Effectiveness of Messenger RNA Coronavirus Disease 2019 (COVID-19) Vaccines Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in a Cohort of Healthcare Personnel

Swift, Melanie D.; Breeher, Laura E.; Tande, Aaron J.; Tommaso, Christopher P.; Hainy, Caitlin; Chu, Haitao; Murad, Mohammad Hassan; Berbari, Elie F.; Virk, Abinash

doi:10.1093/cid/ciab361

Cited by 94 publications

(94 citation statements)

References 9 publications

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“…Recent data from the CDC showed that the widely used mRNA vaccines in the US reduce the infection risk by 91% and data from different groups confirm that breakthrough infections after full vaccination are scarce (9)(10)(11). Data also show that vaccines reduce symptomatic and asymptomatic infections (12)(13)(14). Our data is consistent with published data, and even though the total number of infections after vaccination is not known, the occurrence of positives after full vaccination in our surveillance cohort has been infrequent.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Infections in mRNA Vaccinated Individuals are Biased for Viruses Encoding Spike E484K and Associated with Reduced Infectious Virus Loads that Correlate with Respiratory Antiviral IgG levels

Mostafa¹,

Luo²,

Morris

et al. 2021

Preprint

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Introduction COVID-19 large scale immunization in the US has been associated with infrequent breakthrough positive molecular testing. Whether a positive test is associated with a high viral RNA load, specific viral variant, recovery of infectious virus, or symptomatic infection is largely not known. Methods In this study, we identified 133 SARS-CoV-2 positive patients who had received two doses of either Pfizer-BioNTech (BNT162b2) or Moderna (mRNA-1273) vaccines, the 2nd of which was received between January and April of 2021. The positive samples were collected between January and May of 2021 with a time that extended from 2 to 100 days after the second dose. Samples were sequenced to characterize the whole genome and Spike protein changes and cycle thresholds that reflect viral loads were determined using a single molecular assay. Local SARS-CoV-2 IgG antibodies were examined using ELISA and specimens were grown on cell culture to assess the recovery of infectious virus as compared to a control unvaccinated cohort from a matched time frame. Results Of 133 specimens, 24 failed sequencing and yielded a negative or very low viral load on the repeat PCR. Of 109 specimens that were used for further genome analysis, 68 (62.4%) were from symptomatic infections, 11 (10.1%) were admitted for COVID-19, and 2 (1.8%) required ICU admission with no associated mortality. The predominant virus variant was the alpha (B.1.1.7), however a significant association between lineage B.1.526 and amino acid change S: E484K with positives after vaccination was noted when genomes were compared to a large control cohort from a matched time frame. A significant reduction of the recovery of infectious virus on cell culture as well as delayed time to the first appearance of cytopathic effect was accompanied by an increase in local IgG levels in respiratory samples of vaccinated individuals but upper respiratory tract IgG levels were not different between symptomatic or asymptomatic infections. Conclusions Vaccination reduces the recovery of infectious virus in breakthrough infections accompanied by an increase in upper respiratory tract local immune responses.

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Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 Infections in mRNA Vaccinated Individuals are Biased for Viruses Encoding Spike E484K and Associated with Reduced Infectious Virus Loads that Correlate with Respiratory Antiviral IgG levels

Mostafa¹,

Luo²,

Morris

et al. 2021

Preprint

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“…** Even though FDA-authorized vaccines are highly effective, breakthrough cases are expected, especially before population immunity reaches sufficient levels to further decrease transmission. However, vaccine breakthrough infections occur in only a small fraction of all vaccinated persons and account for a small percentage of all COVID-19 cases (5)(6)(7)(8). The number of COVID-19 cases, hospitalizations, and deaths that will be prevented among vaccinated persons will far exceed the number of vaccine breakthrough cases.…”

mentioning

confidence: 99%

“…CDC will continue to lead studies in multiple U.S. sites to evaluate vaccine effectiveness and collect information on all COVID-19 vaccine breakthrough infections regardless of clinical status. Additional information and resources to help public health departments and laboratories investigate and report COVID-19 vaccine breakthrough cases are available at https://www.cdc.gov/vaccines/covid-19/ health-departments/breakthrough-cases.html.FDA-authorized COVID-19 vaccines are safe and effective(1)(2)(3)(4)(5)(6)(7)(8). CDC recommends that all persons aged ≥12 years be vaccinated with an FDA-authorized COVID-19 vaccine ¶ ¶ (10).…”

mentioning

confidence: 99%

COVID-19 Vaccine Breakthrough Infections Reported to CDC — United States, January 1–April 30, 2021

