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Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings.
Thompson, Mark G; Stenehjem, Edward; Grannis, Shaun; Ball, Sarah W; Naleway, Allison L; Ong, Toan C; DeSilva, Malini B; Natarajan, Karthik; Bozio, Catherine H; Lewis, Ned; Dascomb, Kristin; Dixon, Brian E; Birch, Rebecca J; Irving, Stephanie A; Rao, Suchitra; Kharbanda, Elyse; Han, Jungmi; Reynolds, Sue; Goddard, Kristin; Grisel, Nancy; Fadel, William F; Levy, Matthew E; Ferdinands, Jill; Fireman, Bruce; Arndorfer, Julie; Valvi, Nimish R; Rowley, Elizabeth A; Patel, Palak; Zerbo, Ousseny; Griggs, Eric P; Porter, Rachael M; Demarco, Maria; Blanton, Lenee; Steffens, Andrea; Zhuang, Yan; Olson, Natalie; Barron, Michelle; Shifflett, Patricia; Schrag, Stephanie J; Verani, Jennifer R; Fry, Alicia; Gaglani, Manjusha; Azziz-Baumgartner, Eduardo; Klein, Nicola P.
  • Thompson MG; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Stenehjem E; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Grannis S; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Ball SW; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Naleway AL; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Ong TC; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • DeSilva MB; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Natarajan K; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Bozio CH; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Lewis N; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Dascomb K; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Dixon BE; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Birch RJ; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Irving SA; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Rao S; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Kharbanda E; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Han J; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Reynolds S; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Goddard K; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Grisel N; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Fadel WF; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Levy ME; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Ferdinands J; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Fireman B; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Arndorfer J; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Valvi NR; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Rowley EA; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Patel P; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Zerbo O; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Griggs EP; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Porter RM; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Demarco M; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Blanton L; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Steffens A; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Zhuang Y; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Olson N; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Barron M; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Shifflett P; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Schrag SJ; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Verani JR; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Fry A; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Gaglani M; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Azziz-Baumgartner E; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
  • Klein NP; From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., C.H.B., S. Reynolds, J.F., P.P., E.P.G., R.M.P., L.B., A.S., N.O., S.J.S., J.R.V., A.F., E.A.-B.); the Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City (E.S
N Engl J Med ; 385(15): 1355-1371, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1397961
ABSTRACT

BACKGROUND:

There are limited data on the effectiveness of the vaccines against symptomatic coronavirus disease 2019 (Covid-19) currently authorized in the United States with respect to hospitalization, admission to an intensive care unit (ICU), or ambulatory care in an emergency department or urgent care clinic.

METHODS:

We conducted a study involving adults (≥50 years of age) with Covid-19-like illness who underwent molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed 41,552 admissions to 187 hospitals and 21,522 visits to 221 emergency departments or urgent care clinics during the period from January 1 through June 22, 2021, in multiple states. The patients' vaccination status was documented in electronic health records and immunization registries. We used a test-negative design to estimate vaccine effectiveness by comparing the odds of a positive test for SARS-CoV-2 infection among vaccinated patients with those among unvaccinated patients. Vaccine effectiveness was adjusted with weights based on propensity-for-vaccination scores and according to age, geographic region, calendar time (days from January 1, 2021, to the index date for each medical visit), and local virus circulation.

RESULTS:

The effectiveness of full messenger RNA (mRNA) vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization, 90% (95% CI, 86 to 93) against infection leading to an ICU admission, and 91% (95% CI, 89 to 93) against infection leading to an emergency department or urgent care clinic visit. The effectiveness of full vaccination with respect to a Covid-19-associated hospitalization or emergency department or urgent care clinic visit was similar with the BNT162b2 and mRNA-1273 vaccines and ranged from 81% to 95% among adults 85 years of age or older, persons with chronic medical conditions, and Black or Hispanic adults. The effectiveness of the Ad26.COV2.S vaccine was 68% (95% CI, 50 to 79) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization and 73% (95% CI, 59 to 82) against infection leading to an emergency department or urgent care clinic visit.

CONCLUSIONS:

Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARS-CoV-2 infection. (Funded by the Centers for Disease Control and Prevention.).
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Ambulatory Care / COVID-19 Vaccines / COVID-19 / Hospitalization Type of study: Experimental Studies / Observational study / Prognostic study Topics: Vaccines Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: N Engl J Med Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Ambulatory Care / COVID-19 Vaccines / COVID-19 / Hospitalization Type of study: Experimental Studies / Observational study / Prognostic study Topics: Vaccines Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: N Engl J Med Year: 2021 Document Type: Article