Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing Covid-19 Hospitalizations in the United States

Mark W Tenforde; Manish M Patel; Adit A Ginde; David J Douin; H Keipp Talbot; Jonathan D Casey; Nicholas M Mohr; Anne Zepeski; Manjusha Gaglani; Tresa McNeal; Shekhar Ghamande; Nathan I Shapiro; Kevin W Gibbs; D Clark Files; David N Hager; Arber Shehu; Matthew E Prekker; Heidi L Erickson; Matthew C Exline; Michelle N Gong; Amira Mohamed; Daniel J Henning; Ithan D Peltan; Samuel M Brown; Emily T Martin; Arnold S Monto; Akram Khan; C Terri Hough; Laurence Busse; Caitlin C ten Lohuis; Abhijit Duggal; Jennifer G Wilson; Alexandra June Gordon; Nida Qadir; Steven Y Chang; Christopher Mallow; Hayley B Gershengorn; Hilary M Babcock; Jennie H Kwon; Natasha Halasa; James D Chappell; Adam S Lauring; Carlos G Grijalva; Todd W Rice; Ian D Jones; William B Stubblefield; Adrienne Baughman; Kelsey N Womack; Christopher J Lindsell; Kimberly W Hart; Yuwei Zhu; Samantha M Olson; Meagan Stephenson; Stephanie J Schrag; Miwako Kobayashi; Jennifer R Verani; Wesley H Self; For the Influenza and Other Viruses in the Acutely Ill (IVY) Network

doi:10.1093/cid/ciab687

. 2021 Aug 6:ciab687. doi: 10.1093/cid/ciab687

Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing Covid-19 Hospitalizations in the United States

Mark W Tenforde ¹, Manish M Patel ¹, Adit A Ginde ², David J Douin ³, H Keipp Talbot ⁴, Jonathan D Casey ⁵, Nicholas M Mohr ⁶, Anne Zepeski ⁶, Manjusha Gaglani ⁷, Tresa McNeal ⁷, Shekhar Ghamande ⁷, Nathan I Shapiro ⁸, Kevin W Gibbs ⁹, D Clark Files ⁹, David N Hager ¹⁰, Arber Shehu ¹⁰, Matthew E Prekker ¹¹, Heidi L Erickson ¹², Matthew C Exline ¹³, Michelle N Gong ¹⁴, Amira Mohamed ¹⁵, Daniel J Henning ¹⁶, Ithan D Peltan ¹⁷, Samuel M Brown ¹⁸, Emily T Martin ¹⁹, Arnold S Monto ¹⁹, Akram Khan ²⁰, C Terri Hough ²⁰, Laurence Busse ²¹, Caitlin C ten Lohuis ²², Abhijit Duggal ²³, Jennifer G Wilson ²⁴, Alexandra June Gordon ²⁴, Nida Qadir ²⁵, Steven Y Chang ²⁵, Christopher Mallow ²⁶, Hayley B Gershengorn ²⁶, Hilary M Babcock ²⁷, Jennie H Kwon ²⁷, Natasha Halasa ²⁸, James D Chappell ²⁸, Adam S Lauring ²⁹, Carlos G Grijalva ³⁰, Todd W Rice ³¹, Ian D Jones ³¹, William B Stubblefield ⁵, Adrienne Baughman ³¹, Kelsey N Womack ³², Christopher J Lindsell ³³, Kimberly W Hart ³³, Yuwei Zhu ³³, Samantha M Olson ¹, Meagan Stephenson ¹, Stephanie J Schrag ¹, Miwako Kobayashi ¹, Jennifer R Verani ^1,^#, Wesley H Self ^34,^#,^✉; For the Influenza and Other Viruses in the Acutely Ill (IVY) Network¹

¹CDC COVID-19 Response Team, Atlanta, Georgia

²Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado

³Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado

⁴Department of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee

⁵Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee

⁶Department of Emergency Medicine, University of Iowa, Iowa City, Iowa

⁷Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas

⁸Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

⁹Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina

¹⁰Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

¹¹Department of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota

¹²Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota

¹³Department of Medicine, The Ohio State University, Columbus, Ohio

¹⁴Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York

¹⁵Department of Medicine, Montefiore Medical Center, Bronx, New York

¹⁶Department of Emergency Medicine, University of Washington, Seattle, Washington

¹⁷Department of Medicine, Baystate Medical Center, Springfield, Massachusetts

¹⁸Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, Utah

¹⁹School of Public Health, University of Michigan, Ann Arbor, Michigan

²⁰Department of Medicine, Oregon Health and Sciences University, Portland, Oregon

²¹Department of Medicine, Emory University, Atlanta, Georgia

²²Emory Critical Care Center, Emory Healthcare, Atlanta, Georgia

²³Department of Medicine, Cleveland Clinic, Cleveland, Ohio

²⁴Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California

²⁵Department of Medicine, University of California-Los Angeles, Los Angeles, California