Birhane¹,

Bressler²,

Chang³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

381

205

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vaccines are a critical tool for controlling the ongoing global pandemic. The Food and Drug Administration (FDA) has issued Emergency Use Authorizations for three COVID-19 vaccines for use in the United States.* In large, randomized-controlled trials, each vaccine was found to be safe and efficacious in preventing symptomatic, laboratoryconfirmed . Despite the high level of vaccine efficacy, a small percentage of fully vaccinated persons (i.e. received all recommended doses of an FDA-authorized COVID-19 vaccine) will develop symptomatic or asymptomatic infections with SARS-CoV-2, the virus that causes .CDC is working with state and territorial health departments to investigate SARS-CoV-2 infections among persons who are fully vaccinated and to monitor trends in case characteristics and SARS-CoV-2 variants identified from persons with these infections. For this surveillance, a vaccine breakthrough infection is defined as the detection of SARS-CoV-2 RNA or antigen in a respiratory specimen collected from a person ≥14 days after receipt of all recommended doses of an FDAauthorized COVID-19 vaccine. State health departments voluntarily report vaccine breakthrough infections to CDC. † When possible, genomic sequencing is performed on respiratory specimens that test positive for SARS-CoV-2 RNA (9). A total of 10,262 SARS-CoV-2 vaccine breakthrough infections had been reported from 46 U.S. states and territories as of April 30, 2021. Among these cases, 6,446 (63%) occurred in females, and the median patient age was 58 years (interquartile range = 40-74 years). Based on preliminary data, 2,725 (27%) vaccine breakthrough infections were asymptomatic, 995 (10%) patients were known to be hospitalized, and 160 (2%) patients died. Among the 995 hospitalized patients, 289 (29%) were asymptomatic or hospitalized for a reason unrelated to COVID-19. The median age of patients who died was 82 years (interquartile range = 71-89 years); 28 (18%) decedents were asymptomatic or died from a cause unrelated to COVID-19. Sequence data were available from 555 (5%) reported cases, 356 (64%) of which were identified as SARS-CoV-2 variants of

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“…Vaccines have shown an early impact on the "domino effect" of the SARS-CoV-2 infection. Several studies provided strong short-term evidence that vaccinating HCWs can substantially reduce symptomatic and asymptomatic SARS-CoV-2 infection and, therefore, might help to reduce transmission of infection in the healthcare settings [5][6][7][8][9][10][11][12]. In this retrospective cohort study, vaccination with two doses of the authorized available mRNA vaccines was associated with a signi cantly lower incidence rate for symptomatic SARS-CoV-2 infection in HCWs.…”

Section: Discussionmentioning

confidence: 89%

“…In general, people are considered fully vaccinated two weeks after their second dose in a 2-dose series, such as the P zer or Moderna vaccines, or two weeks after a single-dose vaccine, such as Johnson & Johnson's Janssen vaccine [2]. Data on mRNA vaccine effectiveness for HCWs, who are frequently at risk of exposure to SARS-CoV-2, has been consistent with the results from the phase 3 randomized clinical trials of the mRNA vaccines, which showed e cacy against symptomatic SARS-CoV-2 infection around 95% [3][4][5][6][7][8][9][10][11][12]. Authorized vaccines are not 100% effective at preventing symptomatic and asymptomatic infections, but they are effective, safe and crucial tools to control the pandemic.…”

Section: Introductionmentioning

confidence: 94%

The association of vaccination and the incidence of new cases of COVID-19 among health care workers, December 16, 2020 through May 4, 2021

Akhrass

Reynolds

Akhrass

et al. 2021

Preprint

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes the coronavirus disease 2019 (COVID-19). This highly transmissible and pathogenic virus has caused a significant threat to health care workers (HCW) as well as human health and public safety. Several studies have shown the value and effectiveness of messenger ribonucleic acid (mRNA) vaccines (mRNA) protecting HCWs from symptomatic or asymptomatic SARS-CoV-2 infections. New research is needed to demonstrate the effectiveness of vaccines where the follow-up periods are more extended than prior research. This study uses a "real-world" cohort of HCWs and provides insight into the effectiveness of the mRNA vaccines against HCWs with symptomatic SARS-CoV-2 infection. Symptomatic SARS-CoV-2 infection occurred in 5 fully vaccinated HCWs and 124 unvaccinated HCWs (incidence rate, 4.14 vs. 95.53 per 100 000 person-days, respectively, incidence risk ratio (IRR), 0.0433 [95% CI, 0.018-0.1]). Receipt of the authorized mRNA vaccines was associated with a significantly lower incidence of symptomatic SARS-CoV-2 infection for a median follow-up of 139 days. Ways to enhance complete vaccination and, subsequently, optimal immunity is required to lift masking restrictions in the health care settings.

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Effectiveness of Messenger RNA Coronavirus Disease 2019 (COVID-19) Vaccines Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in a Cohort of Healthcare Personnel

Abstract: In a large cohort of US healthcare personnel (HCP) without prior COVID-19 infection, 94,382 doses of mRNA COVID-19 vaccine were administered to 49,220 individuals. The adjusted vaccine effectiveness following two doses of each of the two available brands of mRNA vaccine exceeded 96%.

Cited by 94 publications

References 9 publications

SARS-CoV-2 Infections in mRNA Vaccinated Individuals are Biased for Viruses Encoding Spike E484K and Associated with Reduced Infectious Virus Loads that Correlate with Respiratory Antiviral IgG levels

SARS-CoV-2 Infections in mRNA Vaccinated Individuals are Biased for Viruses Encoding Spike E484K and Associated with Reduced Infectious Virus Loads that Correlate with Respiratory Antiviral IgG levels

COVID-19 Vaccine Breakthrough Infections Reported to CDC — United States, January 1–April 30, 2021

The association of vaccination and the incidence of new cases of COVID-19 among health care workers, December 16, 2020 through May 4, 2021

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