Effectiveness of a Third Dose of Pfizer-BioNTech and Moderna Vaccines in Preventing COVID-19 Hospitalization Among Immunocompetent and Immunocompromised Adults — United States, August–December 2021

Tenforde, Mark W; Patel, Manish; Gaglani, Manjusha; Ginde, Adit A.; Douin, David J.; Talbot, H. Keipp; Casey, Jonathan D; Mohr, Nicholas M.; Zepeski, Anne; McNeal, Tresa; Ghamande, Shekhar; Gibbs, Kevin W.; Files, D. Clark; Hager, David N.; Shehu, Arber; Prekker, Matthew E.; Erickson, Heidi L.; Gong, Michelle N.; Mohamed, Amira; Johnson, Nicholas J.; Srinivasan, Vasisht; Steingrub, Jay S.; Peltan, Ithan D.; Brown, Samuel M.; Martin, Emily T.; Monto, Arnold S.; Khan, Akram; Hough, Catherine L.; Busse, Laurence W.; Duggal, Abhijit; Wilson, Jennifer G.; Qadir, Nida; Chang, Steven Y.; Mallow, Christopher; Rivas, Carolina; Babcock, Hilary M.; Kwon, Jennie H.; Exline, Matthew C.; Botros, Mena; Lauring, Adam S.; Shapiro, Nathan I.; Halasa, Natasha; Chappell, James D.; Grijalva, Carlos G; Rice, Todd W.; Jones, Ian D.; Stubblefield, William B; Baughman, Adrienne; Womack, Kelsey N.; Rhoads, Jillian P.; Lindsell, Christopher J.; Hart, Kimberly W.; Zhu, Yuwei; Naioti, Eric A.; Adams, Katherine; Lewis, Nathaniel M.; Surie, Diya; McMorrow, Meredith; Self, Wesley H.; Calhoun, Nicole; Murthy, Kempapura; Herrick, Judy; McKillop, Amanda; Hoffman, Eric P.; Zayed, Martha; Smith, Michael; Kindle, Ryan; Kozikowski, Lori-Ann; Souza, Lesley De; Ouellette, Scott; Thornton-Thompson, Sherell; Mehkri, Omar; Ashok, Kiran; Gole, Susan; King, Alexander L.; Poynter, Bryan; Lohuis, Caitlin Ten; Stanley, Nicholas; Hendrickson, Audrey; Caspers, Sean; Tordsen, Walker; Kaus, Olivia; Scharber, Tyler; Jorgensen, Jeffrey L.; Bowers, Robert; King, Jennifer; Aston, Valerie; Rothman, Richard E.; Ali, Harith; Nair, Rahul; Karow, Sarah; Robart, Emily; Maldonado, Paulo Nunes; Khan, Maryiam; So, Preston; Krol, Olivia; Martinez, J. Luna; Zouyed, Zachary; Acosta, Michael; Bazyarboroujeni, Reihaneh; Jung, Hae-Un; Reddy, Raju C.; Zhang, Richard; Gordon, Alexandra Jun; Levitt, Joe; Pérez, Cynthia; Visweswaran, Anita; Roque, Jonasel; Chandrasekaran, Sukantha; Frankel, Trevor; Garner, Omai B.; Ángeles, Los; Goff, Jennifer; Huynh, David; Jensen, Kelly; Driver, Conner; Carricato, Michael; Chambers, Ian; Nassar, Paul; Stout, Lori; Sibenaller, Zita A.; Walter, Alicia; Marès, J.; Pfannenstiel, Spenser; Gershengorn, Hayley B.; McSpadden, EJ; Truscon, Rachel; Thomas, Lara J.; Bielak, Ramsay; Valvano, Weronika Damek; R, Fong; Fitzsimmons, William J.; Blair, Christopher; Gilbert, Julie; Crider, Christine D.; Steinbock, Kyle A.; Paulson, Thomas C.; Anderson, Layla A.; Kampe, Christy; Johnson, Jakea; Short, Laura L.; Ezzell, Lauren J.; Whitsett, Margaret E.; McHenry, Rendie; Hargrave, Samarian J.; Blair, Marica; Luther, Jennifer L.; Pulido, Claudia Guevara; Peterson, Bryan P. M.; LaRose, Mary; Landreth, Leigha; Hicks, Madeline; Parks, Lisa; Bongu, Jahnavi; McDonald, David; Cass, Candice; Seiler, Sondra; Park, David; Hink, Tiffany; Wallace, Meghan A.; Burnham, Carey-Ann D.; Arter, Olivia G.

