Vaccine effectiveness of primary series and booster doses against covid-19 associated hospital admissions in the United States: living test negative design study. (11th October 2022)

• Record Type: Journal Article
• Authors: Adams, Katherine; Rhoads, Jillian P; Surie, Diya; Gaglani, Manjusha; Ginde, Adit A; McNeal, Tresa; Talbot, H Keipp; Casey, Jonathan D; Zepeski, Anne; Shapiro, Nathan I; Gibbs, Kevin W; Files, D Clark; Hager, David N; Frosch, Anne E; Exline, Matthew C; Mohamed, Amira; Johnson, Nicholas J; Steingrub, Jay S; Peltan, Ithan D; Brown, Samuel M; Martin, Emily T; Lauring, Adam S; Khan, Akram; Busse, Laurence W; Duggal, Abhijit; Wilson, Jennifer G; Chang, Steven Y; Mallow, Christopher; Kwon, Jennie H; Chappell, James D; Halasa, Natasha; Grijalva, Carlos G; Lindsell, Christopher J; Lester, Sandra N; Thornburg, Natalie J; Park, SoHee; McMorrow, Meredith L; Patel, Manish M; Tenforde, Mark W; Self, Wesley H;
• Other Names: author non-byline.; Ghamande Shekhar author non-byline.; Calhoun Nicole author non-byline.; Murthy Kempapura author non-byline.; Herrick Judy author non-byline.; McKillop Amanda author non-byline.; Hoffman Eric author non-byline.; Zayed Martha author non-byline.; Smith Michael author non-byline.; Kozikowski Lori-Ann author non-byline.; De Souza Lesley author non-byline.; Ouellette Scott author non-byline.; Bolstad Michael author non-byline.; Coviello Brianna author non-byline.; Ciottone Robert author non-byline.; Devilla Arnaldo author non-byline.; Grafals Ana author non-byline.; Higgins Conor author non-byline.; Ottanelli Carlo author non-byline.; Redman Kimberly author non-byline.; Scaffidi Douglas author non-byline.; Weingart Alexander author non-byline.; Lewis Nathaniel author non-byline.; Mehkri Omar author non-byline.; Mitchell Megan author non-byline.; Griffith Zachary author non-byline.; Brennan Connery author non-byline.; Ashok Kiran author non-byline.; Poynter Bryan author non-byline.; ten Lohuis Caitlin author non-byline.; Stanley Nicholas author non-byline.; Zhang Sophia author non-byline.; Prekker Matthew author non-byline.; Erickson Heidi author non-byline.; Hendrickson Audrey author non-byline.; Caspers Sean author non-byline.; Tordsen Walker author non-byline.; Kaus Olivia author non-byline.; Scharber Tyler author non-byline.; Lumpkin Jenna author non-byline.; Smith Cassie author non-byline.; Marshall Hunter author non-byline.; Shehu Arber author non-byline.; Ali Harith author non-byline.; Rothman Richard E author non-byline.; Mohamed Amira author non-byline.; Nair Rahul author non-byline.; Chen Jen-Ting (Tina) author non-byline.; Karow Sarah author non-byline.; Robart Emily author non-byline.; Maldonado Paulo Nunes author non-byline.; Khan Maryiam author non-byline.; So Preston author non-byline.; So Madison author non-byline.; Schwartz Elizabeth author non-byline.; Botros Mena author non-byline.; Hough Catherine L author non-byline.; Jung Haeun author non-byline.; Martinez Jesus author non-byline.; Luong Andrea author non-byline.; Huynh Bao author non-byline.; Ibrahim Habiba author non-byline.; Villanueva-Vargas Cynthia author non-byline.; Villanueva-Vargas Juliana author non-byline.; Quadri Suha author non-byline.; Gordon Alexandra June author non-byline.; Levitt Joe author non-byline.; Perez Cynthia author non-byline.; Visweswaran Anita author non-byline.; Roque Jonasel author non-byline.; Qadir Nida author non-byline.; Frankel Trevor author non-byline.; Garner Omai author non-byline.; Chandrasekaran Sukantha author non-byline.; Douin David author non-byline.; Jensen Kelly author non-byline.; Huynh David author non-byline.; Steinwand Aimee author non-byline.; Withers Cori author non-byline.; Mohr Nicholas author non-byline.; Nassar Paul author non-byline.; Landers Shannon author non-byline.; Nielsen Karin author non-byline.; Briggs Noble author non-byline.; Fairfield Cathy author non-byline.; Gershengorn Hayley author non-byline.; Rivas Carolina author non-byline.; Monto Arnold author non-byline.; McSpadden E J author non-byline.; Truscon Rachel author non-byline.; Kaniclides Anne author non-byline.; Thomas Lara author non-byline.; Bielak Ramsay author non-byline.; Valvano Weronika Damek author non-byline.; Fong Rebecca author non-byline.; Fitzsimmons William J author non-byline.; Blair Christopher author non-byline.; Gilbert Julie author non-byline.; Baker Leigh author non-byline.; Srinivasan Vasisht author non-byline.; Crider Christine D author non-byline.; Steinbock Kyle A author non-byline.; Paulsen Thomas C author non-byline.; Anderson Layla A author non-byline.; Jones Ian author non-byline.; Womack Kelsey author non-byline.; Baughman Adrienne author non-byline.; Kampe Christy author non-byline.; Johnson Jakea author non-byline.; Hart Kim author non-byline.; Rice Todd author non-byline.; Stubblefield William B author non-byline.; Zhu Yuwei author non-byline.; Short Laura L author non-byline.; Ezzell Lauren J author non-byline.; Whitsett Margaret E author non-byline.; McHenry Rendie E author non-byline.; Hargrave Samarian J author non-byline.; Blair Marcia author non-byline.; Luther Jennifer L author non-byline.; Pulido Claudia Guevara author non-byline.; Peterson Bryan P M author non-byline.; LaRose Mary author non-byline.; Landreth Leigha author non-byline.; Hicks Madeline author non-byline.; Parks Lisa author non-byline.; Babcock Hilary author non-byline.; Bongu Jahnavi author non-byline.; McDonald David author non-byline.; Cass Candice author non-byline.; Seiler Sondra author non-byline.; Park David author non-byline.; Hink Tiffany author non-byline.; Wallace Meghan author non-byline.; Burnham Carey-Ann author non-byline.; Arter Olivia G author non-byline.;
• Is Part Of: BMJ. Volume 379(2022)
• Publication Date: 2022-10-11
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610
• DOI: 10.1136/bmj-2022-072065
• Languages: English
• ISSNs: 0007-1447

