Receipt of BNT162b2 Vaccine and COVID-19 Ambulatory Visits in US Children Younger Than 5 Years

Tartof, Sara Y.; Frankland, Timothy B.; Slezak, Jeff M.; Puzniak, Laura; Ackerson, Bradley K.; Jodar, Luis; McLaughlin, John M.

doi:10.1001/jama.2023.17473

Cited by 7 publications

(10 citation statements)

References 4 publications

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“…Similar to our previous reports, [4][5][6][7][8] we performed a test-negative case-control study to compare the odds of receipt of a Pfizer-BioNTech BNT162b2 XBB1.5-adapted monovalent vaccine (2023-2024 formulation) between COVID-19 cases and test-negative controls. We included patients ≥18 years of age at Kaiser Permanente Southern California (KPSC) who were diagnosed with acute respiratory infection (ARI; Table S1) and tested for SARS-CoV-2 using polymerase chain reaction (PCR) during a hospital admission or emergency department (ED), urgent care (UC), or in-person outpatient encounter from October 10, 2023 through December 10, 2023.…”

Section: Design Setting and Participantsmentioning

confidence: 87%

BNT162b2 XBB1.5-adapted Vaccine and COVID-19 Hospital Admissions and Ambulatory Visits in US Adults

Tartof,

Slezak,

Frankland

et al. 2023

Preprint

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ImportanceData describing the early additional protection afforded by recently recommended XBB1.5- adapted COVID-19 vaccines are limited.ObjectiveWe estimated the association between receipt of BNT162b2 XBB1.5-adapted vaccine (Pfizer- BioNTech 2023–2024 formulation) and medically attended COVID-19 outcomes among adults ≥18 years of age.Design, Setting, and ParticipantsWe performed a test-negative case-control study to compare the odds of BNT162b2 XBB1.5- adapted vaccine receipt between COVID-19 cases and test-negative controls among adults in the Kaiser Permanente Southern California health system between October 11 and December 10, 2023. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated from multivariable logistic regression models that were adjusted for patient demographic and clinical characteristics.ExposureThe primary exposure was receipt of BNT162b2 XBB1.5-adapted vaccine compared to not receiving an XBB1.5-adapted vaccine of any kind, regardless of prior COVID-19 vaccination or SARS-CoV-2 infection history. We also compared receipt of prior (non-XBB1.5-adapted) versions of COVID-19 vaccines to the unvaccinated to estimate remaining protection from older vaccines.Main Outcomes and MeasuresCases were those with a positive SARS-CoV-2 polymerase chain reaction test, and controls tested negative. Analyses were done separately for COVID-19 hospital admissions, emergency department (ED) and urgent care (UC) encounters, and outpatient visits.ResultsAmong 4232 cases and 19,775 controls with median age of 54 years, adjusted ORs for testing positive for SARS-CoV-2 among those who received BNT162b2 XBB1.5-adapted vaccine a median of 30 days ago (vsnot having received an XBB1.5-adapted vaccine of any kind) were 0.37 (95% CI: 0.20–0.67) for COVID-19 hospitalization, 0.42 (0.34–0.53) for ED/UC visits, and 0.42 (0.27–0.66) for outpatient visits. Compared to the unvaccinated, those who had received only older versions of COVID-19 vaccines did not show significantly reduced risk of COVID-19 outcomes, including hospital admission.Conclusions and RelevanceOur findings reaffirm current recommendations for broad age-based use of annually updated COVID-19 vaccines given that (1) XBB1.5-adapted vaccines provided significant additional protection against a range of COVID-19 outcomes and (2) older versions of COVID-19 vaccines offered little, if any, additional protection, including against hospital admission, regardless of the number or type of prior doses received.KEY POINTSQuestionsDoes receiving the BNT162b2 XBB1.5-adapted vaccine offer additional protection against COVID-19 hospital admission and ambulatory visits in US adults ≥18 years of age compared to not receiving an XBB1.5-adapted vaccine of any kind? Do older versions of COVID-19 vaccine still provide any protection compared to the unvaccinated?FindingsThe BNT162b2 XBB1.5-adapted vaccine (Pfizer-BioNTech 2023–2024 formulation) provided significant additional protection against a range of COVID-19 outcomes during a period when XBB sub-lineages were predominant but JN.1 was also co-circulating and rapidly increasing in prevalence. Older versions of COVID-19 vaccines offered little, if any, additional protection compared to the unvaccinated, including against COVID-19 hospital admission, regardless of the number or type of prior doses received.MeaningOur findings reaffirm current recommendations for broad age-based use of annually updated COVID-19 vaccines.

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Section: Design Setting and Participantsmentioning

confidence: 87%

BNT162b2 XBB1.5-adapted Vaccine and COVID-19 Hospital Admissions and Ambulatory Visits in US Adults

Tartof,

Slezak,

Frankland

et al. 2023

Preprint

Self Cite

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“…16,19 However, subsequent reports with longer study periods that included more JN.1 co-circulation have shown sequentially lower VE. A report from Kaiser Permanente Southern California that included data through mid-December showed a slightly lower overall VE of roughly 60% against COVID-19 hospitalization, 15 and a recent CDC report that included data through the end of January 2024 showed roughly 40-50% VE against COVID-19 hospitalization. 29 This latter CDC estimate 29 is similar to the 40% overall VE against hospitalization we observed in this study which also included data through the end of January 2024.…”

Section: Discussionmentioning

confidence: 99%

“…These data add to a growing body of evidence that BNT162b2 XBB vaccine was effective at preventing a range of COVID-19 outcomes during the 2023-2024 respiratory virus season. [15][16][17][18][19]29 Notably, however, VE point estimates were lower for all three COVID-19 outcomes, including hospitalization, during the time period when COVID-19 was likely caused by JN.1 sub-lineages (24-35%) than when caused by XBB sub-lineages (50-61%), although CIs overlapped.…”

Section: Discussionmentioning

confidence: 99%

“…Reassuringly, annual updates to mRNA COVID-19 vaccines have restored protection against COVID-19 that has eroded over time due to a combination of waning of vaccine protection and the emergence of antigenically distinct strains. [9][10][11][12][13]15,17,29 Thus, analogous to influenza, although prior versions of COVID-19 vaccines once provided high levels of protection, the combination of waning vaccine-induced immunity and continuous SARS-CoV-2 strain evolution eventually renders prior versions of vaccines less effective over time, even against severe clinical outcomes like hospitalization. This, in turn, warrants routine updates to COVID-19 vaccines, as with influenza, so long as SARS-CoV-2 continues to circulate and cause disease.…”

Section: Discussionmentioning

confidence: 99%

“…14 Data from the early portion of the 2023-2024 respiratory season indicated that XBB vaccines have been effective at preventing COVID-19, including severe disease. [15][16][17][18][19] JN.1, which is antigenically and phylogenetically distinct from XBB sub-lineages, was first detected in late August of 2023 and became the predominant circulating variant in the United States and elsewhere by mid-tolate December 2023. 20 JN.1 has shown some signs of immune-escape, [21][22][23] which in turn could reduce the effectiveness of current XBB vaccines.…”

Section: Introductionmentioning

confidence: 99%

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

Caffrey,

Appaneal,

Lopes

et al. 2024

Preprint

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Data evaluating effectiveness of XBB.1.5-adapted vaccines against JN.1-related endpoints are scarce. We performed a nationwide test-negative case-control study within the US Veterans Affairs Healthcare System 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. These data underscore the importance of strain match to maximize the public health impact of COVID-19 vaccination.

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Estimated Effectiveness of the BNT162b2 XBB Vaccine Against COVID-19

Tartof,

Slezak,

Frankland

et al. 2024

JAMA Intern Med

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ImportanceData describing the early additional protection afforded by the recently recommended BNT162b2 XBB vaccine (Pfizer-BioNTech; 2023-2024 formulation) are limited.ObjectiveTo estimate the association between receipt of the BNT162b2 XBB vaccine and medically attended COVID-19 outcomes among US adults 18 years and older.Design, Setting, and ParticipantsThis test-negative case-control study was performed to estimate the effectiveness of the BNT162b2 XBB vaccine against COVID-19–associated hospitalization and emergency department (ED) or urgent care (UC) encounters among adults in the Kaiser Permanente Southern California health system between October 10, 2023, and December 10, 2023. Cases were those presenting with an acute respiratory illness and who had a positive SARS-CoV-2 polymerase chain reaction test; controls had an acute respiratory illness but tested negative for SARS-CoV-2.ExposureThe primary exposure was receipt of the BNT162b2 XBB vaccine compared with not receiving an XBB vaccine of any kind, regardless of prior COVID-19 vaccination or SARS-CoV-2 infection history. Receipt of prior (non-XBB) versions of COVID-19 vaccines was also compared with being unvaccinated to estimate remaining protection from older vaccines.Main Outcomes and MeasuresAnalyses for cases and controls were conducted separately for COVID-19 hospital admissions and ED/UC encounters. Adjusted odds ratios and 95% CIs were estimated from multivariable logistic regression models that were adjusted for patient demographic and clinical characteristics. Estimation of vaccine effectiveness was calculated as 1 − odds ratio × 100%.ResultsAmong 2854 cases and 15 345 controls (median [IQR] age, 56 [37-72] years; 10 658 [58.6%] female), adjusted estimation of effectiveness of the BNT162b2 XBB vaccine received a median of 34 days prior vs not having received an XBB vaccine of any kind was 62% (95% CI, 32%-79%) against COVID-19 hospitalization and 58% (95% CI, 48%-67%) for ED/UC visits. Compared with being unvaccinated, those who had received only older versions of COVID-19 vaccines did not show statistically significant reduced risk of COVID-19 outcomes, including hospital admission.Conclusions and RelevanceFindings of this case-control study reaffirm current recommendations for broad age-based use of annually updated COVID-19 vaccines given that (1) the BNT162b2 XBB vaccine provided statistically significant additional protection against a range of COVID-19 outcomes and (2) older versions of COVID-19 vaccines offered little, if any, long-term protection, including against hospital admission, regardless of the number or type of prior doses received.

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Receipt of BNT162b2 Vaccine and COVID-19 Ambulatory Visits in US Children Younger Than 5 Years

Abstract: This study examines the association of the receipt of wild-type BNT162b2 vaccine with medically attended COVID-19 outcomes among children younger than 5 years in the US.

Cited by 7 publications

References 4 publications

BNT162b2 XBB1.5-adapted Vaccine and COVID-19 Hospital Admissions and Ambulatory Visits in US Adults

BNT162b2 XBB1.5-adapted Vaccine and COVID-19 Hospital Admissions and Ambulatory Visits in US Adults

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

Estimated Effectiveness of the BNT162b2 XBB Vaccine Against COVID-19

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