ABSTRACT
Background: Though the use of home testing is increasing, it is not represented in the reported coronavirus disease 2019 (COVID-19) metrics. As the epidemic and its tracking evolve, it is critical to understand who the excluded home-tested persons are relative to those in reported metrics. Methods: Five New York State databases were linked to understand the trends in home-tested COVID-19 cases compared to laboratory-confirmed cases from November 2021 to April 2022. Frequency distributions, logistic regression adjusted odds ratios (aOR), and 95% confidence intervals (CI) were used to compare the characteristics of home-tested and laboratory-tested persons. Results: Of 592,227 confirmed COVID-19 cases, 71,531 (12%) had a home-test-only, 515,001 (87%) had a laboratory-test-only and 5,695 (1%) had both a home-test and laboratory-test during this period. Home-tested cases, as a percentage of confirmed COVID-19 cases, increased from 1% in November 2021 to 22% in April 2022. Children aged 5-11 years with 3.74 aOR (95% CI:3.53, 3.96) and adolescents aged 12-17 years with 3.24 aOR (95% CI:3.07, 3.43) were more likely to have home-test-only than adults aged 65 and above. Boosted (aOR 1.87, 95% CI:1.82, 1.93), in K-12 school settings (aOR 2.33, 95% CI:2.27, 2.40), or possibly infected by a household member (aOR 1.17, 95% CI:1.13, 1.22) were more likely to report home-test-only than laboratory-test-only. Individuals hospitalized (aOR 0.04, 95% CI:0.03, 0.06), with underlying conditions (aOR 0.85, 95% CI:0.83, 0.87), pregnant (aOR 0.76, 95% CI:0.66, 0.86), Hispanic (aOR 0.50:95% CI:0.48, 0.53), Asian (aOR 0.31, 95% CI:0.28, 0.34), or Black (aOR 0.45, 95% CI:0.42, 047) were less likely to utilize the home test only compared to the laboratory test only. Conclusion: The number of individuals using home tests only as a proportion of confirmed COVID-19 cases continues to increase. Home test-only cases are less likely to be hospitalized and have a lower potential for severe disease as measured by age, vaccination status, and underlying conditions. Thus, those with severe disease and the potential for severe disease are represented as official metrics. Racial and ethnic differences exist between persons reporting home and laboratory tests.
Subject(s)
COVID-19ABSTRACT
Importance: There is limited evidence on the effectiveness of the BNT162b2 vaccine for children, particularly those 5-11 years and after the Omicron variant's emergence. Objective: To estimate BNT162b2 vaccine effectiveness against COVID cases and hospitalizations among children 5-11 years and 12-17 years during December, 2021 and January, 2022. Design: Analyses of cohorts constructed from linked statewide immunization, laboratory testing, and hospitalization databases. Setting/Participants: New York State children 5-17 years. Main outcomes/measures: New laboratory-confirmed COVID-19 cases and hospitalizations. Comparisons were made using the incidence rate ratio (IRR), comparing outcomes by vaccination status, and estimated vaccine effectiveness (VE: 1-[1/IRR]). Results: From December 13, 2021 to January 30, 2022, among 852,384 fully-vaccinated children 12-17 years and 365,502 children 5-11 years, VE against cases declined from 66% (95% CI: 64%, 67%) to 51% (95% CI: 48%, 54%) for those 12-17 years and from 68% (95% CI: 63%, 72%) to 12% (95% CI: 6%, 16%) for those 5-11 years. During the January 24-30 week, VE for children 11 years was 11% (95%CI -3%, 23%) and for those age 12 was 67% (95% CI: 62%, 71%). VE against hospitalization declined changed from 85% (95% CI: 63%, 95%) to 73% (95% CI: 53%, 87%) for children 12-17 years, and from 100% (95% CI: -189%, 100%) to 48% (95% CI: -12%, 75%) for those 5-11 years. Among children newly fully-vaccinated December 13, 2021 to January 2, 2022, VE against cases within two weeks of full vaccination for children 12-17 years was 76% (95% CI: 71%, 81%) and by 28-34 days it was 56% (95% CI: 43%, 63%). For children 5-11, VE against cases declined from 65% (95% CI: 62%, 68%) to 12% (95% CI: 8%, 16%) by 28-34 days. Conclusions and Relevance: In the Omicron era, the effectiveness against cases of BNT162b2 declined rapidly for children, particularly those 5-11 years. However, vaccination of children 5-11 years was protective against severe disease and is recommended. These results highlight the potential need to study alternative vaccine dosing for children and the continued importance layered protections, including mask wearing, to prevent infection and transmission.
