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. 2023 Oct 31;229(3):648–659. doi: 10.1093/infdis/jiad474

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© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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Figure 1. — Selection criteria. ^aThe number of months between the last original wild-type COVID-19 mRNA dose and the testing date was calculated as the whole number representing the difference between the month and year of the last original wild-type COVID-19 mRNA dose and the month and year of the SARS-CoV-2 test date. Due to not having days, removing those with a difference of 0–2 months may remove some patients who have a difference of 3 months between the last original wild-type COVID-19 mRNA dose and the SARS-CoV-2 test date (ie, last original wild-type COVID-19 mRNA dose on the first day of July and SARS-CoV-2 test on the last day of September). Using this decision rule ensured that individuals who received their BA.4/5 bivalent dose too early or those who had received 2–4 original wild-type doses but were not yet eligible to receive a BA.4/5 bivalent dose were removed from the analysis, but may have also excluded some individuals who received their dose 2 months ago. Furthermore, the dichotomization of time since last original wild-type dose (2–6 months ago vs ≥7 months ago) could result in some misclassification of individuals classified as having received their last original wild-type dose 6 or 7 months ago. For example, the 2–6 month category could include some individuals who were vaccinated closer to 7 months ago and those in the ≥7 month category could include some individuals who received their last original wild-type dose closer to 6 months ago. ^bThe number of months between vaccine doses is calculated as the whole number representing the difference between the month and year of the last original wild-type COVID-19 mRNA dose and the month and year of the BA.4/5 bivalent dose. Due to not having days, removing those with a difference of 0–2 months may remove some patients who had a difference of 3 months between the last original wild-type COVID-19 mRNA dose and the BA.4/5 bivalent dose (ie, last original wild-type COVID-19 mRNA dose on the first day of July and BA.4/5 bivalent dose on the last day of September). ^cThe number of months between the last BA.4/5 bivalent mRNA vaccine dose and the testing date is a whole number calculated as the difference between the month and year of the testing date and the month and year of the last BA.4/5 bivalent vaccine dose. For doses received in the same month or the month before completing the SARS-CoV-2 test scheduling questionnaire, an additional question was asked to specify whether the dose was received ≥2 weeks before testing, and only doses received ≥2 weeks before testing were included. Doses received ≥2 weeks before testing but in the same month of testing were coded as having their last bivalent dose 0 months ago. ^dIndividuals testing multiple times at a Walgreens pharmacy between 1 January 2022 and 31 January 2023 were identified by merging testing questionnaire data based on the patient’s first name, last name, phone number, address state, date of birth, and gender. We removed records where the patient reported having received fewer vaccine doses than they had in an earlier questionnaire (from 1 January 2022 to 31 January 2023). ^eRepeat testers were identified by merging questionnaire data based on the patient’s first name, last name, phone number, address state, date of birth, and gender. We removed records where the patient reported having received fewer vaccines than they had in an earlier survey.