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Incidence of Severe COVID-19 Illness Following Vaccination and Booster With BNT162b2, mRNA-1273, and Ad26.COV2.S Vaccines.
JAMA. 2022 10 11; 328(14):1427-1437.JAMA

Abstract

Importance

Evidence describing the incidence of severe COVID-19 illness following vaccination and booster with BNT162b2, mRNA-1273, and Ad26.COV2.S vaccines is needed, particularly for high-risk populations.

Objective

To describe the incidence of severe COVID-19 illness among a cohort that received vaccination plus a booster vaccine dose.

Design, Setting, and Participants

Retrospective cohort study of adults receiving care at Veterans Health Administration facilities across the US who received a vaccination series plus 1 booster against SARS-CoV-2, conducted from July 1, 2021, to May 30, 2022. Patients were eligible if they had received a primary care visit in the prior 2 years and had documented receipt of all US Food and Drug Administration-authorized doses of the initial mRNA vaccine or viral vector vaccination series after December 11, 2020, and a subsequent documented booster dose between July 1, 2021, and April 29, 2022. The analytic cohort consisted of 1 610 719 participants.

Exposures

Receipt of any combination of mRNA-1273 (Moderna), BNT162b2 (Pfizer-BioNTech), and Ad26.COV2.S (Janssen/Johnson & Johnson) primary vaccination series and a booster dose.

Main Outcomes and Measures

Outcomes were breakthrough COVID-19 (symptomatic infection), hospitalization with COVID-19 pneumonia and/or death, and hospitalization with severe COVID-19 pneumonia and/or death. A subgroup analysis of nonoverlapping populations included those aged 65 years or older, those with high-risk comorbid conditions, and those with immunocompromising conditions.

Results

Of 1 610 719 participants, 1 100 280 (68.4%) were aged 65 years or older and 132 243 (8.2%) were female; 1 133 785 (70.4%) had high-risk comorbid conditions, 155 995 (9.6%) had immunocompromising conditions, and 1 467 879 (91.1%) received the same type of mRNA vaccine (initial series and booster). Over 24 weeks, 125.0 (95% CI, 123.3-126.8) per 10 000 persons had breakthrough COVID-19, 8.9 (95% CI, 8.5-9.4) per 10 000 persons were hospitalized with COVID-19 pneumonia or died, and 3.4 (95% CI, 3.1-3.7) per 10 000 persons were hospitalized with severe pneumonia or died. For high-risk populations, incidence of hospitalization with COVID-19 pneumonia or death was as follows: aged 65 years or older, 1.9 (95% CI, 1.4-2.6) per 10 000 persons; high-risk comorbid conditions, 6.7 (95% CI, 6.2-7.2) per 10 000 persons; and immunocompromising conditions, 39.6 (95% CI, 36.6-42.9) per 10 000 persons. Subgroup analyses of patients hospitalized with COVID-19 pneumonia or death by time after booster demonstrated similar incidence estimates among those aged 65 years or older and with high-risk comorbid conditions but not among those with immunocompromising conditions.

Conclusions and Relevance

In a US cohort of patients receiving care at Veterans Health Administration facilities during a period of Delta and Omicron variant predominance, there was a low incidence of hospitalization with COVID-19 pneumonia or death following vaccination and booster with any of BNT162b2, mRNA-1273, or Ad26.COV2.S vaccines.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Kelly JD
San Francisco VA Medical Center, San Francisco, California. Department of Epidemiology and Biostatistics, University of California, San Francisco. Institute for Global Health Sciences, University of California, San Francisco. F. I. Proctor Foundation, University of California, San Francisco.
Leonard S
San Francisco VA Medical Center, San Francisco, California.
Hoggatt KJ
San Francisco VA Medical Center, San Francisco, California. Department of Medicine, University of California, San Francisco.
Boscardin WJ
Department of Epidemiology and Biostatistics, University of California, San Francisco.
Lum EN
San Francisco VA Medical Center, San Francisco, California.
Moss-Vazquez TA
San Francisco VA Medical Center, San Francisco, California.
Andino R
Department of Microbiology and Immunology, University of California, San Francisco.
Wong JK
San Francisco VA Medical Center, San Francisco, California. Department of Medicine, University of California, San Francisco.
Byers A
San Francisco VA Medical Center, San Francisco, California.
Bravata DM
Department of Veterans Affairs Health Services and Development Center for Health Information and Communication and Department of Medicine, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana. Department of Medicine, Indiana University School of Medicine, Indianapolis. Regenstrief Institute, Indianapolis, Indiana.
Tien PC
San Francisco VA Medical Center, San Francisco, California. Department of Medicine, University of California, San Francisco.
Keyhani S
San Francisco VA Medical Center, San Francisco, California. Department of Medicine, University of California, San Francisco.

