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Mésidor M, Liu Y, Talbot D, Skowronski DM, De Serres G, Merckx J, Koushik A, Tadrous M, Carazo S, Jiang C, Schnitzer ME. Test negative design for vaccine effectiveness estimation in the context of the COVID-19 pandemic: A systematic methodology review. Vaccine 2024; 42:995-1003. [PMID: 38072756 DOI: 10.1016/j.vaccine.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND During the height of the global COVID-19 pandemic, the test-negative design (TND) was extensively used in many countries to evaluate COVID-19 vaccine effectiveness (VE). Typically, the TND involves the recruitment of care-seeking individuals who meet a common clinical case definition. All participants are then tested for an infection of interest. OBJECTIVES To review and describe the variation in TND methodology, and disclosure of potential biases, as applied to the evaluation of COVID-19 VE during the early vaccination phase of the pandemic. METHODS We conducted a systematic review by searching four biomedical databases using defined keywords to identify peer-reviewed articles published between January 1, 2020, and January 25, 2022. We included only original articles that employed a TND to estimate VE of COVID-19 vaccines in which cases and controls were evaluated based on SARS-CoV-2 laboratory test results. RESULTS We identified 96 studies, 35 of which met the defined criteria. Most studies were from North America (16 studies) and targeted the general population (28 studies). Outcome case definitions were based primarily on COVID-19-like symptoms; however, several papers did not consider or specify symptoms. Cases and controls had the same inclusion criteria in only half of the studies. Most studies relied upon administrative or hospital databases assembled for a different (non-evaluation) clinical purpose. Potential unmeasured confounding (20 studies), misclassification of current SARS-CoV-2 infection (16 studies) and selection bias (10 studies) were disclosed as limitations by some studies. CONCLUSION We observed potentially meaningful deviations from the validated design in the application of the TND during the COVID-19 pandemic.
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Affiliation(s)
- Miceline Mésidor
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Yan Liu
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Denis Talbot
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Québec, Canada.
| | - Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada; University of British Columbia, Vancouver, Canada
| | - Gaston De Serres
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Institut national de santé publique du Québec, Québec, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Anita Koushik
- Département de médecine sociale et préventive, Université de Montréal, Québec, Canada
| | | | - Sara Carazo
- Institut national de santé publique du Québec, Québec, Canada
| | - Cong Jiang
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Mireille E Schnitzer
- Faculty of Pharmacy, Université de Montréal, Québec, Canada; Département de médecine sociale et préventive, Université de Montréal, Québec, Canada.
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2
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Petráš M, Máčalík R, Janovská D, Čelko AM, Dáňová J, Selinger E, Doleček J, Neradová S, Franklová M, Dlouhý P, Rosina J, Lesná IK. Risk factors affecting COVID-19 vaccine effectiveness identified from 290 cross-country observational studies until February 2022: a meta-analysis and meta-regression. BMC Med 2022; 20:461. [PMID: 36434597 PMCID: PMC9701077 DOI: 10.1186/s12916-022-02663-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Observational studies made it possible to assess the impact of risk factors on the long-term effectiveness of mRNA and adenoviral vector (AdV) vaccines against COVID-19. METHODS A computerized literature search was undertaken using the MEDLINE, EMBASE, and MedRxiv databases to identify eligible studies, with no language restrictions, published up to 28 February 2022. Eligible were observational studies assessing vaccine effectiveness (VE) by disease severity with reference groups of unvaccinated participants or participants immunized with one, two, or three vaccine doses. Our study was carried out in compliance with the PRISMA and MOOSE guidelines. The risk of study bias was identified using the Newcastle-Ottawa Quality Assessment Scale. The GRADE guidelines were applied to assess the strength of evidence for the primary outcome. The synthesis was conducted using a meta-analysis and meta-regression. RESULTS Out of a total of 14,155 publications, 290 studies were included. Early VE of full vaccination against COVID-19 of any symptomatology and severity decreased from 96% (95% CI, 95-96%) for mRNA and from 86% (95% CI, 83-89%) for AdV vaccines to 67% for both vaccine types in the last 2 months of 2021. A similar 1-year decline from 98 to 86% was found for severe COVID-19 after full immunization with mRNA, but not with AdV vaccines providing persistent 82-87% effectiveness. Variant-reduced VE was only associated with Omicron regardless of disease severity, vaccine type, or vaccination completeness. The level of protection was reduced in participants aged >65 years, with a comorbidity or those in long-term care or residential homes independently of the number of doses received. The booster effect of the third mRNA dose was unclear because incompletely restored effectiveness, regardless of disease severity, declined within a short-term interval of 4 months. CONCLUSIONS Full vaccination provided an early high, yet waning level of protection against COVID-19 of any severity with a strong impact on the high-risk population. Moreover, the potential risk of new antigenically distinct variants should not be underestimated, and any future immunization strategy should include variant-updated vaccines.
