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Hospitalized patients with severe COVID-19 during the Omicron wave in Israel - benefits of a fourth vaccine dose.
Brosh-Nissimov, Tal; Hussein, Khetam; Wiener-Well, Yonit; Orenbuch-Harroch, Efrat; Elbaz, Meital; Lipman-Arens, Shelly; Maor, Yasmin; Yagel, Yael; Chazan, Bibiana; Hershman-Sarafov, Mirit; Rahav, Galia; Zimhony, Oren; Shimshovitz, Adi Zaidman; Chowers, Michal.
  • Brosh-Nissimov T; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.
  • Hussein K; Infectious Diseases Unit, Samson Assuta-Ashdod University Hospital, Ashdod, Israel.
  • Wiener-Well Y; Rambam Health Care Campus, Haifa, Israel.
  • Orenbuch-Harroch E; Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel.
  • Elbaz M; Shaare Zedek Medical Center, Jerusalem, Israel.
  • Lipman-Arens S; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Maor Y; Division of Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
  • Yagel Y; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Chazan B; Department of Infectious Diseases, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel.
  • Hershman-Sarafov M; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Rahav G; Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel.
  • Zimhony O; Infectious disease and Infection Control Unit, Hillel Yaffe Medical Center, Hadera, Israel.
  • Shimshovitz AZ; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Chowers M; Infectious Disease Unit, Wolfson Medical Center, Holon, Israel.
Clin Infect Dis ; 2022 Jun 20.
Article in English | MEDLINE | ID: covidwho-2228382
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

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Topics: Vaccines / Variants Language: English Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Topics: Vaccines / Variants Language: English Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid