Effectiveness of mRNA Vaccination in Preventing COVID-19–Associated Invasive Mechanical Ventilation and Death — United States, March 2021–January 2022

Tenforde, Mark W; Self, Wesley H.; 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.; Frosch, Anne E.; 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; Adams, Katherine; Surie, Diya; McMorrow, Meredith; Patel, Manish

doi:10.15585/mmwr.mm7112e1

Cited by 127 publications

(113 citation statements)

References 7 publications

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“…35 Similarly, a US study estimated VE of two doses of mRNA vaccines against severe Omicron disease, defined as COVID-19 requiring invasive mechanical ventilation or in-hospital death, of 79% (95% CI: 66%, 87%) a median of 265 days after the second dose; and three dose VE of 94% (95% CI: 88%, 97%), similar to our estimate of 98.1% (95% CI: 97.1%, 98.8%). 36 Despite the overall consistency between our results and those presented in other studies, it is possible that VE, particularly against severe outcomes, has been overestimated in our study.…”

Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

“…36 In this scenario so-called 'healthy vaccinee bias', by which vaccine recipients are healthier than their unvaccinated peers, may inflate the estimates. 35 Although we have accounted for age in the current estimates, a lack of individual-level data on controls mean that this cannot be formally assessed with currently available data. However, our estimates for BNT162b2 and CoronaVac are similar to other studies using alternative designs, and we anticipate the magnitude of overestimation is unlikely to be substantial.…”

Section: Discussionmentioning

confidence: 99%

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Vaccine effectiveness of two and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong

McMenamin

Nealon

Lin

et al. 2022

Preprint

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Background: Hong Kong maintained extremely low circulation of SARS-CoV-2 until a major community epidemic of Omicron BA.2 starting in January 2022. Both mRNA BNT162b2 (BioNTech/Fosun Pharma) and inactivated CoronaVac (Sinovac) vaccines are widely available, however coverage has remained low in older adults. Vaccine effectiveness in this predominantly infection-naive population is unknown. Methods: We used individual-level case data on mild/moderate, severe/fatal and fatal hospitalized COVID-19 from December 31, 2021 to March 8, 2022, along with census information and coverage data of BNT162b2 and CoronaVac. We used a negative binomial model, adjusting for age and calendar day to estimate vaccine effectiveness of one, two and three dose schedules of both vaccines, and relative effectiveness by number of doses and vaccine type. Findings: A total of 12.7 million vaccine doses were administered in the 7.3 million population of Hong Kong, and we analyzed data from confirmed cases with mild/moderate (N=5,474), severe/fatal (N=5,294) and fatal (N=4,093) COVID-19. Two doses of either vaccine protected against severe disease and death, with higher effectiveness among adults ≥60 years with BNT162b2 (VE: 88.2%, 95% confidence interval, CI: 84.4%, 91.1%) compared to CoronaVac (VE: 74.1%, 95% CI: 67.8%, 79.2%). Three doses of either vaccine offered very high levels of protection against severe outcomes (VE: 98.1%, 95% CI: 97.1%, 98.8%). Interpretation: Third doses of either BNT162b2 or CoronaVac provide substantial additional protection against severe COVID-19 and should be prioritized, particularly in older adults who received CoronaVac primary schedules. Longer follow-up is needed to assess persistence of different vaccine platforms and schedules.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Vaccine effectiveness of two and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong

McMenamin

Nealon

Lin

et al. 2022

Preprint

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“…One study presented from the IVY network of 21 hospitals in the United States showed that vaccine effectiveness against two doses of mRNA vaccines for hospital admission with omicron was 65% (95% CI, 51-75%), while it was 79% (95% CI, 66-87%) for invasive mechanical ventilation or in-hospital death. [15] , [16] The difference in vaccine effectiveness against these same outcomes was less during the delta period for two mRNA doses – 88% (95% CI 86-90%) and 85% (95% CI, 83-87%), respectively. In general, omicron patients were older and more medically complex than delta patients, suggesting a higher likelihood of exacerbation of comorbid conditions.…”

