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Coverage and Estimated Effectiveness of mRNA COVID-19 Vaccines Among US Veterans.
JAMA Netw Open. 2021 10 01; 4(10):e2128391.JN

Abstract

Importance

Effectiveness of mRNA vaccinations in a diverse older population with high comorbidity is unknown.

Objectives

To describe the scope of the COVID-19 vaccination rollout among US veterans, and to estimate mRNA COVID-19 vaccine effectiveness (VE) as measured by rates of SARS-CoV-2 infection.

Design, Setting, and Participants

This matched test-negative case-control study was conducted using SARS-CoV-2 test results at Veterans Health Administration sites from December 14, 2020, to March 14, 2021. Vaccine coverage was estimated for all veterans. VE against SARS-CoV-2 infection and COVID-19-related hospitalization and death were estimated using electronic health records from veterans who routinely sought care at a VHA facility and had a test result positive for SARS-CoV-2 (cases) or negative for SARS-CoV-2 (controls). Cases and controls were matched on time of test and geographic region. Data were analyzed from May to July 2021.

Exposures

Vaccination status, defined as unvaccinated, partially vaccinated (≥14 days after first dose until second dose), or fully vaccinated (≥14 days after second dose), at time of test.

Main Outcomes and Measures

The main outcome of interest was a positive result for SARS-CoV-2 on a polymerase chain reaction or antigen test. Secondary outcomes included COVID-19-related hospitalization and death, defined by discharge data and proximity of event to positive test result. VE was estimated from odds ratios for SARS-CoV-2 infection with 95% CIs.

Results

Among 6 647 733 veterans included (3 350 373 veterans [50%] aged ≥65 years; 6 014 798 [90%] men and 632 935 [10%] women; 461 645 Hispanic veterans of any race [7%], 1 102 471 non-Hispanic Black veterans [17%], and 4 361 621 non-Hispanic White veterans [66%]), 1 363 180 (21%) received at least 1 COVID-19 vaccination by March 7, 2021. In this period, during which the share of SARS-CoV-2 variants Alpha, Epsilon, and Iota had started to increase in the US, estimates of COVID-19 VE against infection, regardless of symptoms, was 95% (95% CI, 93%-96%) for full vaccination and 64% (95% CI, 59%-68%) for partial vaccination. Estimated VE against COVID-19-related hospitalization for full vaccination was 91% (95% CI 83%-95%); there were no deaths among veterans who were fully vaccinated. VE against infection was similar across subpopulations (non-Hispanic Black, 94% [95% CI, 88%-97%]; Hispanic [any race], 83% [95% CI, 45%-95%]; non-Hispanic White, 92% [95% CI 88%-94%]; rural, 94% [95% CI, 89%-96%]; urban, 93% 95% CI, 89%-95%]).

Conclusions and Relevance

For veterans of all racial and ethnic subgroups living in urban or rural areas, mRNA vaccination was associated with substantially decreased risk of COVID-19 infection and hospitalization, with no deaths among fully vaccinated veterans.

Authors+Show Affiliations

White River Junction Veterans Affairs Medical Center, White River Junction, Vermont. Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.White River Junction Veterans Affairs Medical Center, White River Junction, Vermont.Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, White Oak, Maryland.White River Junction Veterans Affairs Medical Center, White River Junction, Vermont.White River Junction Veterans Affairs Medical Center, White River Junction, Vermont.White River Junction Veterans Affairs Medical Center, White River Junction, Vermont.Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, White Oak, Maryland.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

