tetano
Editor, Senior Moderator
N Engl J Med
. 2021 Sep 8.
doi: 10.1056/NEJMoa2110362. Online ahead of print.
Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings
Mark G Thompson[SUP] 1 [/SUP], Edward Stenehjem[SUP] 1 [/SUP], Shaun Grannis[SUP] 1 [/SUP], Sarah W Ball[SUP] 1 [/SUP], Allison L Naleway[SUP] 1 [/SUP], Toan C Ong[SUP] 1 [/SUP], Malini B DeSilva[SUP] 1 [/SUP], Karthik Natarajan[SUP] 1 [/SUP], Catherine H Bozio[SUP] 1 [/SUP], Ned Lewis[SUP] 1 [/SUP], Kristin Dascomb[SUP] 1 [/SUP], Brian E Dixon[SUP] 1 [/SUP], Rebecca J Birch[SUP] 1 [/SUP], Stephanie A Irving[SUP] 1 [/SUP], Suchitra Rao[SUP] 1 [/SUP], Elyse Kharbanda[SUP] 1 [/SUP], Jungmi Han[SUP] 1 [/SUP], Sue Reynolds[SUP] 1 [/SUP], Kristin Goddard[SUP] 1 [/SUP], Nancy Grisel[SUP] 1 [/SUP], William F Fadel[SUP] 1 [/SUP], Matthew E Levy[SUP] 1 [/SUP], Jill Ferdinands[SUP] 1 [/SUP], Bruce Fireman[SUP] 1 [/SUP], Julie Arndorfer[SUP] 1 [/SUP], Nimish R Valvi[SUP] 1 [/SUP], Elizabeth A Rowley[SUP] 1 [/SUP], Palak Patel[SUP] 1 [/SUP], Ousseny Zerbo[SUP] 1 [/SUP], Eric P Griggs[SUP] 1 [/SUP], Rachael M Porter[SUP] 1 [/SUP], Maria Demarco[SUP] 1 [/SUP], Lenee Blanton[SUP] 1 [/SUP], Andrea Steffens[SUP] 1 [/SUP], Yan Zhuang[SUP] 1 [/SUP], Natalie Olson[SUP] 1 [/SUP], Michelle Barron[SUP] 1 [/SUP], Patricia Shifflett[SUP] 1 [/SUP], Stephanie J Schrag[SUP] 1 [/SUP], Jennifer R Verani[SUP] 1 [/SUP], Alicia Fry[SUP] 1 [/SUP], Manjusha Gaglani[SUP] 1 [/SUP], Eduardo Azziz-Baumgartner[SUP] 1 [/SUP], Nicola P Klein[SUP] 1 [/SUP]
Affiliations
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, 85 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.).
. 2021 Sep 8.
doi: 10.1056/NEJMoa2110362. Online ahead of print.
Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings
Mark G Thompson[SUP] 1 [/SUP], Edward Stenehjem[SUP] 1 [/SUP], Shaun Grannis[SUP] 1 [/SUP], Sarah W Ball[SUP] 1 [/SUP], Allison L Naleway[SUP] 1 [/SUP], Toan C Ong[SUP] 1 [/SUP], Malini B DeSilva[SUP] 1 [/SUP], Karthik Natarajan[SUP] 1 [/SUP], Catherine H Bozio[SUP] 1 [/SUP], Ned Lewis[SUP] 1 [/SUP], Kristin Dascomb[SUP] 1 [/SUP], Brian E Dixon[SUP] 1 [/SUP], Rebecca J Birch[SUP] 1 [/SUP], Stephanie A Irving[SUP] 1 [/SUP], Suchitra Rao[SUP] 1 [/SUP], Elyse Kharbanda[SUP] 1 [/SUP], Jungmi Han[SUP] 1 [/SUP], Sue Reynolds[SUP] 1 [/SUP], Kristin Goddard[SUP] 1 [/SUP], Nancy Grisel[SUP] 1 [/SUP], William F Fadel[SUP] 1 [/SUP], Matthew E Levy[SUP] 1 [/SUP], Jill Ferdinands[SUP] 1 [/SUP], Bruce Fireman[SUP] 1 [/SUP], Julie Arndorfer[SUP] 1 [/SUP], Nimish R Valvi[SUP] 1 [/SUP], Elizabeth A Rowley[SUP] 1 [/SUP], Palak Patel[SUP] 1 [/SUP], Ousseny Zerbo[SUP] 1 [/SUP], Eric P Griggs[SUP] 1 [/SUP], Rachael M Porter[SUP] 1 [/SUP], Maria Demarco[SUP] 1 [/SUP], Lenee Blanton[SUP] 1 [/SUP], Andrea Steffens[SUP] 1 [/SUP], Yan Zhuang[SUP] 1 [/SUP], Natalie Olson[SUP] 1 [/SUP], Michelle Barron[SUP] 1 [/SUP], Patricia Shifflett[SUP] 1 [/SUP], Stephanie J Schrag[SUP] 1 [/SUP], Jennifer R Verani[SUP] 1 [/SUP], Alicia Fry[SUP] 1 [/SUP], Manjusha Gaglani[SUP] 1 [/SUP], Eduardo Azziz-Baumgartner[SUP] 1 [/SUP], Nicola P Klein[SUP] 1 [/SUP]
Affiliations
- PMID: 34496194
- DOI: 10.1056/NEJMoa2110362
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, 85 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.).