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Comparative effectiveness of third doses of mRNA-based COVID-19 vaccines in US veterans.
Nat Microbiol. 2023 01; 8(1):55-63.NM

Abstract

Vaccination against SARS-CoV-2 has been effective in reducing the burden of severe disease and death from COVID-19. Third doses of mRNA-based vaccines have provided a way to address waning immunity and broaden protection against emerging SARS-CoV-2 variants. However, their comparative effectiveness for a range of COVID-19 outcomes across diverse populations is unknown. We emulated a target trial using electronic health records of US veterans who received a third dose of either BNT162b2 or mRNA-1273 vaccines between 20 October 2021 and 8 February 2022, during a period that included Delta- and Omicron-variant waves. Eligible veterans had previously completed an mRNA vaccine primary series. We matched recipients of each vaccine in a 1:1 ratio according to recorded risk factors. Each vaccine group included 65,196 persons. The excess number of events over 16 weeks per 10,000 persons for BNT162b2 compared with mRNA-1273 was 45.4 (95% CI: 19.4, 84.7) for documented infection, 3.7 (2.2, 14.1) for symptomatic COVID-19, 10.6 (5.1, 19.7) for COVID-19 hospitalization, 2.0 (-3.1, 6.3) for COVID-19 intensive care unit admission and 0.2 (-2.2, 4.0) for COVID-19 death. After emulating a second target trial of veterans who received a third dose between 1 January and 1 March 2022, during a period restricted to Omicron-variant predominance, the excess number of events over 9 weeks per 10,000 persons for BNT162b2 compared with mRNA-1273 was 63.2 (95% CI: 15.2, 100.7) for documented infection. The 16-week risks of COVID-19 outcomes were low after a third dose of mRNA-1273 or BNT162b2, although risks were lower with mRNA-1273 than with BNT162b2, particularly for documented infection.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Dickerman BA
CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Gerlovin H
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA. hanna.gerlovin@va.gov.
Madenci AL
CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Figueroa Muñiz MJ
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
Wise JK
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.
Adhikari N
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
Ferolito BR
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.
Kurgansky KE
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Gagnon DR
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
Cho K
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA. Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Casas JP
Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA. Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Hernán MA
CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

MeSH

HumansSARS-CoV-2COVID-192019-nCoV Vaccine mRNA-1273BNT162 VaccineCOVID-19 VaccinesVeteransRNA, Messenger

Pub Type(s)

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

Language

eng

PubMed ID

36593297

Citation

Dickerman, Barbra A., et al. "Comparative Effectiveness of Third Doses of mRNA-based COVID-19 Vaccines in US Veterans." Nature Microbiology, vol. 8, no. 1, 2023, pp. 55-63.
Dickerman BA, Gerlovin H, Madenci AL, et al. Comparative effectiveness of third doses of mRNA-based COVID-19 vaccines in US veterans. Nat Microbiol. 2023;8(1):55-63.
Dickerman, B. A., Gerlovin, H., Madenci, A. L., Figueroa Muñiz, M. J., Wise, J. K., Adhikari, N., Ferolito, B. R., Kurgansky, K. E., Gagnon, D. R., Cho, K., Casas, J. P., & Hernán, M. A. (2023). Comparative effectiveness of third doses of mRNA-based COVID-19 vaccines in US veterans. Nature Microbiology, 8(1), 55-63. https://doi.org/10.1038/s41564-022-01272-z
Dickerman BA, et al. Comparative Effectiveness of Third Doses of mRNA-based COVID-19 Vaccines in US Veterans. Nat Microbiol. 2023;8(1):55-63. PubMed PMID: 36593297.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative effectiveness of third doses of mRNA-based COVID-19 vaccines in US veterans. AU - Dickerman,Barbra A, AU - Gerlovin,Hanna, AU - Madenci,Arin L, AU - Figueroa Muñiz,Michael J, AU - Wise,Jessica K, AU - Adhikari,Nimish, AU - Ferolito,Brian R, AU - Kurgansky,Katherine E, AU - Gagnon,David R, AU - Cho,Kelly, AU - Casas,Juan P, AU - Hernán,Miguel A, Y1 - 2023/01/02/ PY - 2022/07/28/received PY - 2022/10/17/accepted PY - 2024/01/02/pmc-release PY - 2023/1/3/pubmed PY - 2023/1/10/medline PY - 2023/1/2/entrez SP - 55 EP - 63 JF - Nature microbiology JO - Nat Microbiol VL - 8 IS - 1 N2 - Vaccination against SARS-CoV-2 has been effective in reducing the burden of severe disease and death from COVID-19. Third doses of mRNA-based vaccines have provided a way to address waning immunity and broaden protection against emerging SARS-CoV-2 variants. However, their comparative effectiveness for a range of COVID-19 outcomes across diverse populations is unknown. We emulated a target trial using electronic health records of US veterans who received a third dose of either BNT162b2 or mRNA-1273 vaccines between 20 October 2021 and 8 February 2022, during a period that included Delta- and Omicron-variant waves. Eligible veterans had previously completed an mRNA vaccine primary series. We matched recipients of each vaccine in a 1:1 ratio according to recorded risk factors. Each vaccine group included 65,196 persons. The excess number of events over 16 weeks per 10,000 persons for BNT162b2 compared with mRNA-1273 was 45.4 (95% CI: 19.4, 84.7) for documented infection, 3.7 (2.2, 14.1) for symptomatic COVID-19, 10.6 (5.1, 19.7) for COVID-19 hospitalization, 2.0 (-3.1, 6.3) for COVID-19 intensive care unit admission and 0.2 (-2.2, 4.0) for COVID-19 death. After emulating a second target trial of veterans who received a third dose between 1 January and 1 March 2022, during a period restricted to Omicron-variant predominance, the excess number of events over 9 weeks per 10,000 persons for BNT162b2 compared with mRNA-1273 was 63.2 (95% CI: 15.2, 100.7) for documented infection. The 16-week risks of COVID-19 outcomes were low after a third dose of mRNA-1273 or BNT162b2, although risks were lower with mRNA-1273 than with BNT162b2, particularly for documented infection. SN - 2058-5276 UR - https://www.unboundmedicine.com/medline/citation/36593297/Comparative_effectiveness_of_third_doses_of_mRNA_based_COVID_19_vaccines_in_US_veterans_ DB - PRIME DP - Unbound Medicine ER -