Subject(s)
COVID-19ABSTRACT
BackgroundUS population-based data on COVID-19 vaccine effectiveness (VE) for the 3 currently FDA-authorized products is limited. Whether declines in VE are due to waning immunity, the Delta variant, or other causes, is debated. MethodsWe conducted a prospective study of 8,834,604 New York adults, comparing vaccine cohorts defined by product, age, and month of full-vaccination to age-specific unvaccinated cohorts, by linking statewide testing, hospital, and vaccine registry databases. VE was estimated from May 1, 2021 for incident laboratory-confirmed COVID-19 cases (weekly life-table hazard rates through September 3) and hospitalizations (monthly incidence rates through August 31). Results155,092 COVID-19 cases and 14,862 hospitalizations occurred. Estimated VE for cases declined contemporaneously across age, products, and time-cohorts, from high levels beginning May 1 (1.8% Delta variant prevalence), to a nadir around July 10 (85.3% Delta), with limited changes thereafter (>95% Delta). Decreases were greatest for Pfizer-BioNTech (-24.6%, -19.1%, -14.1% for 18-49, 50-64 years, and [≥]65 years, respectively), and similar for Moderna (-18.0%, -11.6%, -9.0%, respectively) and Janssen (-19.2%, -10.8, -10.9%, respectively). VE for hospitalization for adults 18-64 years was >86% across cohorts, without time trend. Among persons [≥]65 years, VE declined from May to August for Pfizer-BioNTech (95.0% to 89.2%) and Moderna (97.2% to 94.1%). VE was lower for Janssen, without trend, ranging 85.5%-82.8%. ConclusionsDeclines in VE for cases may have been primarily driven by factors other than waning. VE for hospitalizations remained high, with modest declines limited to Pfizer-BioNTech and Moderna recipients [≥]65 years, supporting targeted booster dosing recommendations.
Subject(s)
COVID-19 , Pulmonary Disease, Chronic ObstructiveABSTRACT
Importance: New York State (NYS) is an epicenter of the United States' COVID-19 epidemic. Reliable estimates of cumulative incidence of SARS-CoV-2 infection in the population are critical to tracking the extent of transmission and informing policies, but US data are lacking, in part because societal closure complicates study conduct. Objective: To estimate the cumulative incidence of SARS-CoV-2 infection and percent of infections diagnosed in New York State, overall and by region, age, sex, and race and ethnicity. Design: Statewide cross-sectional seroprevalence study, conducted April 19-28, 2020. Setting: Grocery stores (n=99) located in 26 counties throughout NYS, which were essential businesses that remained open during a period of societal closure and attract a heterogenous clientele. Participants: Convenience sample of patrons >=18 years and residing in New York State, recruited consecutively upon entering stores and via an in-store flyer. Exposures: Region (New York City, Westchester/Rockland, Long Island, Rest of New York State), age, sex, race and ethnicity. Main Outcomes: Primary outcome: cumulative incidence of SARS-CoV-2 infection, based on dry-blood spot (DBS) SARS-CoV-2 antibody reactivity; secondary outcome: percent of infections diagnosed. Results: Among 15,101 adults with suitable DBS specimens, 1,887 (12.5%) were reactive using a validated SARS-CoV-2 IgG microsphere immunoassay (sensitivity 87.9%, specificity 99.75%). Following post-stratification weighting on region, sex, age, and race and ethnicity and adjustment for assay characteristics, estimated cumulative incidence through March 29 was 14.0% (95% CI: 13.3-14.7%), corresponding to 2,139,300 (95% CI: 2,035,800-2,242,800) infection-experienced adults. Cumulative incidence was higher among Hispanic/Latino (29.2%, 95% CI: 27.2-31.2%), non-Hispanic black/African American (20.2% 95% CI, 18.1-22.3%), and non-Hispanic Asian (12.4%, 95% CI: 9.4-15.4%) adults than non-Hispanic white adults (8.1%, 95% CI: 7.4-8.7%, p