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. 2024 Nov 2;15(1):9490.
doi: 10.1038/s41467-024-53842-w.

Effectiveness of BNT162b2 XBB vaccine in the US Veterans Affairs Healthcare System

Aisling R Caffrey  1   2   3   4 , Haley J Appaneal  5   6   7 , Vrishali V Lopes  5 , Laura Puzniak  8 , Evan J Zasowski  8 , Luis Jodar  8 , Kerry L LaPlante  5   6   7 , John M McLaughlin  8
Affiliations

Effectiveness of BNT162b2 XBB vaccine in the US Veterans Affairs Healthcare System

Aisling R Caffrey et al. Nat Commun. .

Abstract

Data evaluating effectiveness of XBB.1.5-adapted vaccines against JN.1-related endpoints are scarce. This nationwide test-negative case-control study within the US Veterans Affairs Healthcare System aims to estimate vaccine effectiveness (VE) of BNT162b2 XBB.1.5-adapted vaccine compared to not receiving an XBB vaccine of any kind against COVID-19 hospitalization, emergency department or urgent care visits (ED/UC), and outpatient visits. Between September 25, 2023 and January 31, 2024, effectiveness was 24-35% during a period of JN.1 predominance and 50-61% during XBB predominance across all outcomes. VE within 60 days of vaccination during the likely JN.1 period was 32% (95% confidence interval 3-52%) against hospitalization, 41% (23-54%) against ED/UC visits, and 31% (1-52%) against outpatient visits. Corresponding VE during the likely XBB period was 62% (44-74%), 52% (37-63%), and 50% (25-66%) by setting, respectively. Here, we show the importance of strain match to maximize the public health impact of COVID-19 vaccination.

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Conflict of interest statement

Haley J. Appaneal has received research funding from Pfizer. Aisling R. Caffrey has received research funding from AbbVie, Merck, and Pfizer. Vrishali V. Lopes has no competing interest to declare. Kerry L. LaPlante has received research funding from AbbVie, Merck, and Pfizer and has been an advisor for Ferring Pharmaceuticals, AbbVie, and Seres Therapeutics. Laura Puzniak, Evan J. Zasowski, Luis Jodar, and John M. McLaughlin are employees and shareholders of Pfizer Inc.

Figures

Fig. 1
Fig. 1. Study selection criteria.
ED/UC= emergency department/urgent care; VA = Veterans Affairs. Patients could contribute more than one ARI episode to the study if the episodes were more than 30 days apart. There were 9 cases and 4372 controls with multiple events.
Fig. 2
Fig. 2. Adjusted vaccine effectiveness of the BNT162b2 XBB vaccine by time period.
A Hospitalization, B ED/UC visits, C Outpatient visits. ED/UC= emergency department/urgent care; IQR= interquartile range; VA= Veterans Affairs Compared the odds of receiving a BNT162b2 XBB vaccine between SARS-CoV-2 positive cases and SARS-CoV-2 negative controls. Adjusted for week of ARI episode, age, sex, race, ethnicity, BMI category, Charlson Comorbidity Index, receipt of 2023–2024 influenza vaccine, receipt of pneumococcal vaccine in the past 5 years, interactions with healthcare systems in the year prior, previous SARS-CoV-2 infection, smoking status, immunocompromised status, and Census region.
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