were included as case-participants and 2,119 as control-participants. Participants received their last monovalent mRNA dose a median of 404 days previously; 1,234 (33.8%) also received a bivalent mRNA dose a median of 93 days previously. Overall, VE of a bivalent dose was 34.1% (95% CI, 22.6%-43.9%) against COVID-19 and was similar by product, days since last monovalent dose, number of prior doses, age group, and presence of underlying health conditions. However, VE declined from 54.8% (95% CI, 40.7%-65.6%) after 7-59 days to 21.6% (95% CI 5.6%-34.9%) after ≥60 days.

Conclusions: Bivalent mRNA COVID-19 vaccines initially conferred approximately 55% protection against COVID-19 among U.S. healthcare personnel. However, protection waned after two months. These findings indicate moderate initial protection against symptomatic SARS-CoV-2 infection by remaining up-to-date with COVID-19 vaccines.

Keywords: Bivalent; COVID-19; COVID-19 vaccines; Healthcare personnel; SARS-CoV-2; Vaccine effectiveness; mRNA vaccines.

Published by Elsevier Ltd.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Monica Brackney owned stock in Moderna from November 2022–April 2023 stock as part of portfolio managed by Parametric Investments Portfolio LLC. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.].

Figures

**Figure 1:**
U.S. healthcare personnel included in analysis of bivalent mRNA COVID-19 vaccine effectiveness^a a. Numbers refer to enrollments as a case or control-participant. Re-enrollments during the analysis period were excluded from the analysis dataset.

See this image and copyright information in PMC

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Effectiveness of a bivalent mRNA vaccine dose against symptomatic SARS-CoV-2 infection among U.S. Healthcare personnel, September 2022-May 2023

Affiliations

Effectiveness of a bivalent mRNA vaccine dose against symptomatic SARS-CoV-2 infection among U.S. Healthcare personnel, September 2022-May 2023

Authors

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Abstract

Conflict of interest statement

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