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Affiliation(s)
- Marek Petráš
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic.
| | - Roman Máčalík
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Daniela Janovská
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Alexander M Čelko
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Jana Dáňová
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Eliška Selinger
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic.,Centre for Public Health Promotion, National Institute of Public Health, 100 00, Prague, Czech Republic
| | - Jonáš Doleček
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Sylva Neradová
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Martina Franklová
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic
| | - Pavel Dlouhý
- Department of Hygiene, Third Faculty of Medicine, Charles University, 100 00, Prague, Czech Republic
| | - Jozef Rosina
- Department of Medical Biophysics and Informatics, Third Faculty of Medicine, Charles University, 100 00, Prague, Czech Republic.,Department of Health Care and Population Protection, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01, Kladno, Czech Republic
| | - Ivana Králová Lesná
- Laboratory for Atherosclerosis Research, Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, 140 21, Prague, Czech Republic.,Department of Anesthesia and Intensive Medicine, First Faculty of Medicine, Charles University and University Military Hospital, 100 00, Prague, Czech Republic
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3
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Frauches TS, Costa CADS, Rodrigues CDS, de Azevedo MCVM, Ferreira MDM, Ramos HBVDS, de Souza Junior WR, Costa AR, Camargo AC, Alonso AH, dos Santos FÁ, Oliveira HDS, Coelho JG, Sobral JFDS, Rodrigues LCDS, Ferreira MMC, Laureano P, da Paz Fernandes RA, Santos RDS, dos Santos RMC, Milagres S, dos Santos VCC, Silva JT, da Silva TM, da Rocha MGC, de São Carlos AE, de Araújo Ramos AM, Bastos FMDA, Francisco DR, Rosa SDS, Linhares LC, Organista RR, Bastos L, Pinto MMK, do Nascimento JPL, da Silveira JPM, dos Santos MQ, da Silva NS, Ferreira NCDS, Reis RBR, de Oliveira RF, Sá VDO, Hammes TRDS, Monteiro JDO, Cardoso PH, Arruda MB, Alvarez P, Maia RA, Ribeiro LDJ, Ferreira OC, Santos A, de Almeida ACM, Garcia L, Pansera C, Tanuri A. COVID-19 cross-sectional study in Maricá, Brazil: The impact of vaccination coverage on viral incidence. PLoS One 2022; 17:e0269011. [PMID: 36121796 PMCID: PMC9484680 DOI: 10.1371/journal.pone.0269011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
Population surveillance in COVID-19 Pandemic is crucial to follow up the pace of disease and its related immunological status. Here we present a cross-sectional study done in Maricá, a seaside town close to the city of Rio de Janeiro, Brazil. Three rounds of study sampling, enrolling a total of 1134 subjects, were performed during May to August 2021. Here we show that the number of individuals carrying detectable IgG antibodies and the neutralizing antibody (NAb) levels were greater in vaccinated groups compared to unvaccinated ones, highlighting the importance of vaccination to attain noticeable levels of populational immunity against SARS-CoV-2. Moreover, we found a decreased incidence of COVID-19 throughout the study, clearly correlated with the level of vaccinated individuals as well as the proportion of individuals with detectable levels of IgG anti-SARS-CoV-2 and NAb. The observed drop occurred even during the introduction of the Delta variant in Maricá, what suggests that the vaccination slowed down the widespread transmission of this variant. Overall, our data clearly support the use of vaccines to drop the incidence associated to SARS-CoV-2.