doi:10.15585/mmwr.mm7104a2

Cited by 80 publications

(63 citation statements)

References 6 publications

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“…Receipt of a third COVID-19 mRNA vaccine dose has increased vaccine effectiveness against hospitalization from 69% to 88% in adults with immunocompromising conditions, including a wide spectrum of conditions. 6 …”

Section: Discussionmentioning

confidence: 99%

“…The Advisory Committee on Immunization Practices (ACIP) recommends a third COVID-19 mRNA vaccine as part of the primary series for those who are moderately-to-severely immunocompromised, or as a booster dose for those who are otherwise immunocompetent. 6 The aim of this study was to evaluate the humoral immunogenicity of a third COVID-19 mRNA vaccine dose in patients with IBD. We hypothesized that patients would mount a significant humoral immune response, and that those on certain immune-modifying therapies, such as systemic corticosteroids or anti-TNF combination therapy, would have relatively lower serum antibody concentrations.…”

Section: Introductionmentioning

confidence: 99%

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Humoral Immunogenicity of 3 COVID-19 Messenger RNA Vaccine Doses in Patients With Inflammatory Bowel Disease

Schell

Knutson

Saha

et al. 2022

Inflammatory Bowel Diseases

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Humoral Immunogenicity of 3 COVID-19 Messenger RNA Vaccine Doses in Patients With Inflammatory Bowel Disease

Schell

Knutson

Saha

et al. 2022

Inflammatory Bowel Diseases

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show abstract

“…In a secondary analysis, we calculated vaccine effectiveness for partial vaccination. Participants were excluded from this analysis if they received a covid-19 vaccine other than an mRNA vaccine (eg, Ad26.COV2 from Janssen/Johnson & Johnson), more than three vaccine doses, or a third vaccine dose before they were authorized in the US 181920…”

Section: Methodsmentioning

confidence: 99%

Clinical severity of, and effectiveness of mRNA vaccines against, covid-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: prospective observational study

Lauring

Tenforde

Chappell

et al. 2022

BMJ

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468

437

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Objectives To characterize the clinical severity of covid-19 associated with the alpha, delta, and omicron SARS-CoV-2 variants among adults admitted to hospital and to compare the effectiveness of mRNA vaccines to prevent hospital admissions related to each variant. Design Case-control study. Setting 21 hospitals across the United States. Participants 11 690 adults (≥18 years) admitted to hospital: 5728 with covid-19 (cases) and 5962 without covid-19 (controls). Patients were classified into SARS-CoV-2 variant groups based on viral whole genome sequencing, and, if sequencing did not reveal a lineage, by the predominant circulating variant at the time of hospital admission: alpha (11 March to 3 July 2021), delta (4 July to 25 December 2021), and omicron (26 December 2021 to 14 January 2022). Main outcome measures Vaccine effectiveness calculated using a test negative design for mRNA vaccines to prevent covid-19 related hospital admissions by each variant (alpha, delta, omicron). Among patients admitted to hospital with covid-19, disease severity on the World Health Organization’s clinical progression scale was compared among variants using proportional odds regression. Results Effectiveness of the mRNA vaccines to prevent covid-19 associated hospital admissions was 85% (95% confidence interval 82% to 88%) for two vaccine doses against the alpha variant, 85% (83% to 87%) for two doses against the delta variant, 94% (92% to 95%) for three doses against the delta variant, 65% (51% to 75%) for two doses against the omicron variant; and 86% (77% to 91%) for three doses against the omicron variant. In-hospital mortality was 7.6% (81/1060) for alpha, 12.2% (461/3788) for delta, and 7.1% (40/565) for omicron. Among unvaccinated patients with covid-19 admitted to hospital, severity on the WHO clinical progression scale was higher for the delta versus alpha variant (adjusted proportional odds ratio 1.28, 95% confidence interval 1.11 to 1.46), and lower for the omicron versus delta variant (0.61, 0.49 to 0.77). Compared with unvaccinated patients, severity was lower for vaccinated patients for each variant, including alpha (adjusted proportional odds ratio 0.33, 0.23 to 0.49), delta (0.44, 0.37 to 0.51), and omicron (0.61, 0.44 to 0.85). Conclusions mRNA vaccines were found to be highly effective in preventing covid-19 associated hospital admissions related to the alpha, delta, and omicron variants, but three vaccine doses were required to achieve protection against omicron similar to the protection that two doses provided against the delta and alpha variants. Among adults admitted to hospital with covid-19, the omicron variant was associated with less severe disease than the delta variant but still resulted in substantial morbidity and mortality. Vaccinated patients admitted to hospital with covid-19 had significantly lower disease severity than unvaccinated patients for all the variants.

