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Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity.
Tenforde, Mark W; Self, Wesley H; Adams, Katherine; Gaglani, Manjusha; Ginde, Adit A; McNeal, Tresa; Ghamande, Shekhar; Douin, David J; Talbot, H Keipp; Casey, Jonathan D; Mohr, Nicholas M; Zepeski, Anne; Shapiro, Nathan I; Gibbs, Kevin W; Files, D Clark; Hager, David N; Shehu, Arber; Prekker, Matthew E; Erickson, Heidi L; Exline, Matthew C; Gong, Michelle N; Mohamed, Amira; Henning, Daniel J; Steingrub, Jay S; Peltan, Ithan D; Brown, Samuel M; Martin, Emily T; Monto, Arnold S; Khan, Akram; Hough, Catherine L; Busse, Laurence W; Ten Lohuis, Caitlin C; Duggal, Abhijit; Wilson, Jennifer G; Gordon, Alexandra June; Qadir, Nida; Chang, Steven Y; Mallow, Christopher; Rivas, Carolina; Babcock, Hilary M; Kwon, Jennie H; Halasa, Natasha; Chappell, James D; Lauring, Adam S; Grijalva, Carlos G; Rice, Todd W; Jones, Ian D; Stubblefield, William B; Baughman, Adrienne; Womack, Kelsey N.
  • Tenforde MW; CDC COVID-19 Response Team, Atlanta, Georgia.
  • Self WH; Vanderbilt Institute for Clinical and Translational Research, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Adams K; CDC COVID-19 Response Team, Atlanta, Georgia.
  • Gaglani M; Baylor Scott & White Health, Texas A&M University College of Medicine, Temple.
  • Ginde AA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora.
  • McNeal T; Baylor Scott & White Health, Texas A&M University College of Medicine, Temple.
  • Ghamande S; Baylor Scott & White Health, Texas A&M University College of Medicine, Temple.
  • Douin DJ; Department of Anesthesiology, University of Colorado School of Medicine, Aurora.
  • Talbot HK; Departments of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Casey JD; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Mohr NM; Department of Emergency Medicine, University of Iowa, Iowa City.
  • Zepeski A; Department of Emergency Medicine, University of Iowa, Iowa City.
  • Shapiro NI; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • Gibbs KW; Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
  • Files DC; Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
  • Hager DN; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Shehu A; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Prekker ME; Departments of Emergency Medicine and Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
  • Erickson HL; Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
  • Exline MC; Department of Medicine, The Ohio State University, Columbus.
  • Gong MN; Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York.
  • Mohamed A; Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
  • Henning DJ; Department of Emergency Medicine, University of Washington, Seattle.
  • Steingrub JS; Department of Medicine, Baystate Medical Center, Springfield, Massachusetts.
  • Peltan ID; Department of Medicine, Intermountain Medical Center, Murray, Utah; and University of Utah, Salt Lake City.
  • Brown SM; Department of Medicine, Intermountain Medical Center, Murray, Utah; and University of Utah, Salt Lake City.
  • Martin ET; School of Public Health, University of Michigan, Ann Arbor.
  • Monto AS; School of Public Health, University of Michigan, Ann Arbor.
  • Khan A; Department of Medicine, Oregon Health & Science University, Portland.
  • Hough CL; Department of Medicine, Oregon Health & Science University, Portland.
  • Busse LW; Department of Medicine, Emory University, Atlanta, Georgia.
  • Ten Lohuis CC; Emory Critical Care Center, Emory Healthcare, Atlanta, Georgia.
  • Duggal A; Department of Medicine, Cleveland Clinic, Cleveland, Ohio.
  • Wilson JG; Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
  • Gordon AJ; Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California.
  • Qadir N; Department of Medicine, University of California-Los Angeles, Los Angeles.
  • Chang SY; Department of Medicine, University of California-Los Angeles, Los Angeles.
  • Mallow C; Department of Medicine, University of Miami, Miami, Florida.
  • Rivas C; Department of Medicine, University of Miami, Miami, Florida.
  • Babcock HM; Department of Medicine, Washington University, St Louis, Missouri.
  • Kwon JH; Department of Medicine, Washington University, St Louis, Missouri.
  • Halasa N; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Chappell JD; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Lauring AS; Departments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor.
  • Grijalva CG; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Rice TW; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Jones ID; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Stubblefield WB; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Baughman A; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
  • Womack KN; Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA ; 326(20): 2043-2054, 2021 11 23.
Article in English | MEDLINE | ID: covidwho-1544165
ABSTRACT
Importance A comprehensive understanding of the benefits of COVID-19 vaccination requires consideration of disease attenuation, determined as whether people who develop COVID-19 despite vaccination have lower disease severity than unvaccinated people.

