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COVID-19 Vaccination Effectiveness Against Infection or Death in a National U.S. Health Care System : A Target Trial Emulation Study.
Ioannou, George N; Locke, Emily R; O'Hare, Ann M; Bohnert, Amy S B; Boyko, Edward J; Hynes, Denise M; Berry, Kristin.
  • Ioannou GN; Division of Gastroenterology, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, Washington (G.N.I.).
  • Locke ER; Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington (E.R.L., K.B.).
  • O'Hare AM; Division of Nephrology, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, Washington (A.M.O.).
  • Bohnert ASB; Departments of Anesthesiology and Psychiatry, University of Michigan Medical School and VA Center for Clinical Management Research, Ann Arbor, Michigan (A.S.B.).
  • Boyko EJ; General Medicine Service, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, Washington (E.J.B.).
  • Hynes DM; Center of Innovation to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, and Health Management and Policy, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Health Data and Informatics Program, Center for Quantitative Life Scie
  • Berry K; Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington (E.R.L., K.B.).
Ann Intern Med ; 175(3): 352-361, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1742919
ABSTRACT

BACKGROUND:

Little is known about real-world COVID-19 vaccine effectiveness (VE) in racially and ethnically diverse, elderly populations with high comorbidity burden.

OBJECTIVE:

To determine the effectiveness of messenger RNA COVID-19 vaccines.

DESIGN:

Target trial emulation study comparing newly vaccinated persons with matched unvaccinated controls.

SETTING:

U.S. Department of Veterans Affairs health care system.

PARTICIPANTS:

Among persons receiving care in the Veterans Affairs health care system (n = 5 766 638), those who received at least 1 dose of the Moderna or Pfizer-BioNTech COVID-19 vaccine from 11 December 2020 to 25 March 2021 (n = 2 099 871) were matched to unvaccinated controls in a 11 ratio according to demographic, clinical, and geographic characteristics. INTERVENTION Follow-up for SARS-CoV-2 infection or SARS-CoV-2-related death, defined as death within 30 days of infection, began after the vaccination date or an identical index date for the matched unvaccinated controls and continued until up to 30 June 2021. MEASUREMENTS Vaccine effectiveness against SARS-CoV-2 infection or SARS-CoV-2-related death.

RESULTS:

Vaccinated and unvaccinated groups were well matched; both were predominantly male (92.9% vs. 93.4%), had advanced age (mean, 68.7 years in both groups), had diverse racial and ethnic distribution (for example, Black 17.3% vs. 17.0%, Hispanic 6.5% vs. 6.1%), and had substantial comorbidity burden. Vaccine effectiveness 7 or more days after the second vaccine dose was 69% (95% CI, 67% to 70%) against SARS-CoV-2 infection and 86% (CI, 82% to 89%) against SARS-CoV-2-related death and was similar when follow-up was extended to 31 March versus 30 June. Vaccine effectiveness against infection decreased with increasing age and comorbidity burden.

LIMITATION:

Predominantly male population and lack of data on SARS-CoV-2 variants.

CONCLUSION:

In an elderly, diverse, high-comorbidity population, COVID-19 VE against infection was substantially lower than previously reported, but VE against death was high. Complementary infection mitigation efforts remain important for pandemic control, even with vaccination. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Evaluation study / Randomized controlled trials Topics: Vaccines / Variants Limits: Aged / Female / Humans / Male Language: English Journal: Ann Intern Med Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Evaluation study / Randomized controlled trials Topics: Vaccines / Variants Limits: Aged / Female / Humans / Male Language: English Journal: Ann Intern Med Year: 2022 Document Type: Article