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“…In a secondary analysis, vaccine effectiveness was calculated for partial vaccination. Participants were excluded from this analysis if they received a COVID-19 vaccine other than an mRNA vaccine (e.g., the Ad26.COV2 vaccine from Janssen), more than 3 vaccine doses , or a third vaccine dose before they were authorized in the United States [18][19][20].…”

Section: Vaccination Statusmentioning

confidence: 99%

Clinical Severity and mRNA Vaccine Effectiveness for Omicron, Delta, and Alpha SARS-CoV-2 Variants in the United States: A Prospective Observational Study

Lauring

Tenforde

Chappell

et al. 2022

Preprint

Self Cite

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ObjectivesTo characterize the clinical severity of COVID-19 caused by Omicron, Delta, and Alpha SARS-CoV-2 variants among hospitalized adults and to compare the effectiveness of mRNA COVID-19 vaccines to prevent hospitalizations caused by each variant.DesignA case-control study of 11,690 hospitalized adults.SettingTwenty-one hospitals across the United States.ParticipantsThis study included 5728 cases hospitalized with COVID-19 and 5962 controls hospitalized without COVID-19. Cases were classified into SARS-CoV-2 variant groups based on viral whole genome sequencing, and if sequencing did not reveal a lineage, by the predominant circulating variant at the time of hospital admission: Alpha (March 11 to July 3, 2021), Delta (July 4 to December 25, 2021), and Omicron (December 26, 2021 to January 14, 2022).Main Outcome MeasuresVaccine effectiveness was calculated using a test-negative design for COVID-19 mRNA vaccines to prevent COVID-19 hospitalizations by each variant (Alpha, Delta, Omicron). Among hospitalized patients with COVID-19, disease severity on the WHO Clinical Progression Ordinal Scale was compared among variants using proportional odds regression.ResultsVaccine effectiveness of the mRNA vaccines to prevent COVID-19-associated hospitalizations included: 85% (95% CI: 82 to 88%) for 2 vaccine doses against Alpha; 85% (95% CI: 83 to 87%) for 2 doses against Delta; 94% (95% CI: 92 to 95%) for 3 doses against Delta; 65% (95% CI: 51 to 75%) for 2 doses against Omicron; and 86% (95% CI: 77 to 91%) for 3 doses against Omicron. Among hospitalized unvaccinated COVID-19 patients, severity on the WHO Clinical Progression Scale was higher for Delta than Alpha (adjusted proportional odds ratio [aPOR] 1.28, 95% CI: 1.11 to 1.46), and lower for Omicron than Delta (aPOR 0.61, 95% CI: 0.49 to 0.77). Compared to unvaccinated cases, severity was lower for vaccinated cases for each variant, including Alpha (aPOR 0.33, 95% CI: 0.23 to 0.49), Delta (aPOR 0.44, 95% CI: 0.37 to 0.51), and Omicron (aPOR 0.61, 95% CI: 0.44 to 0.85).ConclusionsmRNA vaccines were highly effective in preventing COVID-19-associated hospitalizations from Alpha, Delta, and Omicron variants, but three vaccine doses were required to achieve protection against Omicron similar to the protection that two doses provided against Delta and Alpha. Among adults hospitalized with COVID-19, Omicron caused less severe disease than Delta, but still resulted in substantial morbidity and mortality. Vaccinated patients hospitalized with COVID-19 had significantly lower disease severity than unvaccinated patients for all the variants.

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Effectiveness of a Third Dose of Pfizer-BioNTech and Moderna Vaccines in Preventing COVID-19 Hospitalization Among Immunocompetent and Immunocompromised Adults — United States, August–December 2021

Cited by 80 publications

References 6 publications

Humoral Immunogenicity of 3 COVID-19 Messenger RNA Vaccine Doses in Patients With Inflammatory Bowel Disease

Humoral Immunogenicity of 3 COVID-19 Messenger RNA Vaccine Doses in Patients With Inflammatory Bowel Disease

Clinical severity of, and effectiveness of mRNA vaccines against, covid-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: prospective observational study

Clinical Severity and mRNA Vaccine Effectiveness for Omicron, Delta, and Alpha SARS-CoV-2 Variants in the United States: A Prospective Observational Study

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