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Affiliation(s)
- Thiago Silva Frauches
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | | | - Claudia dos Santos Rodrigues
- Centro de Testagem e Aconselhamento, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Marcelo Costa Velho Mendes de Azevedo
- Universidade do Rio de Janeiro—UNIRIO, Rio de Janeiro, Brazil
- Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | | | | | - Wilson Rodrigues de Souza Junior
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Andréa Ribeiro Costa
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Adriana Cardoso Camargo
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Adriana Halfeld Alonso
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Fábio Álvaro dos Santos
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Hércules da Silva Oliveira
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Janaína Guimarães Coelho
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Joyce Florentina da Silva Sobral
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | | | - Marcio Martins Casaes Ferreira
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Patricia Laureano
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Raquel Adalgiza da Paz Fernandes
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Renata da Silva Santos
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Rose Mary Carvalho dos Santos
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Sanderson Milagres
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | | | - Jussara Teixeira Silva
- Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Daina Raylle Francisco
- Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Sabrina dos Santos Rosa
- Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Layla Corrêa Linhares
- Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | | | - Leandro Bastos
- Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | | | | | | | | | - Nathaly Santos da Silva
- Secretaria de Cultura e Direitos Humanos, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | | | - Rafael Brito Ramirez Reis
- Secretaria de Cultura e Direitos Humanos, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Ruan Fonseca de Oliveira
- Secretaria de Cultura e Direitos Humanos, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Valdinei de Oliveira Sá
- Secretaria de Cultura e Direitos Humanos, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | | | | | - Pedro Henrique Cardoso
- Instituto de Tecnologia de Imunobiológicos Bio-Manguinhos, Fundação Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil
| | - Mônica Barcellos Arruda
- Instituto de Tecnologia de Imunobiológicos Bio-Manguinhos, Fundação Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil
| | - Patricia Alvarez
- Instituto de Tecnologia de Imunobiológicos Bio-Manguinhos, Fundação Oswaldo Cruz/Fiocruz, Rio de Janeiro, Brazil
| | - Richard Araujo Maia
- Laboratório de Virologia Molecular, Instituto de Biologia, Departamento de Genética, Universidade Federal do Rio de Janeiro/UFRJ, Rio de Janeiro, Brazil
| | - Liane de Jesus Ribeiro
- Laboratório de Virologia Molecular, Instituto de Biologia, Departamento de Genética, Universidade Federal do Rio de Janeiro/UFRJ, Rio de Janeiro, Brazil
| | - Orlando Costa Ferreira
- Laboratório de Virologia Molecular, Instituto de Biologia, Departamento de Genética, Universidade Federal do Rio de Janeiro/UFRJ, Rio de Janeiro, Brazil
| | | | | | - Lauro Garcia
- Laboratório Blessing, Maricá, Rio de Janeiro, Brazil
| | - Celso Pansera
- Laboratório Central Dr. Rímolo Neto/LACEN, Secretaria Municipal de Saúde, Prefeitura Municipal de Maricá, Maricá, Rio de Janeiro, Brazil
| | - Amilcar Tanuri
- Instituto de Ciência, Tecnologia e Inovação de Maricá/ICTIM, Maricá, Rio de Janeiro, Brazil
- Laboratório de Virologia Molecular, Instituto de Biologia, Departamento de Genética, Universidade Federal do Rio de Janeiro/UFRJ, Rio de Janeiro, Brazil
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Abstract
OBJECTIVE To examine COVID-19 vaccine effectiveness over six 7-day intervals after the first dose and assess underlying bias in observational data. DESIGN AND SETTING Retrospective cohort study using Columbia University Irving Medical Center data linked to state and city immunisation registries. OUTCOMES AND MEASURES We used large-scale propensity score matching with up to 54 987 covariates, fitted Cox proportional hazards models and constructed Kaplan-Meier plots for two main outcomes (COVID-19 infection and COVID-19-associated hospitalisation). We conducted manual chart review of cases in week 1 in both groups along with a set of secondary analyses for other index date, outcome and population choices. RESULTS The study included 179 666 patients. We observed increasing effectiveness after the first dose of mRNA vaccines with week 6 effectiveness approximating 84% (95% CI 72% to 91%) for COVID-19 infection and 86% (95% CI 69% to 95%) for COVID-19-associated hospitalisation. When analysing unexpectedly high effectiveness in week 1, chart review revealed that vaccinated patients are less likely to seek care after vaccination and are more likely to be diagnosed with COVID-19 during the encounters for other conditions. Secondary analyses highlighted potential outcome misclassification for International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis, the influence of excluding patients with prior COVID-19 infection and anchoring in the unexposed group. Long-term vaccine effectiveness in fully vaccinated patients matched the results of the randomised trials. CONCLUSIONS For vaccine effectiveness studies, observational data need to be scrutinised to ensure compared groups exhibit similar health-seeking behaviour and are equally likely to be captured in the data. While we found that studies may be capable of accurately estimating long-term effectiveness despite bias in early weeks, the early week results should be reported in every study so that we may gain a better understanding of the biases. Given the difference in temporal trends of vaccine exposure and patients' baseline characteristics, indirect comparison of vaccines may produce biased results.