Abstract

Abstract: Objective: To compare the effectiveness of a primary covid-19 vaccine series plus booster doses with a primary series alone for the prevention of hospital admission with omicron related covid-19 in the United States. Design: Multicenter observational case-control study with a test negative design. Setting: Hospitals in 18 US states. Participants: 4760 adults admitted to one of 21 hospitals with acute respiratory symptoms between 26 December 2021 and 30 June 2022, a period when the omicron variant was dominant. Participants included 2385 (50.1%) patients with laboratory confirmed covid-19 (cases) and 2375 (49.9%) patients who tested negative for SARS-CoV-2 (controls). Main outcome measures: The main outcome was vaccine effectiveness against hospital admission with covid-19 for a primary series plus booster doses and a primary series alone by comparing the odds of being vaccinated with each of these regimens versus being unvaccinated among cases versus controls. Vaccine effectiveness analyses were stratified by immunosuppression status (immunocompetent, immunocompromised). The primary analysis evaluated all covid-19 vaccine types combined, and secondary analyses evaluated specific vaccine products. Results: Overall, median age of participants was 64 years (interquartile range 52-75 years), 994 (20.8%) were immunocompromised, 85 (1.8%) were vaccinated with a primary series plus two boosters, 1367 (28.7%) with a primary series plus one booster, and 1875 (39.3%) with a primary series alone, and 1433 (30.1%) were unvaccinated. Among immunocompetent participants, vaccine effectiveness for prevention of hospital admission with omicron related covid-19 for a primary series plus two boosters was 63% (95% confidence interval 37% to 78%), a primary series plus one booster was 65% (58% to 71%), and for a primary series alone was 37% (25% to 47%) (P<0.001 for the pooled boosted regimens compared with a primary series alone). Vaccine effectiveness was higher for a boosted regimen than for a primary series alone for both mRNA vaccines (BNT162b2 (Pfizer-BioNTech): 73% (44% to 87%) for primary series plus two boosters, 64% (55% to 72%) for primary series plus one booster, and 36% (21% to 48%) for primary series alone (P<0.001); mRNA-1273 (Moderna): 68% (17% to 88%) for primary series plus two boosters, 65% (55% to 73%) for primary series plus one booster, and 41% (25% to 54%) for primary series alone (P=0.001)). Among immunocompromised patients, vaccine effectiveness for a primary series plus one booster was 69% (31% to 86%) and for a primary series alone was 49% (30% to 63%) (P=0.04). Conclusion: During the first six months of 2022 in the US, booster doses of a covid-19 vaccine provided additional benefit beyond a primary vaccine series alone for preventing hospital admissions with omicron related covid-19. Readers' note: This article is a living test negative design study that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.