IMPORTANCE: Monitoring COVID-19 vaccine performance over time since vaccination and against emerging variants informs control measures and vaccine policies. OBJECTIVE: To estimate the associations between symptomatic SARS-CoV-2 infection and receipt of BNT162b2, mRNA-1273, and Ad26.COV2.S by day since vaccination before and during Delta variant predominance (pre-Delta period: March 13-May 29, 2021; Delta period: July 18-October 17, 2021). DESIGN, SETTING, AND PARTICIPANTS: Test-negative, case-control design with data from 6884 US COVID-19 testing sites in the pharmacy-based Increasing Community Access to Testing platform. This study included 1 634 271 laboratory-based SARS-CoV-2 nucleic acid amplification tests (NAATs) from adults 20 years and older and 180 112 NAATs from adolescents 12 to 19 years old with COVID-19-like illness from March 13 to October 17, 2021. EXPOSURES: COVID-19 vaccination (1 Ad26.COV2.S dose or 2 mRNA doses) 14 or more days prior. MAIN OUTCOMES AND MEASURES: Association between symptomatic infection and prior vaccination measured using the odds ratio (OR) from spline-based multivariable logistic regression. RESULTS: The analysis included 390 762 test-positive cases (21.5%) and 1 423 621 test-negative controls (78.5%) (59.9% were 20-44 years old; 9.9% were 12-19 years old; 58.9% were female; 71.8% were White). Among adults 20 years and older, the BNT162b2 mean OR for days 14 to 60 after a second dose (initial OR) was lower during the pre-Delta period (0.10 [95% CI, 0.09-0.11]) than during the Delta period (0.16 [95% CI, 0.16-0.17]) and increased with time since vaccination (per-month change in OR, pre-Delta: 0.04 [95% CI, 0.02-0.05]; Delta: 0.03 [95% CI, 0.02-0.03]). The initial mRNA-1273 OR was 0.05 (95% CI, 0.04-0.05) during the pre-Delta period, 0.10 (95% CI, 0.10-0.11) during the Delta period, and increased with time (per-month change in OR, pre-Delta: 0.02 [95% CI, 0.005-0.03]; Delta: 0.03 [95% CI, 0.03-0.04]). The Ad26.COV2.S initial OR was 0.42 (95% CI, 0.37-0.47) during the pre-Delta period and 0.62 (95% CI, 0.58-0.65) during the Delta period and did not significantly increase with time since vaccination. Among adolescents, the BNT162b2 initial OR during the Delta period was 0.06 (95% CI, 0.05-0.06) among 12- to 15-year-olds, increasing by 0.02 (95% CI, 0.01-0.03) per month, and 0.10 (95% CI, 0.09-0.11) among 16- to 19-year-olds, increasing by 0.04 (95% CI, 0.03-0.06) per month. CONCLUSIONS AND RELEVANCE: Among adults, the OR for the association between symptomatic SARS-CoV-2 infection and COVID-19 vaccination (as an estimate of vaccine effectiveness) was higher during Delta variant predominance, suggesting lower protection. For mRNA vaccination, the steady increase in OR by month since vaccination was consistent with attenuation of estimated effectiveness over time; attenuation related to time was greater than that related to variant.
IMPORTANCE: Monitoring COVID-19 vaccine performance over time since vaccination and against emerging variants informs control measures and vaccine policies. OBJECTIVE: To estimate the associations between symptomatic SARS-CoV-2 infection and receipt of BNT162b2, mRNA-1273, and Ad26.COV2.S by day since vaccination before and during Delta variant predominance (pre-Delta period: March 13-May 29, 2021; Delta period: July 18-October 17, 2021). DESIGN, SETTING, AND PARTICIPANTS: Test-negative, case-control design with data from 6884 US COVID-19 testing sites in the pharmacy-based Increasing Community Access to Testing platform. This study included 1 634 271 laboratory-based SARS-CoV-2 nucleic acid amplification tests (NAATs) from adults 20 years and older and 180 112 NAATs from adolescents 12 to 19 years old with COVID-19-like illness from March 13 to October 17, 2021. EXPOSURES: COVID-19 vaccination (1 Ad26.COV2.S dose or 2 mRNA doses) 14 or more days prior. MAIN OUTCOMES AND MEASURES: Association between symptomatic infection and prior vaccination measured using the odds ratio (OR) from spline-based multivariable logistic regression. RESULTS: The analysis included 390 762 test-positive cases (21.5%) and 1 423 621 test-negative controls (78.5%) (59.9% were 20-44 years old; 9.9% were 12-19 years old; 58.9% were female; 71.8% were White). Among adults 20 years and older, the BNT162b2 mean OR for days 14 to 60 after a second dose (initial OR) was lower during the pre-Delta period (0.10 [95% CI, 0.09-0.11]) than during the Delta period (0.16 [95% CI, 0.16-0.17]) and increased with time since vaccination (per-month change in OR, pre-Delta: 0.04 [95% CI, 0.02-0.05]; Delta: 0.03 [95% CI, 0.02-0.03]). The initial mRNA-1273 OR was 0.05 (95% CI, 0.04-0.05) during the pre-Delta period, 0.10 (95% CI, 0.10-0.11) during the Delta period, and increased with time (per-month change in OR, pre-Delta: 0.02 [95% CI, 0.005-0.03]; Delta: 0.03 [95% CI, 0.03-0.04]). The Ad26.COV2.S initial OR was 0.42 (95% CI, 0.37-0.47) during the pre-Delta period and 0.62 (95% CI, 0.58-0.65) during the Delta period and did not significantly increase with time since vaccination. Among adolescents, the BNT162b2 initial OR during the Delta period was 0.06 (95% CI, 0.05-0.06) among 12- to 15-year-olds, increasing by 0.02 (95% CI, 0.01-0.03) per month, and 0.10 (95% CI, 0.09-0.11) among 16- to 19-year-olds, increasing by 0.04 (95% CI, 0.03-0.06) per month. CONCLUSIONS AND RELEVANCE: Among adults, the OR for the association between symptomatic SARS-CoV-2 infection and COVID-19 vaccination (as an estimate of vaccine effectiveness) was higher during Delta variant predominance, suggesting lower protection. For mRNA vaccination, the steady increase in OR by month since vaccination was consistent with attenuation of estimated effectiveness over time; attenuation related to time was greater than that related to variant.
