Hospitalized Patients With Severe Coronavirus Disease 2019 During the Omicron Wave in Israel: Benefits of a Fourth Vaccine Dose. (16th July 2022)

• Record Type: Journal Article
• Authors: Brosh-Nissimov, Tal; Hussein, Khetam; Wiener-Well, Yonit; Orenbuch-Harroch, Efrat; Elbaz, Meital; Lipman-Arens, Shelly; Maor, Yasmin; Yagel, Yael; Chazan, Bibiana; Hershman-Sarafov, Mirit; Rahav, Galia; Zimhony, Oren; Zaidman Shimshovitz, Adi; Chowers, Michal
• Is Part Of: Clinical infectious diseases. Volume 76:Number 3(2023)
• Page Start: e234
• Page End: e239
• Publication Date: 2022-07-16
• Subjects: COVID-19 -- BNT162b2 -- vaccine -- booster -- fourth dose; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciac501
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Waning immunity and an increased incidence of coronavirus disease 2019 (COVID-19) during the Omicron outbreak led the Israeli Ministry of Health to recommend a fourth vaccine dose for high-risk individuals. In this study, we assessed its effect for hospitalized patients with severe breakthrough COVID-19. Methods: In this multicenter cohort study of hospitalized adults with severe COVID-19 in Israel, from 15 to 31 January 2022, cases were divided according to the number of vaccinations received. Poor outcome was defined as mechanical ventilation or in-hospital death and was compared between 3- and 4-dose vaccinees using logistic regression. Results: Included were 1049 patients, median age 80 years. Among them, 394 were unvaccinated, 386 and 88 had received 3 or 4 doses, respectively. The 3-dose group was older, included more males, and immunosuppressed patients but with similar outcomes, 49% vs 51% compared with unvaccinated patients ( P = .72). Patients who received 4 doses were similarly older and immunosuppressed but had better outcomes compared with unvaccinated patients, 34% vs 51% ( P < .01). We examined independent predictors for poor outcome in patients who received either 3 or 4 doses a median of 161 days or 14 days before diagnosis, respectively. Receipt of the fourth dose was associated with protection (odds ratio, 0.51; 95% confidence interval, .3–.87), as was remdesivir. Male sex, chronic renal failure, and dementia were associated with poor outcomes. Conclusions: Among hospitalized patients with severe breakthrough COVID-19, a recent fourth dose was associated with significant protection against mechanical ventilation or death compared with 3 doses. Abstract : This multicenter, cohort study of hospitalized patients with severe coronavirus disease 2019 showed that receipt of a recent fourth vaccine dose was associated with a significantly lower risk of death or mechanical ventilation compared with a remote 3-dose vaccination.