34613401

Citation

Young-Xu, Yinong, et al. "Coverage and Estimated Effectiveness of mRNA COVID-19 Vaccines Among US Veterans." JAMA Network Open, vol. 4, no. 10, 2021, pp. e2128391.
Young-Xu Y, Korves C, Roberts J, et al. Coverage and Estimated Effectiveness of mRNA COVID-19 Vaccines Among US Veterans. JAMA Netw Open. 2021;4(10):e2128391.
Young-Xu, Y., Korves, C., Roberts, J., Powell, E. I., Zwain, G. M., Smith, J., & Izurieta, H. S. (2021). Coverage and Estimated Effectiveness of mRNA COVID-19 Vaccines Among US Veterans. JAMA Network Open, 4(10), e2128391. https://doi.org/10.1001/jamanetworkopen.2021.28391
Young-Xu Y, et al. Coverage and Estimated Effectiveness of mRNA COVID-19 Vaccines Among US Veterans. JAMA Netw Open. 2021 10 1;4(10):e2128391. PubMed PMID: 34613401.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Coverage and Estimated Effectiveness of mRNA COVID-19 Vaccines Among US Veterans. AU - Young-Xu,Yinong, AU - Korves,Caroline, AU - Roberts,Jeff, AU - Powell,Ethan I, AU - Zwain,Gabrielle M, AU - Smith,Jeremy, AU - Izurieta,Hector S, Y1 - 2021/10/01/ PY - 2021/10/6/entrez PY - 2021/10/7/pubmed PY - 2021/10/15/medline SP - e2128391 EP - e2128391 JF - JAMA network open JO - JAMA Netw Open VL - 4 IS - 10 N2 - Importance: Effectiveness of mRNA vaccinations in a diverse older population with high comorbidity is unknown. Objectives: To describe the scope of the COVID-19 vaccination rollout among US veterans, and to estimate mRNA COVID-19 vaccine effectiveness (VE) as measured by rates of SARS-CoV-2 infection. Design, Setting, and Participants: This matched test-negative case-control study was conducted using SARS-CoV-2 test results at Veterans Health Administration sites from December 14, 2020, to March 14, 2021. Vaccine coverage was estimated for all veterans. VE against SARS-CoV-2 infection and COVID-19-related hospitalization and death were estimated using electronic health records from veterans who routinely sought care at a VHA facility and had a test result positive for SARS-CoV-2 (cases) or negative for SARS-CoV-2 (controls). Cases and controls were matched on time of test and geographic region. Data were analyzed from May to July 2021. Exposures: Vaccination status, defined as unvaccinated, partially vaccinated (≥14 days after first dose until second dose), or fully vaccinated (≥14 days after second dose), at time of test. Main Outcomes and Measures: The main outcome of interest was a positive result for SARS-CoV-2 on a polymerase chain reaction or antigen test. Secondary outcomes included COVID-19-related hospitalization and death, defined by discharge data and proximity of event to positive test result. VE was estimated from odds ratios for SARS-CoV-2 infection with 95% CIs. Results: Among 6 647 733 veterans included (3 350 373 veterans [50%] aged ≥65 years; 6 014 798 [90%] men and 632 935 [10%] women; 461 645 Hispanic veterans of any race [7%], 1 102 471 non-Hispanic Black veterans [17%], and 4 361 621 non-Hispanic White veterans [66%]), 1 363 180 (21%) received at least 1 COVID-19 vaccination by March 7, 2021. In this period, during which the share of SARS-CoV-2 variants Alpha, Epsilon, and Iota had started to increase in the US, estimates of COVID-19 VE against infection, regardless of symptoms, was 95% (95% CI, 93%-96%) for full vaccination and 64% (95% CI, 59%-68%) for partial vaccination. Estimated VE against COVID-19-related hospitalization for full vaccination was 91% (95% CI 83%-95%); there were no deaths among veterans who were fully vaccinated. VE against infection was similar across subpopulations (non-Hispanic Black, 94% [95% CI, 88%-97%]; Hispanic [any race], 83% [95% CI, 45%-95%]; non-Hispanic White, 92% [95% CI 88%-94%]; rural, 94% [95% CI, 89%-96%]; urban, 93% 95% CI, 89%-95%]). Conclusions and Relevance: For veterans of all racial and ethnic subgroups living in urban or rural areas, mRNA vaccination was associated with substantially decreased risk of COVID-19 infection and hospitalization, with no deaths among fully vaccinated veterans. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/34613401/Coverage_and_Estimated_Effectiveness_of_mRNA_COVID_19_Vaccines_Among_US_Veterans_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2021.28391 DB - PRIME DP - Unbound Medicine ER -