Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity.

Journal: Jama
Published:
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.

Authors
Mark Tenforde, Wesley Self, Katherine Adams, Manjusha Gaglani, Adit Ginde, Tresa Mcneal, Shekhar Ghamande, David Douin, H Talbot, Jonathan Casey, Nicholas Mohr, Anne Zepeski, Nathan Shapiro, Kevin Gibbs, D Files, David Hager, Arber Shehu, Matthew Prekker, Heidi Erickson, Matthew Exline, Michelle Gong, Amira Mohamed, Daniel Henning, Jay Steingrub, Ithan Peltan, Samuel Brown, Emily Martin, Arnold Monto, Akram Khan, Catherine Hough, Laurence Busse, Caitlin Ten Lohuis, Abhijit Duggal, Jennifer Wilson, Alexandra Gordon, Nida Qadir, Steven Chang, Christopher Mallow, Carolina Rivas, Hilary Babcock, Jennie Kwon, Natasha Halasa, James Chappell, Adam Lauring, Carlos Grijalva, Todd Rice, Ian Jones, William Stubblefield, Adrienne Baughman, Kelsey Womack, Jillian Rhoads, Christopher Lindsell, Kimberly Hart, Yuwei Zhu, Samantha Olson, Miwako Kobayashi, Jennifer Verani, Manish Patel