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Affiliation(s)
- Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- Medical Informatics Services, New York-Presbyterian Hospital, New York, New York, USA
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5
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Britton A, Fleming-Dutra KE, Shang N, Smith ZR, Dorji T, Derado G, Accorsi EK, Ajani UA, Miller J, Schrag SJ, Verani JR. Association of COVID-19 Vaccination With Symptomatic SARS-CoV-2 Infection by Time Since Vaccination and Delta Variant Predominance. JAMA 2022; 327:1032-1041. [PMID: 35157002 PMCID: PMC8845038 DOI: 10.1001/jama.2022.2068] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Monitoring COVID-19 vaccine performance over time since vaccination and against emerging variants informs control measures and vaccine policies. OBJECTIVE To estimate the associations between symptomatic SARS-CoV-2 infection and receipt of BNT162b2, mRNA-1273, and Ad26.COV2.S by day since vaccination before and during Delta variant predominance (pre-Delta period: March 13-May 29, 2021; Delta period: July 18-October 17, 2021). DESIGN, SETTING, AND PARTICIPANTS Test-negative, case-control design with data from 6884 US COVID-19 testing sites in the pharmacy-based Increasing Community Access to Testing platform. This study included 1 634 271 laboratory-based SARS-CoV-2 nucleic acid amplification tests (NAATs) from adults 20 years and older and 180 112 NAATs from adolescents 12 to 19 years old with COVID-19-like illness from March 13 to October 17, 2021. EXPOSURES COVID-19 vaccination (1 Ad26.COV2.S dose or 2 mRNA doses) 14 or more days prior. MAIN OUTCOMES AND MEASURES Association between symptomatic infection and prior vaccination measured using the odds ratio (OR) from spline-based multivariable logistic regression. RESULTS The analysis included 390 762 test-positive cases (21.5%) and 1 423 621 test-negative controls (78.5%) (59.9% were 20-44 years old; 9.9% were 12-19 years old; 58.9% were female; 71.8% were White). Among adults 20 years and older, the BNT162b2 mean OR for days 14 to 60 after a second dose (initial OR) was lower during the pre-Delta period (0.10 [95% CI, 0.09-0.11]) than during the Delta period (0.16 [95% CI, 0.16-0.17]) and increased with time since vaccination (per-month change in OR, pre-Delta: 0.04 [95% CI, 0.02-0.05]; Delta: 0.03 [95% CI, 0.02-0.03]). The initial mRNA-1273 OR was 0.05 (95% CI, 0.04-0.05) during the pre-Delta period, 0.10 (95% CI, 0.10-0.11) during the Delta period, and increased with time (per-month change in OR, pre-Delta: 0.02 [95% CI, 0.005-0.03]; Delta: 0.03 [95% CI, 0.03-0.04]). The Ad26.COV2.S initial OR was 0.42 (95% CI, 0.37-0.47) during the pre-Delta period and 0.62 (95% CI, 0.58-0.65) during the Delta period and did not significantly increase with time since vaccination. Among adolescents, the BNT162b2 initial OR during the Delta period was 0.06 (95% CI, 0.05-0.06) among 12- to 15-year-olds, increasing by 0.02 (95% CI, 0.01-0.03) per month, and 0.10 (95% CI, 0.09-0.11) among 16- to 19-year-olds, increasing by 0.04 (95% CI, 0.03-0.06) per month. CONCLUSIONS AND RELEVANCE Among adults, the OR for the association between symptomatic SARS-CoV-2 infection and COVID-19 vaccination (as an estimate of vaccine effectiveness) was higher during Delta variant predominance, suggesting lower protection. For mRNA vaccination, the steady increase in OR by month since vaccination was consistent with attenuation of estimated effectiveness over time; attenuation related to time was greater than that related to variant.