Section: Approaches To Evaluating Vaccine Effectiveness Of Severe Cov...mentioning

confidence: 94%

“…[3] , [4] Between December 3, 2021 and April 7, 2022, there were 21 vaccine effectiveness studies that met our inclusion criteria that reported results for severe omicron disease for five vaccines ( Table 1 and Figure). [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] The majority (n=13, 62%) of studies used hospitalization with some clinical evidence of Covid-19 disease as the outcome, while six (29%) studies used hospitalization with PCR-confirmed infection without clinical criteria, and 4 (17%) used other outcomes besides hospitalization. (Two studies evaluated vaccine effectiveness for more than one severe outcome.)…”

Section: Vaccine Effectiveness Against Severe Disease Among Persons W...mentioning

confidence: 99%

Assessing vaccine effectiveness against severe COVID-19 disease caused by omicron variant. Report from a meeting of the World Health Organization

Feikin

Abu‐Raddad

Andrews³

et al. 2022

Vaccine

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Persistence and Protective Potential of SARS-CoV-2 Antibody Levels After COVID-19 Vaccination in a West Virginia Nursing Home Cohort

et al. 2022

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IMPORTANCE West Virginia prioritized SARS-CoV-2 vaccine delivery to nursing home facilities because of increased risk of severe illness in elderly populations. However, the persistence and protective role of antibody levels remain unclear.OBJECTIVE To examine the persistence of humoral immunity after COVID-19 vaccination and the association of SARS-CoV-2 antibody levels and subsequent infection among nursing home residents and staff. DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional study, blood samples were procured between September 13 and November 30, 2021, from vaccinated residents and staff at participating nursing home facilities in the state of West Virginia for measurement of SARS-CoV-2 antibody (antireceptor binding domain [RBD] IgG). SARS-CoV-2 infection and vaccination history were documented during specimen collection and through query of the state SARS-CoV-2 surveillance system through January 16, 2022.EXPOSURE SARS-CoV-2 vaccination (with BNT162b2, messenger RNA-1273, or Ad26.COV2.S). MAIN OUTCOMES AND MEASURESAnti-RBD IgG levels were assessed using multivariate analysis to examine associations between time since vaccination or infection, age, sex, booster doses, and vaccine type. Antibody levels from participants who became infected after specimen collection were compared with those without infection to correlate antibody levels with subsequent infection. RESULTSAmong 2139 SARS-CoV-2 vaccinated residents and staff from participating West Virginia nursing facilities (median [range] age, 67 [18-103] years; 1660 [78%] female; 2045 [96%] White), anti-RBD IgG antibody levels decreased with time after vaccination or infection (mean [SE] estimated coefficient, −0.025 [0.0015]; P < .001). Multivariate regression modeling of participants with (n = 608) and without (n = 1223) a known history of SARS-CoV-2 infection demonstrated significantly higher mean (SE) antibody indexes with a third (booster) vaccination (with infection: 11.250 [1.2260]; P < .001; without infection: 8.056 [0.5333]; P < .001). Antibody levels (calculated bydividing the sample signal by the mean calibrator signal) were significantly lower among participants who later experienced breakthrough infection during the Delta surge (median, 2.3; 95% CI, 1.8-2.9) compared with those without breakthrough infection (median, 5.8; 95% CI, 5.5-6.1) (P = .002); however, no difference in absorbance indexes was observed in participants with breakthrough infections occurring after specimen collection (median, 5.9; 95% CI, 3.7-11.1) compared with those without breakthrough infection during the Omicron surge (median, 5.8; 95% CI, 5.6-6.2) (P = .70). CONCLUSIONS AND RELEVANCEIn this cross-sectional study, anti-RBD IgG levels decreased after vaccination or infection. Higher antibody responses were found in individuals who received a third (continued)

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Effectiveness of mRNA Vaccination in Preventing COVID-19–Associated Invasive Mechanical Ventilation and Death — United States, March 2021–January 2022

Cited by 127 publications

References 7 publications

Vaccine effectiveness of two and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong

Vaccine effectiveness of two and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong

Assessing vaccine effectiveness against severe COVID-19 disease caused by omicron variant. Report from a meeting of the World Health Organization

Persistence and Protective Potential of SARS-CoV-2 Antibody Levels After COVID-19 Vaccination in a West Virginia Nursing Home Cohort

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