MeSH

2019-nCoV Vaccine mRNA-1273Ad26COVS1AdultAgedBNT162 VaccineCOVID-19FemaleHospitalizationHumansImmunization, SecondaryIncidenceMalePneumoniaRetrospective StudiesSARS-CoV-2United StatesVaccinationVeterans Health Services

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36156706

Citation

Kelly, J Daniel, et al. "Incidence of Severe COVID-19 Illness Following Vaccination and Booster With BNT162b2, mRNA-1273, and Ad26.COV2.S Vaccines." JAMA, vol. 328, no. 14, 2022, pp. 1427-1437.
Kelly JD, Leonard S, Hoggatt KJ, et al. Incidence of Severe COVID-19 Illness Following Vaccination and Booster With BNT162b2, mRNA-1273, and Ad26.COV2.S Vaccines. JAMA. 2022;328(14):1427-1437.
Kelly, J. D., Leonard, S., Hoggatt, K. J., Boscardin, W. J., Lum, E. N., Moss-Vazquez, T. A., Andino, R., Wong, J. K., Byers, A., Bravata, D. M., Tien, P. C., & Keyhani, S. (2022). Incidence of Severe COVID-19 Illness Following Vaccination and Booster With BNT162b2, mRNA-1273, and Ad26.COV2.S Vaccines. JAMA, 328(14), 1427-1437. https://doi.org/10.1001/jama.2022.17985
Kelly JD, et al. Incidence of Severe COVID-19 Illness Following Vaccination and Booster With BNT162b2, mRNA-1273, and Ad26.COV2.S Vaccines. JAMA. 2022 10 11;328(14):1427-1437. PubMed PMID: 36156706.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of Severe COVID-19 Illness Following Vaccination and Booster With BNT162b2, mRNA-1273, and Ad26.COV2.S Vaccines. AU - Kelly,J Daniel, AU - Leonard,Samuel, AU - Hoggatt,Katherine J, AU - Boscardin,W John, AU - Lum,Emily N, AU - Moss-Vazquez,Tristan A, AU - Andino,Raul, AU - Wong,Joseph K, AU - Byers,Amy, AU - Bravata,Dawn M, AU - Tien,Phyllis C, AU - Keyhani,Salomeh, PY - 2023/03/26/pmc-release PY - 2022/9/27/pubmed PY - 2022/10/14/medline PY - 2022/9/26/entrez SP - 1427 EP - 1437 JF - JAMA JO - JAMA VL - 328 IS - 14 N2 - Importance: Evidence describing the incidence of severe COVID-19 illness following vaccination and booster with BNT162b2, mRNA-1273, and Ad26.COV2.S vaccines is needed, particularly for high-risk populations. Objective: To describe the incidence of severe COVID-19 illness among a cohort that received vaccination plus a booster vaccine dose. Design, Setting, and Participants: Retrospective cohort study of adults receiving care at Veterans Health Administration facilities across the US who received a vaccination series plus 1 booster against SARS-CoV-2, conducted from July 1, 2021, to May 30, 2022. Patients were eligible if they had received a primary care visit in the prior 2 years and had documented receipt of all US Food and Drug Administration-authorized doses of the initial mRNA vaccine or viral vector vaccination series after December 11, 2020, and a subsequent documented booster dose between July 1, 2021, and April 29, 2022. The analytic cohort consisted of 1 610 719 participants. Exposures: Receipt of any combination of mRNA-1273 (Moderna), BNT162b2 (Pfizer-BioNTech), and Ad26.COV2.S (Janssen/Johnson & Johnson) primary vaccination series and a booster dose. Main Outcomes and Measures: Outcomes were breakthrough COVID-19 (symptomatic infection), hospitalization with COVID-19 pneumonia and/or death, and hospitalization with severe COVID-19 pneumonia and/or death. A subgroup analysis of nonoverlapping populations included those aged 65 years or older, those with high-risk comorbid conditions, and those with immunocompromising conditions. Results: Of 1 610 719 participants, 1 100 280 (68.4%) were aged 65 years or older and 132 243 (8.2%) were female; 1 133 785 (70.4%) had high-risk comorbid conditions, 155 995 (9.6%) had immunocompromising conditions, and 1 467 879 (91.1%) received the same type of mRNA vaccine (initial series and booster). Over 24 weeks, 125.0 (95% CI, 123.3-126.8) per 10 000 persons had breakthrough COVID-19, 8.9 (95% CI, 8.5-9.4) per 10 000 persons were hospitalized with COVID-19 pneumonia or died, and 3.4 (95% CI, 3.1-3.7) per 10 000 persons were hospitalized with severe pneumonia or died. For high-risk populations, incidence of hospitalization with COVID-19 pneumonia or death was as follows: aged 65 years or older, 1.9 (95% CI, 1.4-2.6) per 10 000 persons; high-risk comorbid conditions, 6.7 (95% CI, 6.2-7.2) per 10 000 persons; and immunocompromising conditions, 39.6 (95% CI, 36.6-42.9) per 10 000 persons. Subgroup analyses of patients hospitalized with COVID-19 pneumonia or death by time after booster demonstrated similar incidence estimates among those aged 65 years or older and with high-risk comorbid conditions but not among those with immunocompromising conditions. Conclusions and Relevance: In a US cohort of patients receiving care at Veterans Health Administration facilities during a period of Delta and Omicron variant predominance, there was a low incidence of hospitalization with COVID-19 pneumonia or death following vaccination and booster with any of BNT162b2, mRNA-1273, or Ad26.COV2.S vaccines. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/36156706/Incidence_of_Severe_COVID_19_Illness_Following_Vaccination_and_Booster_With_BNT162b2_mRNA_1273_and_Ad26_COV2_S_Vaccines_ DB - PRIME DP - Unbound Medicine ER -