Abstract
Background
Waning vaccine-immunity and an increased incidence of COVID-19 during the Omicron outbreak led the Israeli Ministry of Health to recommend a fourth dose of BNT162b2 for high-risk individuals. This study assessed the effect of that dose for hospitalized patients with severe/critical, breakthrough COVID-19.
Methods
In this multi-center retrospective cohort study of hospitalized adults with severe/critical COVID-19 in Israel, from 01/15/2022–01/31/2022, 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 1,049 patients, median age 80 years (IQR 69-87), 51% males. Among them, 394 were unvaccinated, 386 had received 3 doses and 88 4 doses. The 3-dose group was older, had more males and immunosuppression, but with similar outcomes, 49% vs. 51% compared to unvaccinated patients (p = 0.72). Patients after 4 doses were similarly older and immunosuppressed, but had better outcomes compared to unvaccinated patients, 34% vs. 51% (p < 0.01). We examined independent predictors for poor outcome in patients with either 3 or 4 doses, received a median of 161 (IQR 147-168) or 14 (IQR 10-18) days before diagnosis, respectively. Receipt of the fourth dose was associated with protection: OR 0.51 (95%CI 0.3-0.87), as was Remdesivir OR 0.65 (95%CI 0.44-0.96). Male sex, chronic renal failure and dementia were associated with poor outcomes.
Conclusions
Among hospitalized patients with severe/critical breakthrough COVID-19, a recent fourth dose was associated with significant protection against mechanical ventilation or death, compared to three doses.
Keywords: COVID-19, BNT162b2, vaccine, booster, fourth dose
Contributor Information
Tal Brosh-Nissimov, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel; Infectious Diseases Unit, Samson Assuta-Ashdod University Hospital, Ashdod, Israel.
Khetam Hussein, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel.
Yonit Wiener-Well, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Efrat Orenbuch-Harroch, Division of Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Meital Elbaz, Department of Infectious Diseases, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Shelly Lipman-Arens, Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel; Infectious disease and Infection Control Unit, Hillel Yaffe Medical Center, Hadera, Israel.
Yasmin Maor, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Wolfson Medical Center, Holon, Israel.
Yael Yagel, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel; Infectious Disease Institute, Soroka Medical Center, Beer Sheba, Israel.
Bibiana Chazan, Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel; Infectious Diseases Unit, Emek Medical Center, Afula, Israel.
Mirit Hershman-Sarafov, Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel; Bnai Zion Medical Center, Haifa, Israel.
Galia Rahav, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel.
Oren Zimhony, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel.
Adi Zaidman Shimshovitz, Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel; Infectious Disease Unit, The Baruch Padeh Medical Center, Tiberias, Israel.
Michal Chowers, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Meir Medical Center, Kfar Saba, Israel.
Supplementary Material
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