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Pneumonia Frequency and Severity in Patients With Symptomatic COVID-19: Impact of mRNA and Adenovirus Vector Vaccines.
AJR Am J Roentgenol. 2022 11; 219(5):752-761.AA

Abstract

BACKGROUND. Additional evidence of the role of COVID-19 vaccination in reducing pneumonia frequency and severity in the setting of breakthrough infection could help combat ongoing vaccine hesitancy. OBJECTIVE. The purpose of this article was to compare the frequency and severity of pneumonia on chest CT in patients with confirmed COVID-19 between patients who are unvaccinated and those who are fully vaccinated by messenger RNA (mRNA) or adenovirus vector vaccines. METHODS. This retrospective single-center study included 467 patients (250 men, 217 women; mean age, 65 ± 17 [SD] years) who underwent chest CT between December 15, 2021, and February 18, 2022, during hospitalization for symptomatic COVID-19, confirmed by reverse transcriptase-polymerase chain reaction assay. A total of 216 patients were unvaccinated, and 167 and 84 patients were fully vaccinated (defined as receipt of the second dose at least 14 days before COVID-19 diagnosis) by the BNT162b2 mRNA vaccine or the ChAdOx1-S adenovirus vector vaccine, respectively. Semiquantitative CT severity scores (CT-SS; 0-25 scale) were determined; CT-SS of 0 indicated absence of pneumonia. Presence of bilateral involvement was assessed in patients with pneumonia. Associations were explored between vaccination status and CT findings. RESULTS. The frequency of the absence of pneumonia was 15% (32/216) in unvaccinated patients, 29% (24/84) in patients fully vaccinated with ChAdOx1-S vaccine, and 51% (85/167) in patients fully vaccinated with BNT162b2 vaccine (unvaccinated and ChAdOx1-S vs BNT162b2: p < .001; unvaccinated vs ChAdOx1-S: p = .08). Mean CT-SS was significantly higher in unvaccinated patients (9.7 ± 6.1) than in patients fully vaccinated with BNT162b2 (5.2 ± 6.1) or ChAdOx1-S (6.2 ± 5.9) vaccine (both p < .001). Full vaccination was significantly associated with CT-SS independent of patient age and sex (estimate = -4.46; p < .001). Frequency of bilateral lung involvement was significantly higher in unvaccinated patients (158/184, 86%) and in patients fully vaccinated with ChAdOx1-S vaccine (54/60, 90%) than in patients fully vaccinated with BNT162b2 vaccine (47/82, 57%) (both p < .001). CONCLUSION. Pneumonia frequency and severity were lower in patients with full vaccination by mRNA and adenovirus vector vaccines who experienced breakthrough infections in comparison with unvaccinated patients. CLINICAL IMPACT. The visual observation by radiologic imaging of the protective effect of vaccination on lung injury in patients with breakthrough infections provides additional evidence supporting the clinical benefit of vaccination.

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Authors+Show Affiliations

Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, I.C.O.T. Hospital, Via Franco Faggiana 1668, 04100, Latina, Italy.

Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, I.C.O.T. Hospital, Via Franco Faggiana 1668, 04100, Latina, Italy.

Department of Diagnostic Imaging and Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy.

Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, I.C.O.T. Hospital, Via Franco Faggiana 1668, 04100, Latina, Italy.

Department of Diagnostic Imaging and Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy.

Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, I.C.O.T. Hospital, Via Franco Faggiana 1668, 04100, Latina, Italy.

Department of Diagnostic Imaging and Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy.

Department of Diagnostic Imaging and Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy.

Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, I.C.O.T. Hospital, Via Franco Faggiana 1668, 04100, Latina, Italy.

MeSH

AgedAged, 80 and overFemaleHumansMaleMiddle AgedAdenoviridaeBNT162 VaccineCOVID-19COVID-19 TestingCOVID-19 VaccinesRetrospective StudiesRNA-Directed DNA PolymeraseChAdOx1 nCoV-19

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35642761

Citation

Vicini, Simone, et al. "Pneumonia Frequency and Severity in Patients With Symptomatic COVID-19: Impact of mRNA and Adenovirus Vector Vaccines." AJR. American Journal of Roentgenology, vol. 219, no. 5, 2022, pp. 752-761.

Vicini S, Bellini D, Iannarelli A, et al. Pneumonia Frequency and Severity in Patients With Symptomatic COVID-19: Impact of mRNA and Adenovirus Vector Vaccines. AJR Am J Roentgenol. 2022;219(5):752-761.

