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Arashiro T, Miwa M, Nakagawa H, Takamatsu J, Oba K, Fujimi S, Kikuchi H, Iwasawa T, Kanbe F, Oyama K, Kanai M, Ogata Y, Asakura T, Asami T, Mizuno K, Sugita M, Jinta T, Nishida Y, Kato H, Atagi K, Higaki T, Nakano Y, Tsutsumi T, Doi K, Okugawa S, Ueda A, Nakamura A, Yoshida T, Shimada-Sammori K, Shimizu K, Fujita Y, Okochi Y, Tochitani K, Nakanishi A, Rinka H, Taniyama D, Yamaguchi A, Uchikura T, Matsunaga M, Aono H, Hamaguchi M, Motoda K, Nakayama S, Yamamoto K, Oka H, Tanaka K, Inoue T, Kobayashi M, Fujitani S, Tsukahara M, Takeda S, Stucky A, Suzuki T, Smith C, Hibberd M, Ariyoshi K, Fujino Y, Arima Y, Takeda S, Hashimoto S, Suzuki M. COVID-19 vaccine effectiveness against severe COVID-19 requiring oxygen therapy, invasive mechanical ventilation, and death in Japan: A multicenter case-control study (MOTIVATE study). Vaccine 2024; 42:677-688. [PMID: 38114409 DOI: 10.1016/j.vaccine.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Since the SARS-CoV-2 Omicron variant became dominant, assessing COVID-19 vaccine effectiveness (VE) against severe disease using hospitalization as an outcome became more challenging due to incidental infections via admission screening and variable admission criteria, resulting in a wide range of estimates. To address this, the World Health Organization (WHO) guidance recommends the use of outcomes that are more specific to severe pneumonia such as oxygen use and mechanical ventilation. METHODS A case-control study was conducted in 24 hospitals in Japan for the Delta-dominant period (August-November 2021; "Delta") and early Omicron (BA.1/BA.2)-dominant period (January-June 2022; "Omicron"). Detailed chart review/interviews were conducted in January-May 2023. VE was measured using various outcomes including disease requiring oxygen therapy, disease requiring invasive mechanical ventilation (IMV), death, outcome restricting to "true" severe COVID-19 (where oxygen requirement is due to COVID-19 rather than another condition(s)), and progression from oxygen use to IMV or death among COVID-19 patients. RESULTS The analysis included 2125 individuals with respiratory failure (1608 cases [75.7%]; 99.2% of vaccinees received mRNA vaccines). During Delta, 2 doses provided high protection for up to 6 months (oxygen requirement: 95.2% [95% CI:88.7-98.0%] [restricted to "true" severe COVID-19: 95.5% {89.3-98.1%}]; IMV: 99.6% [97.3-99.9%]; fatal: 98.6% [92.3-99.7%]). During Omicron, 3 doses provided high protection for up to 6 months (oxygen requirement: 85.5% [68.8-93.3%] ["true" severe COVID-19: 88.1% {73.6-94.7%}]; IMV: 97.9% [85.9-99.7%]; fatal: 99.6% [95.2-99.97]). There was a trend towards higher VE for more severe and specific outcomes. CONCLUSION Multiple outcomes pointed towards high protection of 2 doses during Delta and 3 doses during Omicron. These results demonstrate the importance of using severe and specific outcomes to accurately measure VE against severe COVID-19, as recommended in WHO guidance in settings of intense transmission as seen during Omicron.
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Affiliation(s)
- Takeshi Arashiro
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan; Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
| | - Maki Miwa
- Emergency and Critical Care Center, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Hidenori Nakagawa
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
| | - Junpei Takamatsu
- Department of Emergency Medicine, Kansai Rosai Hospital, Hyogo, Japan
| | - Kunihiro Oba
- Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Hitoshi Kikuchi
- Department of Emergency Medicine, Sagamihara Kyodo Hospital, Kanagawa, Japan
| | - Takamasa Iwasawa
- Department of Cardiology, Yokosuka General Hospital Uwamachi, Kanagawa, Japan
| | - Fumiko Kanbe
- Intensive Care Unit, Ageo Central General Hospital, Saitama, Japan
| | - Keisuke Oyama
- Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan
| | - Masayuki Kanai
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Yoshitaka Ogata
- Department of Critical Care Medicine, Yao Tokushukai General Hospital, Osaka, Japan
| | - Takanori Asakura
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Takahiro Asami
- Department of Internal Medicine, Sano Kosei General Hospital, Tochigi, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Torahiko Jinta
- Department of Pulmonary Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Yusuke Nishida
- Department of General Internal Medicine and Infectious Diseases, Saitama Medical Center, Saitama, Japan
| | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
| | - Kazuaki Atagi
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Japan
| | - Taiki Higaki
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Japan
| | - Yoshio Nakano
- Department of Internal Medicine, Kinan Hospital, Wakayama, Japan
| | - Takeya Tsutsumi
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Shu Okugawa
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihiro Ueda
- Department of Infectious Diseases, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Akira Nakamura
- Department of Internal Medicine, Asahi General Hospital, Chiba, Japan
| | - Toru Yoshida
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kaoru Shimada-Sammori
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan TAMA Medical Center, Tokyo, Japan
| | - Keiki Shimizu
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan TAMA Medical Center, Tokyo, Japan
| | - Yasuo Fujita
- Department of Emergency, Akita Red Cross Hospital, Akita, Japan
| | - Yasumi Okochi
- Department of Respiratory Medicine, Japan Community Health Care Organization Tokyo Yamate Medical Center, Tokyo, Japan
| | - Kentaro Tochitani
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan
| | - Asuka Nakanishi
- Department of Pulmonary Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Hiroshi Rinka
- Department of Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Daisuke Taniyama
- Department of Infectious Diseases, Showa General Hospital, Tokyo, Japan
| | - Asase Yamaguchi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Toshio Uchikura
- Department of Emergency and General Internal Medicine, Yokosuka General Hospital Uwamachi, Kanagawa, Japan
| | - Maiko Matsunaga
- Department of Pharmacy, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Hiromi Aono
- Department of Respiratory Medicine, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Masanari Hamaguchi
- Department of Critical Care Medicine, Yao Tokushukai General Hospital, Osaka, Japan
| | - Kentaro Motoda
- Department of Clinical Research, Yao Tokushukai General Hospital, Osaka, Japan
| | - Sohei Nakayama
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Kei Yamamoto
- Department of General Internal Medicine and Infectious Diseases, Saitama Medical Center, Saitama, Japan
| | - Hideaki Oka
- Department of General Internal Medicine and Infectious Diseases, Saitama Medical Center, Saitama, Japan
| | - Katsushi Tanaka
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
| | - Takeshi Inoue
- Clinical Research Support Center, Asahi General Hospital, Chiba, Japan
| | - Mieko Kobayashi
- Clinical Research Support Center, Asahi General Hospital, Chiba, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Maki Tsukahara
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Saki Takeda
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ashley Stucky
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tadaki Suzuki
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Chris Smith
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Martin Hibberd
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Koya Ariyoshi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Yuji Fujino
- Non-Profit Organization Japan ECMO Network, Tokyo, Japan; Department of Anesthesiology and Intensive Care, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuzo Arima
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shinhiro Takeda
- Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan; Non-Profit Organization Japan ECMO Network, Tokyo, Japan; Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
| | - Satoru Hashimoto
- Non-Profit Organization Japan ECMO Network, Tokyo, Japan; Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
| | - Motoi Suzuki
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
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