Open Forum Infect Dis . Absolute and Relative Vaccine Effectiveness of Primary and Booster Series of COVID-19 Vaccines (mRNA and Adenovirus Vector) Against COVID-19 Hospitalizations in the United States, December 2021-April 2022

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Open Forum Infect Dis


. 2022 Dec 31;10(1):ofac698.
doi: 10.1093/ofid/ofac698. eCollection 2023 Jan.
Absolute and Relative Vaccine Effectiveness of Primary and Booster Series of COVID-19 Vaccines (mRNA and Adenovirus Vector) Against COVID-19 Hospitalizations in the United States, December 2021-April 2022


Nathaniel M Lewis ¹ , Nancy Murray ¹ , Katherine Adams ¹ , Diya Surie ¹ , Manjusha Gaglani ² , Adit A Ginde ³ , Tresa McNeal ² , Shekhar Ghamande ² , David J Douin ⁴ , H Keipp Talbot ⁵ , Jonathan D Casey ⁶ , Nicholas M Mohr ⁷ , Anne Zepeski ⁷ , Nathan I Shapiro ⁸ , Kevin W Gibbs ⁹ , D Clark Files ⁹ , David N Hager ¹⁰ , Harith Ali ¹⁰ , Matthew E Prekker ¹¹ , Anne E Frosch ¹² , Matthew C Exline ¹³ , Michelle N Gong ¹⁴ , Amira Mohamed ¹⁵ , Nicholas J Johnson ¹⁶ , Vasisht Srinivasan ¹⁷ , Jay S Steingrub ¹⁸ , Ithan D Peltan ¹⁹ , Samuel M Brown ¹⁹ , Emily T Martin ²⁰ , Arnold S Monto ²⁰ , Adam S Lauring ²¹ , Akram Khan ²² , Catherine L Hough ²² , Laurence W Busse ²³ , William Bender ²³ , Abhijit Duggal ²⁴ , Jennifer G Wilson ²⁵ , Alexandra June Gordon ²⁵ , Nida Qadir ²⁶ , Steven Y Chang ²⁶ , Christopher Mallow ²⁷ , Carolina Rivas ²⁷ , Hilary M Babcock ²⁸ , Jennie H Kwon ²⁸ , James D Chappell ²⁹ , Natasha Halasa ²⁹ , Carlos G Grijalva ³⁰ , Todd W Rice ⁶ , William B Stubblefield ³¹ , Adrienne Baughman ³¹ , Christopher J Lindsell ³² , Kimberly W Hart ³² , Jillian P Rhoads ³³ , Meredith L McMorrow ¹ , Mark W Tenforde ¹ , Wesley H Self ³⁴ , Manish M Patel ¹ ; Influenza and Other Viruses in the Acutely Ill (IVY) Network



Collaborators, Affiliations

• PMID: 36695662
• PMCID: PMC9868348
• DOI: 10.1093/ofid/ofac698

Abstract

Background: Coronavirus disease 2019 (COVID-19) vaccine effectiveness (VE) studies are increasingly reporting relative VE (rVE) comparing a primary series plus booster doses with a primary series only. Interpretation of rVE differs from traditional studies measuring absolute VE (aVE) of a vaccine regimen against an unvaccinated referent group. We estimated aVE and rVE against COVID-19 hospitalization in primary-series plus first-booster recipients of COVID-19 vaccines.
Methods: Booster-eligible immunocompetent adults hospitalized at 21 medical centers in the United States during December 25, 2021-April 4, 2022 were included. In a test-negative design, logistic regression with case status as the outcome and completion of primary vaccine series or primary series plus 1 booster dose as the predictors, adjusted for potential confounders, were used to estimate aVE and rVE.
Results: A total of 2060 patients were analyzed, including 1104 COVID-19 cases and 956 controls. Relative VE against COVID-19 hospitalization in boosted mRNA vaccine recipients versus primary series only was 66% (95% confidence interval [CI], 55%-74%); aVE was 81% (95% CI, 75%-86%) for boosted versus 46% (95% CI, 30%-58%) for primary. For boosted Janssen vaccine recipients versus primary series, rVE was 49% (95% CI, -9% to 76%); aVE was 62% (95% CI, 33%-79%) for boosted versus 36% (95% CI, -4% to 60%) for primary.
Conclusions: Vaccine booster doses increased protection against COVID-19 hospitalization compared with a primary series. Comparing rVE measures across studies can lead to flawed interpretations of the added value of a new vaccination regimen, whereas difference in aVE, when available, may be a more useful metric.

Keywords: COVID-19; absolute vaccine effectiveness; booster vaccine series; primary vaccine series; relative vaccine effectiveness.