Mark W Tenforde1, Wesley H Self2, Katherine Adams1, Manjusha Gaglani3, Adit A Ginde4, Tresa McNeal3, Shekhar Ghamande3, David J Douin5, H Keipp Talbot6, Jonathan D Casey7, Nicholas M Mohr8, Anne Zepeski8, Nathan I Shapiro9, Kevin W Gibbs10, D Clark Files10, David N Hager11, Arber Shehu11, Matthew E Prekker12, Heidi L Erickson13, Matthew C Exline14, Michelle N Gong15, Amira Mohamed16, Daniel J Henning17, Jay S Steingrub18, Ithan D Peltan19, Samuel M Brown19, Emily T Martin20, Arnold S Monto20, Akram Khan21, Catherine L Hough21, Laurence W Busse22, Caitlin C Ten Lohuis23, Abhijit Duggal24, Jennifer G Wilson25, Alexandra June Gordon25, Nida Qadir26, Steven Y Chang26, Christopher Mallow27, Carolina Rivas27, Hilary M Babcock28, Jennie H Kwon28, Natasha Halasa29, James D Chappell29, Adam S Lauring30, Carlos G Grijalva31, Todd W Rice7, Ian D Jones32, William B Stubblefield32, Adrienne Baughman32, Kelsey N Womack33, Jillian P Rhoads33, Christopher J Lindsell34, Kimberly W Hart34, Yuwei Zhu34, Samantha M Olson1, Miwako Kobayashi1, Jennifer R Verani1, Manish M Patel1. 1. CDC COVID-19 Response Team, Atlanta, Georgia. 2. Vanderbilt Institute for Clinical and Translational Research, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 3. Baylor Scott & White Health, Texas A&M University College of Medicine, Temple. 4. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora. 5. Department of Anesthesiology, University of Colorado School of Medicine, Aurora. 6. Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee. 7. Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 8. Department of Emergency Medicine, University of Iowa, Iowa City. 9. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 10. Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. 11. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 12. Departments of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota. 13. Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota. 14. Department of Medicine, The Ohio State University, Columbus. 15. Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York. 16. Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. 17. Department of Emergency Medicine, University of Washington, Seattle. 18. Department of Medicine, Baystate Medical Center, Springfield, Massachusetts. 19. Department of Medicine, Intermountain Medical Center, Murray, Utah; and University of Utah, Salt Lake City. 20. School of Public Health, University of Michigan, Ann Arbor. 21. Department of Medicine, Oregon Health & Science University, Portland. 22. Department of Medicine, Emory University, Atlanta, Georgia. 23. Emory Critical Care Center, Emory Healthcare, Atlanta, Georgia. 24. Department of Medicine, Cleveland Clinic, Cleveland, Ohio. 25. Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California. 26. Department of Medicine, University of California-Los Angeles, Los Angeles. 27. Department of Medicine, University of Miami, Miami, Florida. 28. Department of Medicine, Washington University, St Louis, Missouri. 29. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee. 30. Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor. 31. Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee. 32. Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 33. Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee. 34. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
Abstract
Importance: A comprehensive understanding of the benefits of COVID-19 vaccination requires consideration of disease attenuation, determined as whether people who develop COVID-19 despite vaccination have lower disease severity than unvaccinated people. Objective: To evaluate the association between vaccination with mRNA COVID-19 vaccines-mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech)-and COVID-19 hospitalization, and, among patients hospitalized with COVID-19, the association with progression to critical disease. Design, Setting, and Participants: A US 21-site case-control analysis of 4513 adults hospitalized between March 11 and August 15, 2021, with 28-day outcome data on death and mechanical ventilation available for patients enrolled through July 14, 2021. Date of final follow-up was August 8, 2021. Exposures: COVID-19 vaccination. Main Outcomes and Measures: Associations were evaluated between prior vaccination and (1) hospitalization for COVID-19, in which case patients were those hospitalized for COVID-19 and control patients were those hospitalized for an alternative diagnosis; and (2) disease progression among patients hospitalized for COVID-19, in which cases and controls were COVID-19 patients with and without progression to death or mechanical ventilation, respectively. Associations were measured with multivariable logistic regression. Results: Among 4513 patients (median age, 59 years [IQR, 45-69]; 2202 [48.8%] women; 23.0% non-Hispanic Black individuals, 15.9% Hispanic individuals, and 20.1% with an immunocompromising condition), 1983 were case patients with COVID-19 and 2530 were controls without COVID-19. Unvaccinated patients accounted for 84.2% (1669/1983) of COVID-19 hospitalizations. Hospitalization for COVID-19 was significantly associated with decreased likelihood of vaccination (cases, 15.8%; controls, 54.8%; adjusted OR, 0.15; 95% CI, 0.13-0.18), including for sequenced SARS-CoV-2 Alpha (8.7% vs 51.7%; aOR, 0.10; 95% CI, 0.06-0.16) and Delta variants (21.9% vs 61.8%; aOR, 0.14; 95% CI, 0.10-0.21). This association was stronger for immunocompetent patients (11.2% vs 53.5%; aOR, 0.10; 95% CI, 0.09-0.13) than immunocompromised patients (40.1% vs 58.8%; aOR, 0.49; 95% CI, 0.35-0.69) (P < .001) and weaker at more than 120 days since vaccination with BNT162b2 (5.8% vs 11.5%; aOR, 0.36; 95% CI, 0.27-0.49) than with mRNA-1273 (1.9% vs 8.3%; aOR, 0.15; 95% CI, 0.09-0.23) (P < .001). Among 1197 patients hospitalized with COVID-19, death or invasive mechanical ventilation by day 28 was associated with decreased likelihood of vaccination (12.0% vs 24.7%; aOR, 0.33; 95% CI, 0.19-0.58). Conclusions and Relevance: Vaccination with an mRNA COVID-19 vaccine was significantly less likely among patients with COVID-19 hospitalization and disease progression to death or mechanical ventilation. These findings are consistent with risk reduction among vaccine breakthrough infections compared with absence of vaccination.
