Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines

Thompson, Mark G.; Burgess, Jefferey L.; Naleway, Allison L.; Tyner, Harmony L.; Yoon, Sarang K; Meece, Jennifer K.; Olsho, Lauren; Caban‐Martinez, Alberto J.; Fowlkes, Ashley; Lutrick, Karen; Groom, Holly; Dunnigan, Kayan; Odean, Marilyn J; Hegmann, Kurt T.; Stefanski, Elisha; Edwards, Laura J.; Schaefer‐Solle, Natasha; Grant, Lauren; Ellingson, Katherine; Kuntz, Jennifer L; Zunie, Tnelda; Thiese, Matthew S.; Ivacic, Lynn; Wesley, Meredith G; Lamberte, Julie Mayo; Sun, Xiaoxiao; Smith, Michael; Phillips, Andrew L; Groover, Kimberly; Yoo, Young Mi; Gerald, Joseph; Brown, Rachel T.; Herring, Meghan K; Joseph, Gregory; Beitel, Shawn; Morrill, Tyler; Mak, Josephine; Rivers, Patrick; Poe, Brandon; Lynch, Brian; Zhou, Yingtao; Zhang, Jing; Kelleher, Anna; Li, Yan; Dickerson, Monica; Hanson, E. W.; Guenther, Kyley; Tong, Suxiang; Bateman, Allen C.; Reisdorf, Erik; Barnes, John; Azziz‐Baumgartner, Eduardo; Hunt, Danielle; Arvay, Melissa L; Kutty, Preeta K.; Fry, Alicia M.; Gaglani, Manjusha

doi:10.1056/nejmoa2107058

Cited by 419 publications

(355 citation statements)

References 25 publications

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“…Differences in characteristics between recipients of the two vaccines might explain this finding, but similar results were also found in another Canadian province 36. Findings were, however, inconsistent in other studies that compared vaccine effectiveness between products after one dose; some found a trend towards higher effectiveness against infection using mRNA-1273,3738 whereas others found no difference 3940. However, the populations in each of these studies were more homogeneous than ours (eg, adults aged ≤40 years, healthcare workers, veterans).…”

Section: Discussioncontrasting

confidence: 81%

Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study

Chung¹,

He²,

Nasreen³

et al. 2021

BMJ

269

163

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Objective To estimate the effectiveness of mRNA covid-19 vaccines against symptomatic infection and severe outcomes (hospital admission or death). Design Test negative design study. Setting Ontario, Canada between 14 December 2020 and 19 April 2021. Participants 324 033 community dwelling people aged ≥16 years who had symptoms of covid-19 and were tested for SARS-CoV-2. Interventions BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine. Main outcome measures Laboratory confirmed SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) and hospital admissions and deaths associated with SARS-CoV-2 infection. Multivariable logistic regression was adjusted for personal and clinical characteristics associated with SARS-CoV-2 and vaccine receipt to estimate vaccine effectiveness against symptomatic infection and severe outcomes. Results Of 324 033 people with symptoms, 53 270 (16.4%) were positive for SARS-CoV-2 and 21 272 (6.6%) received at least one dose of vaccine. Among participants who tested positive, 2479 (4.7%) were admitted to hospital or died. Vaccine effectiveness against symptomatic infection observed ≥14 days after one dose was 60% (95% confidence interval 57% to 64%), increasing from 48% (41% to 54%) at 14-20 days after one dose to 71% (63% to 78%) at 35-41 days. Vaccine effectiveness observed ≥7 days after two doses was 91% (89% to 93%). Vaccine effectiveness against hospital admission or death observed ≥14 days after one dose was 70% (60% to 77%), increasing from 62% (44% to 75%) at 14-20 days to 91% (73% to 97%) at ≥35 days, whereas vaccine effectiveness observed ≥7 days after two doses was 98% (88% to 100%). For adults aged ≥70 years, vaccine effectiveness estimates were observed to be lower for intervals shortly after one dose but were comparable to those for younger people for all intervals after 28 days. After two doses, high vaccine effectiveness was observed against variants with the E484K mutation. Conclusions Two doses of mRNA covid-19 vaccines were observed to be highly effective against symptomatic infection and severe outcomes. Vaccine effectiveness of one dose was observed to be lower, particularly for older adults shortly after the first dose.

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Section: Discussioncontrasting

confidence: 81%

Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study

Chung¹,

He²,

Nasreen³

et al. 2021

BMJ

269

163

View full text Add to dashboard Cite

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“…The patient recovered with treatment which included a course of oral steroids. In this symptomatic episode, the high Ct values were congruent with post-vaccination breakthrough infections that tend to have a lower viral load ( 23 ).…”

Section: Discussionmentioning

confidence: 93%

Severe SARS-CoV-2 Breakthrough Reinfection With Delta Variant After Recovery From Breakthrough Infection by Alpha Variant in a Fully Vaccinated Health Worker

Shastri

Parikh

Aggarwal³

et al. 2021

Front. Med.

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Background: Post infection immunity and post vaccination immunity both confer protection against COVID-19. However, there have been many whole genome sequencing proven reinfections and breakthrough infections. Both are most often mild and caused by Variants of Concern (VOC).Methods: The patient in our study underwent serial COVID-19 RT-PCR, blood tests for serology, acute phase reactants, and chest imaging as part of clinical care. We interviewed the patient for clinical history and retrieved reports and case papers. We retrieved stored RT-PCR positive samples for whole genome sequencing (WGS) of SARS-CoV-2 from the patient's breakthrough infections and the presumed index case.Findings: The patient had three RT-PCR confirmed SARS-CoV-2 infections. Two breakthrough infections occurred in quick succession with the first over 3 weeks after complete vaccination with COVISHIELD and despite post-vaccination seroconversion. The first breakthrough infection was due to the Alpha variant and the second due to the Delta variant. The Delta variant infection resulted in hypoxia, hospitalization, and illness lasting seven weeks. Serial serology, acute phase reactants, and chest imaging supported WGS in establishing distinct episodes of infection. WGS established a fully vaccinated family member as the index case.Interpretation: The patient had an Alpha variant breakthrough infection despite past infection, complete vaccination, and seroconversion. Despite boosting after this infection, the patient subsequently had a severe Delta variant breakthrough infection. This was also a WGS proven reinfection and, therefore, a case of breakthrough reinfection. The patient acquired the infection from a fully vaccinated family member.

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“…During December 14, 2020–April 10, 2021, data from the HEROES-RECOVER Cohorts, * a network of prospective cohorts among frontline workers, showed that the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines were approximately 90% effective in preventing symptomatic and asymptomatic infection with SARS-CoV-2, the virus that causes COVID-19, in real-world conditions ( 1 , 2 ). This report updates vaccine effectiveness (VE) estimates including all COVID-19 vaccines available through August 14, 2021, and examines whether VE differs for adults with increasing time since completion of all recommended vaccine doses.…”

mentioning

confidence: 99%

Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance — Eight U.S. Locations, December 2020–August 2021

Fowlkes¹,

Gaglani²,

Groover³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines

Cited by 419 publications

References 25 publications

Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study

Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study

Severe SARS-CoV-2 Breakthrough Reinfection With Delta Variant After Recovery From Breakthrough Infection by Alpha Variant in a Fully Vaccinated Health Worker

Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 (Delta) Variant Predominance — Eight U.S. Locations, December 2020–August 2021

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