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Affiliation(s)
- Amadea Britton
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nong Shang
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Zachary R. Smith
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Tandin Dorji
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Gordana Derado
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Emma K. Accorsi
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Umed A. Ajani
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Joseph Miller
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Stephanie J. Schrag
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Jennifer R. Verani
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
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6
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Accorsi EK, Britton A, Fleming-Dutra KE, Smith ZR, Shang N, Derado G, Miller J, Schrag SJ, Verani JR. Association Between 3 Doses of mRNA COVID-19 Vaccine and Symptomatic Infection Caused by the SARS-CoV-2 Omicron and Delta Variants. JAMA 2022; 327:639-651. [PMID: 35060999 PMCID: PMC8848203 DOI: 10.1001/jama.2022.0470] [Citation(s) in RCA: 436] [Impact Index Per Article: 218.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Assessing COVID-19 vaccine performance against the rapidly spreading SARS-CoV-2 Omicron variant is critical to inform public health guidance. OBJECTIVE To estimate the association between receipt of 3 doses of Pfizer-BioNTech BNT162b2 or Moderna mRNA-1273 vaccine and symptomatic SARS-CoV-2 infection, stratified by variant (Omicron and Delta). DESIGN, SETTING, AND PARTICIPANTS A test-negative case-control analysis among adults 18 years or older with COVID-like illness tested December 10, 2021, through January 1, 2022, by a national pharmacy-based testing program (4666 COVID-19 testing sites across 49 US states). EXPOSURES Three doses of mRNA COVID-19 vaccine (third dose ≥14 days before test and ≥6 months after second dose) vs unvaccinated and vs 2 doses 6 months or more before test (ie, eligible for a booster dose). MAIN OUTCOMES AND MEASURES Association between symptomatic SARS-CoV-2 infection (stratified by Omicron or Delta variants defined using S-gene target failure) and vaccination (3 doses vs unvaccinated and 3 doses vs 2 doses). Associations were measured with multivariable multinomial regression. Among cases, a secondary outcome was median cycle threshold values (inversely proportional to the amount of target nucleic acid present) for 3 viral genes, stratified by variant and vaccination status. RESULTS Overall, 23 391 cases (13 098 Omicron; 10 293 Delta) and 46 764 controls were included (mean age, 40.3 [SD, 15.6] years; 42 050 [60.1%] women). Prior receipt of 3 mRNA vaccine doses was reported for 18.6% (n = 2441) of Omicron cases, 6.6% (n = 679) of Delta cases, and 39.7% (n = 18 587) of controls; prior receipt of 2 mRNA vaccine doses was reported for 55.3% (n = 7245), 44.4% (n = 4570), and 41.6% (n = 19 456), respectively; and being unvaccinated was reported for 26.0% (n = 3412), 49.0% (n = 5044), and 18.6% (n = 8721), respectively. The adjusted odds ratio for 3 doses vs unvaccinated was 0.33 (95% CI, 0.31-0.35) for Omicron and 0.065 (95% CI, 0.059-0.071) for Delta; for 3 vaccine doses vs 2 doses the adjusted odds ratio was 0.34 (95% CI, 0.32-0.36) for Omicron and 0.16 (95% CI, 0.14-0.17) for Delta. Median cycle threshold values were significantly higher in cases with 3 doses vs 2 doses for both Omicron and Delta (Omicron N gene: 19.35 vs 18.52; Omicron ORF1ab gene: 19.25 vs 18.40; Delta N gene: 19.07 vs 17.52; Delta ORF1ab gene: 18.70 vs 17.28; Delta S gene: 23.62 vs 20.24). CONCLUSIONS AND RELEVANCE Among individuals seeking testing for COVID-like illness in the US in December 2021, receipt of 3 doses of mRNA COVID-19 vaccine (compared with unvaccinated and with receipt of 2 doses) was less likely among cases with symptomatic SARS-CoV-2 infection compared with test-negative controls. These findings suggest that receipt of 3 doses of mRNA vaccine, relative to being unvaccinated and to receipt of 2 doses, was associated with protection against both the Omicron and Delta variants, although the higher odds ratios for Omicron suggest less protection for Omicron than for Delta.
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Affiliation(s)
- Emma K. Accorsi
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amadea Britton
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Zachary R. Smith
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Nong Shang
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Gordana Derado
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Joseph Miller
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Stephanie J. Schrag
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
| | - Jennifer R. Verani
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia
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