Vicini, S., Bellini, D., Iannarelli, A., Rengo, M., Pelle, G., Ruggiero, S., Fusco, M., Ambrogi, C., & Carbone, I. (2022). Pneumonia Frequency and Severity in Patients With Symptomatic COVID-19: Impact of mRNA and Adenovirus Vector Vaccines. AJR. American Journal of Roentgenology, 219(5), 752-761. https://doi.org/10.2214/AJR.22.27843

Vicini S, et al. Pneumonia Frequency and Severity in Patients With Symptomatic COVID-19: Impact of mRNA and Adenovirus Vector Vaccines. AJR Am J Roentgenol. 2022;219(5):752-761. PubMed PMID: 35642761.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Pneumonia Frequency and Severity in Patients With Symptomatic COVID-19: Impact of mRNA and Adenovirus Vector Vaccines. AU - Vicini,Simone, AU - Bellini,Davide, AU - Iannarelli,Angelo, AU - Rengo,Marco, AU - Pelle,Giuseppe, AU - Ruggiero,Sergio, AU - Fusco,Michele, AU - Ambrogi,Cesare, AU - Carbone,Iacopo, Y1 - 2022/06/01/ PY - 2022/6/2/pubmed PY - 2022/10/26/medline PY - 2022/6/1/entrez KW - COVID-19 KW - COVID-19 breakthrough infection KW - CT KW - SARS-CoV-2 KW - vaccination SP - 752 EP - 761 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 219 IS - 5 N2 - BACKGROUND. Additional evidence of the role of COVID-19 vaccination in reducing pneumonia frequency and severity in the setting of breakthrough infection could help combat ongoing vaccine hesitancy. OBJECTIVE. The purpose of this article was to compare the frequency and severity of pneumonia on chest CT in patients with confirmed COVID-19 between patients who are unvaccinated and those who are fully vaccinated by messenger RNA (mRNA) or adenovirus vector vaccines. METHODS. This retrospective single-center study included 467 patients (250 men, 217 women; mean age, 65 ± 17 [SD] years) who underwent chest CT between December 15, 2021, and February 18, 2022, during hospitalization for symptomatic COVID-19, confirmed by reverse transcriptase-polymerase chain reaction assay. A total of 216 patients were unvaccinated, and 167 and 84 patients were fully vaccinated (defined as receipt of the second dose at least 14 days before COVID-19 diagnosis) by the BNT162b2 mRNA vaccine or the ChAdOx1-S adenovirus vector vaccine, respectively. Semiquantitative CT severity scores (CT-SS; 0-25 scale) were determined; CT-SS of 0 indicated absence of pneumonia. Presence of bilateral involvement was assessed in patients with pneumonia. Associations were explored between vaccination status and CT findings. RESULTS. The frequency of the absence of pneumonia was 15% (32/216) in unvaccinated patients, 29% (24/84) in patients fully vaccinated with ChAdOx1-S vaccine, and 51% (85/167) in patients fully vaccinated with BNT162b2 vaccine (unvaccinated and ChAdOx1-S vs BNT162b2: p < .001; unvaccinated vs ChAdOx1-S: p = .08). Mean CT-SS was significantly higher in unvaccinated patients (9.7 ± 6.1) than in patients fully vaccinated with BNT162b2 (5.2 ± 6.1) or ChAdOx1-S (6.2 ± 5.9) vaccine (both p < .001). Full vaccination was significantly associated with CT-SS independent of patient age and sex (estimate = -4.46; p < .001). Frequency of bilateral lung involvement was significantly higher in unvaccinated patients (158/184, 86%) and in patients fully vaccinated with ChAdOx1-S vaccine (54/60, 90%) than in patients fully vaccinated with BNT162b2 vaccine (47/82, 57%) (both p < .001). CONCLUSION. Pneumonia frequency and severity were lower in patients with full vaccination by mRNA and adenovirus vector vaccines who experienced breakthrough infections in comparison with unvaccinated patients. CLINICAL IMPACT. The visual observation by radiologic imaging of the protective effect of vaccination on lung injury in patients with breakthrough infections provides additional evidence supporting the clinical benefit of vaccination. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/35642761/Pneumonia_Frequency_and_Severity_in_Patients_With_Symptomatic_COVID_19:_Impact_of_mRNA_and_Adenovirus_Vector_Vaccines_ DB - PRIME DP - Unbound Medicine ER -