²⁶Department of Medicine, University of Miami, Miami, Florida

²⁷Department of Medicine, Washington University, St. Louis, Missouri

²⁸Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee

²⁹Department of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan

³⁰Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee

³¹Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee

³²Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee

³³Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee

³⁴Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee

^✉

Corresponding Author:Wesley H. Self, MD, MPH; Vanderbilt University Medical Center; 312 Oxford House, 1313 21st Avenue South, Nashville, Tennessee 37232. Email: wesley.self@vumc.org; phone: 615-936-8047; fax: 615-936-3754

Dr. Self and Dr. Verani contributed equally to this work

PMCID: PMC8436392 PMID: 34358310

Abstract

Background

As SARS-CoV-2 vaccination coverage increases in the United States (US), there is a need to understand the real-world effectiveness against severe Covid-19 and among people at increased risk for poor outcomes.

Methods

In a multicenter case-control analysis of US adults hospitalized March 11-May 5, 2021, we evaluated vaccine effectiveness to prevent Covid-19 hospitalizations by comparing odds of prior vaccination with an mRNA vaccine (Pfizer-BioNTech or Moderna) between cases hospitalized with Covid-19 and hospital-based controls who tested negative for SARS-CoV-2.

Results

Among 1212 participants, including 593 cases and 619 controls, median age was 58 years, 22.8% were Black, 13.9% were Hispanic, and 21.0% had immunosuppression. SARS-CoV-2 lineage B.1.1.7 (Alpha) was the most common variant (67.9% of viruses with lineage determined). Full vaccination (receipt of two vaccine doses ≥14 days before illness onset) had been received by 8.2% of cases and 36.4% of controls. Overall vaccine effectiveness was 87.1% (95% CI: 80.7 to 91.3%). Vaccine effectiveness was similar for Pfizer-BioNTech and Moderna vaccines, and highest in adults aged 18-49 years (97.4%; 95% CI: 79.3 to 99.7%). Among 45 patients with vaccine-breakthrough Covid hospitalizations, 44 (97.8%) were ≥50 years old and 20 (44.4%) had immunosuppression. Vaccine effectiveness was lower among patients with immunosuppression (62.9%; 95% CI: 20.8 to 82.6%) than without immunosuppression (91.3%; 95% CI: 85.6 to 94.8%).

Conclusion

During March–May 2021, SARS-CoV-2 mRNA vaccines were highly effective for preventing Covid-19 hospitalizations among US adults. SARS-CoV-2 vaccination was beneficial for patients with immunosuppression, but effectiveness was lower in the immunosuppressed population.

Keywords: COVID-19, vaccine effectiveness, mRNA vaccines, hospitalized, immunocompromised

Supplementary Material

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ciab687_suppl_Supplementary_Material_2

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

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ciab687_suppl_Supplementary_Material_2

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PERMALINK

Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing Covid-19 Hospitalizations in the United States

Mark W Tenforde, MD, PhD

Manish M Patel, MD

Adit A Ginde, MD, MPH

David J Douin, MD

H Keipp Talbot, MD, MPH

Jonathan D Casey, MD, MSci

Nicholas M Mohr, MD, MS

Anne Zepeski, PharmD

Manjusha Gaglani, MBBS

Tresa McNeal, MD

Shekhar Ghamande, MD

Nathan I Shapiro, MD, MPH

Kevin W Gibbs, MD

D Clark Files, MD

David N Hager, MD, PhD

Arber Shehu, MD

Matthew E Prekker, MD, MPH

Heidi L Erickson, MD

Matthew C Exline, MD, MPH

Michelle N Gong, MD

Amira Mohamed, MD

Daniel J Henning, MD, MPH

Ithan D Peltan, MD, MSc

Samuel M Brown, MD, MS

Emily T Martin, PhD

Arnold S Monto, MD

Akram Khan, MD

C Terri Hough, MD

Laurence Busse, MD

Caitlin C ten Lohuis, ACNP-BC

Abhijit Duggal, MD

Jennifer G Wilson, MD

Alexandra June Gordon, MD

Nida Qadir, MD

Steven Y Chang, MD, PhD

Christopher Mallow, MD, MHS

Hayley B Gershengorn, MD

Hilary M Babcock, MD, MPH

Jennie H Kwon, DO, MS

Natasha Halasa, MD, MPH

James D Chappell, MD, PhD

Adam S Lauring, MD, PhD

Carlos G Grijalva, MD, MPH

Todd W Rice, MD, MSci

Ian D Jones, MD

William B Stubblefield, MD, MPH

Adrienne Baughman

Kelsey N Womack, PhD

Christopher J Lindsell, PhD

Kimberly W Hart, MA

Yuwei Zhu, MD, MS

Samantha M Olson, MPH

Meagan Stephenson, MPH

Stephanie J Schrag, DPhil

Miwako Kobayashi, MD

Jennifer R Verani, MD

Wesley H Self, MD, MPH

Abstract

Background

Methods

Results

Conclusion

Supplementary Material

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

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