Objective:

To evaluate the association between vaccination with mRNA COVID-19 vaccines-mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech)-and COVID-19 hospitalization, and, among patients hospitalized with COVID-19, the association with progression to critical disease. Design, Setting, and

Participants:

A US 21-site case-control analysis of 4513 adults hospitalized between March 11 and August 15, 2021, with 28-day outcome data on death and mechanical ventilation available for patients enrolled through July 14, 2021. Date of final follow-up was August 8, 2021. Exposures COVID-19 vaccination. Main Outcomes and

Measures:

Associations were evaluated between prior vaccination and (1) hospitalization for COVID-19, in which case patients were those hospitalized for COVID-19 and control patients were those hospitalized for an alternative diagnosis; and (2) disease progression among patients hospitalized for COVID-19, in which cases and controls were COVID-19 patients with and without progression to death or mechanical ventilation, respectively. Associations were measured with multivariable logistic regression.

Results:

Among 4513 patients (median age, 59 years [IQR, 45-69]; 2202 [48.8%] women; 23.0% non-Hispanic Black individuals, 15.9% Hispanic individuals, and 20.1% with an immunocompromising condition), 1983 were case patients with COVID-19 and 2530 were controls without COVID-19. Unvaccinated patients accounted for 84.2% (1669/1983) of COVID-19 hospitalizations. Hospitalization for COVID-19 was significantly associated with decreased likelihood of vaccination (cases, 15.8%; controls, 54.8%; adjusted OR, 0.15; 95% CI, 0.13-0.18), including for sequenced SARS-CoV-2 Alpha (8.7% vs 51.7%; aOR, 0.10; 95% CI, 0.06-0.16) and Delta variants (21.9% vs 61.8%; aOR, 0.14; 95% CI, 0.10-0.21). This association was stronger for immunocompetent patients (11.2% vs 53.5%; aOR, 0.10; 95% CI, 0.09-0.13) than immunocompromised patients (40.1% vs 58.8%; aOR, 0.49; 95% CI, 0.35-0.69) (P < .001) and weaker at more than 120 days since vaccination with BNT162b2 (5.8% vs 11.5%; aOR, 0.36; 95% CI, 0.27-0.49) than with mRNA-1273 (1.9% vs 8.3%; aOR, 0.15; 95% CI, 0.09-0.23) (P < .001). Among 1197 patients hospitalized with COVID-19, death or invasive mechanical ventilation by day 28 was associated with decreased likelihood of vaccination (12.0% vs 24.7%; aOR, 0.33; 95% CI, 0.19-0.58). Conclusions and Relevance Vaccination with an mRNA COVID-19 vaccine was significantly less likely among patients with COVID-19 hospitalization and disease progression to death or mechanical ventilation. These findings are consistent with risk reduction among vaccine breakthrough infections compared with absence of vaccination.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hospitalization Type of study: Observational study / Risk factors Topics: Vaccines / Variants Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: JAMA Year: 2021 Document Type: Article Affiliation country: Jama.2021.19499

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hospitalization Type of study: Observational study / Risk factors Topics: Vaccines / Variants Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: JAMA Year: 2021 Document Type: Article Affiliation country: Jama.2021.19499