Importance: A comprehensive understanding of the benefits of COVID-19 vaccination requires consideration of disease attenuation, determined as whether people who develop COVID-19 despite vaccination have lower disease severity than unvaccinated people. Objective: To evaluate the association between vaccination with mRNA COVID-19 vaccines-mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech)-and COVID-19 hospitalization, and, among patients hospitalized with COVID-19, the association with progression to critical disease. Design, Setting, and Participants: A US 21-site case-control analysis of 4513 adults hospitalized between March 11 and August 15, 2021, with 28-day outcome data on death and mechanical ventilation available for patients enrolled through July 14, 2021. Date of final follow-up was August 8, 2021. Exposures: COVID-19 vaccination. Main Outcomes and Measures: Associations were evaluated between prior vaccination and (1) hospitalization for COVID-19, in which case patients were those hospitalized for COVID-19 and control patients were those hospitalized for an alternative diagnosis; and (2) disease progression among patients hospitalized for COVID-19, in which cases and controls were COVID-19 patients with and without progression to death or mechanical ventilation, respectively. Associations were measured with multivariable logistic regression. Results: Among 4513 patients (median age, 59 years [IQR, 45-69]; 2202 [48.8%] women; 23.0% non-Hispanic Black individuals, 15.9% Hispanic individuals, and 20.1% with an immunocompromising condition), 1983 were case patients with COVID-19 and 2530 were controls without COVID-19. Unvaccinated patients accounted for 84.2% (1669/1983) of COVID-19 hospitalizations. Hospitalization for COVID-19 was significantly associated with decreased likelihood of vaccination (cases, 15.8%; controls, 54.8%; adjusted OR, 0.15; 95% CI, 0.13-0.18), including for sequenced SARS-CoV-2 Alpha (8.7% vs 51.7%; aOR, 0.10; 95% CI, 0.06-0.16) and Delta variants (21.9% vs 61.8%; aOR, 0.14; 95% CI, 0.10-0.21). This association was stronger for immunocompetent patients (11.2% vs 53.5%; aOR, 0.10; 95% CI, 0.09-0.13) than immunocompromised patients (40.1% vs 58.8%; aOR, 0.49; 95% CI, 0.35-0.69) (P < .001) and weaker at more than 120 days since vaccination with BNT162b2 (5.8% vs 11.5%; aOR, 0.36; 95% CI, 0.27-0.49) than with mRNA-1273 (1.9% vs 8.3%; aOR, 0.15; 95% CI, 0.09-0.23) (P < .001). Among 1197 patients hospitalized with COVID-19, death or invasive mechanical ventilation by day 28 was associated with decreased likelihood of vaccination (12.0% vs 24.7%; aOR, 0.33; 95% CI, 0.19-0.58). Conclusions and Relevance: Vaccination with an mRNA COVID-19 vaccine was significantly less likely among patients with COVID-19 hospitalization and disease progression to death or mechanical ventilation. These findings are consistent with risk reduction among vaccine breakthrough infections compared with absence of vaccination.
Authors: Noemi F Freise; Milena Kivel; Olaf Grebe; Christian Meyer; Bahram Wafaisade; Matthias Peiper; Tobias Zeus; Jan Schmidt; Judith Neuwahl; Danny Jazmati; Tom Luedde; Edwin Bölke; Torsten Feldt; Björn Erik Ole Jensen; Johannes Bode; Verena Keitel; Jan Haussmann; Balint Tamaskovics; Wilfried Budach; Johannes C Fischer; Wolfram Trudo Knoefel; Marion Schneider; Peter Arne Gerber; Alessia Pedoto; Dieter Häussinger; Martijn van Griensven; Amir Rezazadeh; Yechan Flaig; Julian Kirchner; Gerald Antoch; Hubert Schelzig; Christiane Matuschek Journal: Eur J Med Res Date: 2022-06-02 Impact factor: 4.981
Authors: Amanda P Smith; Evan P Williams; Taylor R Plunkett; Muneeswaran Selvaraj; Lindey C Lane; Lillian Zalduondo; Yi Xue; Peter Vogel; Rudragouda Channappanavar; Colleen B Jonsson; Amber M Smith Journal: Front Immunol Date: 2022-05-12 Impact factor: 8.786
Authors: Dania M AlKhafaji; Reem J Al Argan; Salma AlBahrani; Abrar J Alwaheed; Safi G Alqatari; Abdulmohsen H Al Elq; Waleed Albaker; Marwan Alwazzeh; Amal S AlSulaiman; Reem S AlSulaiman; Hussain M Almadan; Ali A Alhammad; Ali N Almajid; Fatimah H Hakami; Wafa K Alanazi Journal: Infect Drug Resist Date: 2022-07-02 Impact factor: 4.177
Authors: Andrew H Karaba; Xianming Zhu; Tao Liang; Kristy H Wang; Alex G Rittenhouse; Olivia Akinde; Yolanda Eby; Jessica E Ruff; Joel N Blankson; Aura T Abedon; Jennifer L Alejo; Andrea L Cox; Justin R Bailey; Elizabeth A Thompson; Sabra L Klein; Daniel S Warren; Jacqueline M Garonzik-Wang; Brian J Boyarsky; Ioannis Sitaras; Andrew Pekosz; Dorry L Segev; Aaron A R Tobian; William A Werbel Journal: Am J Transplant Date: 2022-01-18 Impact factor: 8.086