Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines.N Engl J Med. 2021 07 22; 385(4):320-329.NEJM
Abstract
BACKGROUND
Information is limited regarding the effectiveness of the two-dose messenger RNA (mRNA) vaccines BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) in preventing infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and in attenuating coronavirus disease 2019 (Covid-19) when administered in real-world conditions.
METHODS
We conducted a prospective cohort study involving 3975 health care personnel, first responders, and other essential and frontline workers. From December 14, 2020, to April 10, 2021, the participants completed weekly SARS-CoV-2 testing by providing mid-turbinate nasal swabs for qualitative and quantitative reverse-transcriptase-polymerase-chain-reaction (RT-PCR) analysis. The formula for calculating vaccine effectiveness was 100% × (1 - hazard ratio for SARS-CoV-2 infection in vaccinated vs. unvaccinated participants), with adjustments for the propensity to be vaccinated, study site, occupation, and local viral circulation.
RESULTS
SARS-CoV-2 was detected in 204 participants (5%), of whom 5 were fully vaccinated (≥14 days after dose 2), 11 partially vaccinated (≥14 days after dose 1 and <14 days after dose 2), and 156 unvaccinated; the 32 participants with indeterminate vaccination status (<14 days after dose 1) were excluded. Adjusted vaccine effectiveness was 91% (95% confidence interval [CI], 76 to 97) with full vaccination and 81% (95% CI, 64 to 90) with partial vaccination. Among participants with SARS-CoV-2 infection, the mean viral RNA load was 40% lower (95% CI, 16 to 57) in partially or fully vaccinated participants than in unvaccinated participants. In addition, the risk of febrile symptoms was 58% lower (relative risk, 0.42; 95% CI, 0.18 to 0.98) and the duration of illness was shorter, with 2.3 fewer days spent sick in bed (95% CI, 0.8 to 3.7).
CONCLUSIONS
Authorized mRNA vaccines were highly effective among working-age adults in preventing SARS-CoV-2 infection when administered in real-world conditions, and the vaccines attenuated the viral RNA load, risk of febrile symptoms, and duration of illness among those who had breakthrough infection despite vaccination. (Funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention.).
Links
Authors+Show Affiliations
From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke's Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) - both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) - both in Texas.
MeSH
Pub Type(s)
Journal Article
Research Support, Non-U.S. Gov't
Language
eng
PubMed ID
34192428
Citation
Thompson, Mark G., et al. "Prevention and Attenuation of Covid-19 With the BNT162b2 and mRNA-1273 Vaccines." The New England Journal of Medicine, vol. 385, no. 4, 2021, pp. 320-329.
Thompson MG, Burgess JL, Naleway AL, et al. Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines. N Engl J Med. 2021;385(4):320-329.
Thompson, M. G., Burgess, J. L., Naleway, A. L., Tyner, H., Yoon, S. K., Meece, J., Olsho, L. E. W., Caban-Martinez, A. J., Fowlkes, A. L., Lutrick, K., Groom, H. C., Dunnigan, K., Odean, M. J., Hegmann, K., Stefanski, E., Edwards, L. J., Schaefer-Solle, N., Grant, L., Ellingson, K., ... Gaglani, M. (2021). Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines. The New England Journal of Medicine, 385(4), 320-329. https://doi.org/10.1056/NEJMoa2107058
Thompson MG, et al. Prevention and Attenuation of Covid-19 With the BNT162b2 and mRNA-1273 Vaccines. N Engl J Med. 2021 07 22;385(4):320-329. PubMed PMID: 34192428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines.