Authors: Katherine E Fleming-Dutra; Amadea Britton; Nong Shang; Gordana Derado; Ruth Link-Gelles; Emma K Accorsi; Zachary R Smith; Joseph Miller; Jennifer R Verani; Stephanie J Schrag Journal: JAMA Date: 2022-06-14 Impact factor: 157.335
Authors: Nicola P Klein; Melissa S Stockwell; Maria Demarco; Manjusha Gaglani; Anupam B Kharbanda; Stephanie A Irving; Suchitra Rao; Shaun J Grannis; Kristin Dascomb; Kempapura Murthy; Elizabeth A Rowley; Alexandra F Dalton; Malini B DeSilva; Brian E Dixon; Karthik Natarajan; Edward Stenehjem; Allison L Naleway; Ned Lewis; Toan C Ong; Palak Patel; Deepika Konatham; Peter J Embi; Sarah E Reese; Jungmi Han; Nancy Grisel; Kristin Goddard; Michelle A Barron; Monica Dickerson; I-Chia Liao; William F Fadel; Duck-Hye Yang; Julie Arndorfer; Bruce Fireman; Eric P Griggs; Nimish R Valvi; Carly Hallowell; Ousseny Zerbo; Sue Reynolds; Jill Ferdinands; Mehiret H Wondimu; Jeremiah Williams; Catherine H Bozio; Ruth Link-Gelles; Eduardo Azziz-Baumgartner; Stephanie J Schrag; Mark G Thompson; Jennifer R Verani Journal: MMWR Morb Mortal Wkly Rep Date: 2022-03-04 Impact factor: 17.586
Authors: Meagan Stephenson; Samantha M Olson; Wesley H Self; Adit A Ginde; Nicholas M Mohr; Manjusha Gaglani; Nathan I Shapiro; Kevin W Gibbs; David N Hager; Matthew E Prekker; Michelle N Gong; Jay S Steingrub; Ithan D Peltan; Emily T Martin; Raju Reddy; Laurence W Busse; Abhijit Duggal; Jennifer G Wilson; Nida Qadir; Christopher Mallow; Jennie H Kwon; Matthew C Exline; James D Chappell; Adam S Lauring; Adrienne Baughman; Christopher J Lindsell; Kimberly W Hart; Nathaniel M Lewis; Manish M Patel; Mark W Tenforde Journal: Influenza Other Respir Viruses Date: 2022-07-11 Impact factor: 5.606
Authors: Hannah Chung; Peter C Austin; Kevin A Brown; Sarah A Buchan; Deshayne B Fell; Cindy Fong; Jonathan B Gubbay; Sharifa Nasreen; Kevin L Schwartz; Maria E Sundaram; Mina Tadrous; Kumanan Wilson; Sarah E Wilson; Jeffrey C Kwong Journal: Open Forum Infect Dis Date: 2022-09-07 Impact factor: 4.423
Authors: Jane K L Teh; David A Bradley; Woo Teck Ang; Kok Lay Teo; Jack Bee Chook; Kee Huong Lai; Suat-Cheng Peh Journal: J Environ Public Health Date: 2022-09-20
Authors: Mark W Tenforde; Wesley H Self; Manjusha Gaglani; Adit A Ginde; David J Douin; H Keipp Talbot; Jonathan D Casey; Nicholas M Mohr; Anne Zepeski; Tresa McNeal; Shekhar Ghamande; Kevin W Gibbs; D Clark Files; David N Hager; Arber Shehu; Matthew E Prekker; Anne E Frosch; Michelle N Gong; Amira Mohamed; Nicholas J Johnson; Vasisht Srinivasan; Jay S Steingrub; Ithan D Peltan; Samuel M Brown; Emily T Martin; Arnold S Monto; Akram Khan; Catherine L Hough; Laurence W Busse; Abhijit Duggal; Jennifer G Wilson; Nida Qadir; Steven Y Chang; Christopher Mallow; Carolina Rivas; Hilary M Babcock; Jennie H Kwon; Matthew C Exline; Mena Botros; Adam S Lauring; Nathan I Shapiro; Natasha Halasa; James D Chappell; Carlos G Grijalva; Todd W Rice; Ian D Jones; William B Stubblefield; Adrienne Baughman; Kelsey N Womack; Jillian P Rhoads; Christopher J Lindsell; Kimberly W Hart; Yuwei Zhu; Katherine Adams; Diya Surie; Meredith L McMorrow; Manish M Patel Journal: MMWR Morb Mortal Wkly Rep Date: 2022-03-25 Impact factor: 35.301