AU - Thompson,Mark G,
AU - Burgess,Jefferey L,
AU - Naleway,Allison L,
AU - Tyner,Harmony,
AU - Yoon,Sarang K,
AU - Meece,Jennifer,
AU - Olsho,Lauren E W,
AU - Caban-Martinez,Alberto J,
AU - Fowlkes,Ashley L,
AU - Lutrick,Karen,
AU - Groom,Holly C,
AU - Dunnigan,Kayan,
AU - Odean,Marilyn J,
AU - Hegmann,Kurt,
AU - Stefanski,Elisha,
AU - Edwards,Laura J,
AU - Schaefer-Solle,Natasha,
AU - Grant,Lauren,
AU - Ellingson,Katherine,
AU - Kuntz,Jennifer L,
AU - Zunie,Tnelda,
AU - Thiese,Matthew S,
AU - Ivacic,Lynn,
AU - Wesley,Meredith G,
AU - Mayo Lamberte,Julie,
AU - Sun,Xiaoxiao,
AU - Smith,Michael E,
AU - Phillips,Andrew L,
AU - Groover,Kimberly D,
AU - Yoo,Young M,
AU - Gerald,Joseph,
AU - Brown,Rachel T,
AU - Herring,Meghan K,
AU - Joseph,Gregory,
AU - Beitel,Shawn,
AU - Morrill,Tyler C,
AU - Mak,Josephine,
AU - Rivers,Patrick,
AU - Poe,Brandon P,
AU - Lynch,Brian,
AU - Zhou,Yingtao,
AU - Zhang,Jing,
AU - Kelleher,Anna,
AU - Li,Yan,
AU - Dickerson,Monica,
AU - Hanson,Erika,
AU - Guenther,Kyley,
AU - Tong,Suxiang,
AU - Bateman,Allen,
AU - Reisdorf,Erik,
AU - Barnes,John,
AU - Azziz-Baumgartner,Eduardo,
AU - Hunt,Danielle R,
AU - Arvay,Melissa L,
AU - Kutty,Preeta,
AU - Fry,Alicia M,
AU - Gaglani,Manjusha,
Y1 - 2021/06/30/
PY - 2021/7/1/pubmed
PY - 2021/7/28/medline
PY - 2021/6/30/entrez
SP - 320
EP - 329
JF - The New England journal of medicine
JO - N Engl J Med
VL - 385
IS - 4
N2 - BACKGROUND: Information is limited regarding the effectiveness of the two-dose messenger RNA (mRNA) vaccines BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) in preventing infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and in attenuating coronavirus disease 2019 (Covid-19) when administered in real-world conditions. METHODS: We conducted a prospective cohort study involving 3975 health care personnel, first responders, and other essential and frontline workers. From December 14, 2020, to April 10, 2021, the participants completed weekly SARS-CoV-2 testing by providing mid-turbinate nasal swabs for qualitative and quantitative reverse-transcriptase-polymerase-chain-reaction (RT-PCR) analysis. The formula for calculating vaccine effectiveness was 100% × (1 - hazard ratio for SARS-CoV-2 infection in vaccinated vs. unvaccinated participants), with adjustments for the propensity to be vaccinated, study site, occupation, and local viral circulation. RESULTS: SARS-CoV-2 was detected in 204 participants (5%), of whom 5 were fully vaccinated (≥14 days after dose 2), 11 partially vaccinated (≥14 days after dose 1 and <14 days after dose 2), and 156 unvaccinated; the 32 participants with indeterminate vaccination status (<14 days after dose 1) were excluded. Adjusted vaccine effectiveness was 91% (95% confidence interval [CI], 76 to 97) with full vaccination and 81% (95% CI, 64 to 90) with partial vaccination. Among participants with SARS-CoV-2 infection, the mean viral RNA load was 40% lower (95% CI, 16 to 57) in partially or fully vaccinated participants than in unvaccinated participants. In addition, the risk of febrile symptoms was 58% lower (relative risk, 0.42; 95% CI, 0.18 to 0.98) and the duration of illness was shorter, with 2.3 fewer days spent sick in bed (95% CI, 0.8 to 3.7). CONCLUSIONS: Authorized mRNA vaccines were highly effective among working-age adults in preventing SARS-CoV-2 infection when administered in real-world conditions, and the vaccines attenuated the viral RNA load, risk of febrile symptoms, and duration of illness among those who had breakthrough infection despite vaccination. (Funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention.).
SN - 1533-4406
UR - https://www.unboundmedicine.com/medline/citation/34192428/Prevention_and_Attenuation_of_Covid_19_with_the_BNT162b2_and_mRNA_1273_Vaccines_
DB - PRIME
DP - Unbound Medicine
ER -
Latest evidence on COVID-19 from PubMed, WHO, CDC.
Visit free Relief Central.
Visit free Relief Central.
Try the Free App:
Related Citations
- Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers - Eight U.S. Locations, December 2020-March 2021.
- Association Between Vaccination With BNT162b2 and Incidence of Symptomatic and Asymptomatic SARS-CoV-2 Infections Among Health Care Workers.
- Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of long-term care facilities in England (VIVALDI): a prospective cohort study.
- Association of a Third Dose of BNT162b2 Vaccine With Incidence of SARS-CoV-2 Infection Among Health Care Workers in Israel.
- Association of mRNA Vaccination With Clinical and Virologic Features of COVID-19 Among US Essential and Frontline Workers.
- Association of Prior SARS-CoV-2 Infection With Risk of Breakthrough Infection Following mRNA Vaccination in Qatar.
- Protection against SARS-CoV-2 after Covid-19 Vaccination and Previous Infection.
- Effectiveness of Pfizer-BioNTech and Moderna Vaccines in Preventing SARS-CoV-2 Infection Among Nursing Home Residents Before and During Widespread Circulation of the SARS-CoV-2 B.1.617.2 (Delta) Variant - National Healthcare Safety Network, March 1-August 1, 2021.
- Effectiveness of BNT162b2 and mRNA-1273 covid-19 vaccines against symptomatic SARS-CoV-2 infection and severe covid-19 outcomes in Ontario, Canada: test negative design study.
- Effectiveness of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines on covid-19 related symptoms, hospital admissions, and mortality in older adults in England: test negative case-control study.