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COVID-19 Management

Does COVID-19 Vaccination Impact Disease Severity for Those with Breakthrough Infections?

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BACKGROUND AND PURPOSE: 

  • Tenforde et al. (JAMA, 2021) evaluated whether COVID-19 vaccination attenuates disease severity for those with breakthrough infections 

METHODS: 

  • Case-control analysis 
    • 21 US hospitals  
  • Participants 
    • Adults hospitalized between March and August, 2021 
    • 28-day outcome data on death and mechanical ventilation available 
  • Exposures 
    • COVID-19 vaccination 
  • Study design 
    • For hospitalization analysis 
      • Case patients: Those with COVID-19 
      • Controls: Those hospitalized for an alternative diagnosis 
    • For disease progression analysis 
      • Case patients: COVID-19 patients with progression to death or mechanical ventilation 
      • Controls: COVID-19 patients without progression 
    • Associations were measured with multivariable logistic regression 
  • Primary outcomes 
    • Hospitalization for COVID-19 
    • Disease progression among those hospitalized 

RESULTS: 

  • Case patients (COVID-19 patients): 1983 | Controls: 2530 
    • Median (IQR) age 59 (45 to 69) years; 48.8% women 
    • 23.0% non-Hispanic Black individuals | 15.9% Hispanic individuals 
    • 20.1% with an immunocompromising condition 
  • Unvaccinated patients accounted for 84.2% of COVID-19 hospitalizations 
  • Hospitalization for COVID-19 was significantly associated with decreased likelihood of vaccination  
    • Cases (COVID-19): 15.8% vaccinated 
    • Controls (other indications): 54.8% vaccinated  
    • aOR 0.15 (95% CI, 0.13 to 0.18) 
  • This included patients with both SARS-CoV-2 Alpha and Delta variants 
    • Alpha 
      • Cases (COVID-19): 8.7% vaccinated 
      • Controls (other indications): 51.7% vaccinated 
      • aOR 0.10 (95% CI, 0.06 to 0.16) 
    • Delta 
      • Cases (COVID-19): 21.9% vaccinated 
      • Controls (other indications): 61.8% vaccinated 
      • aOR 0.14 (95% CI, 0.10 to 0.21) 
  • Association with vaccination status was stronger for immunocompetent patients vs immunocompromised patients (P<0.001) 
    • Immunocompetent 
      • Cases (COVID-19): 11.2% vaccinated 
      • Controls (other indications): 53.5% vaccinated 
      • aOR 0.10 (95% CI, 0.09 to 0.13) 
    • Immunocompromised 
      • Cases (COVID-19): 40.1% vaccinated 
      • Controls (other indications): 58.8% vaccinated 
      • aOR 0.49 (95% CI, 0.35 to 0.69) 
  • The association was weaker at more than 120 days since vaccination with Pfizer vs Moderna (P<0.001) 
    • Pfizer 
      • Cases (COVID-19): 5.8% vaccinated 
      • Controls (other indications): 11.5% vaccinated 
      • aOR 0.36 (95% CI, 0.27 to 0.49) 
    • Moderna 
      • Cases (COVID-19): 1.9% vaccinated 
      • Controls (other indications): 8.3% vaccinated 
      • aOR 0.15 (95% CI, 0.09 to 0.23) 
  • Among the 1197 patients hospitalized with COVID-19, death or invasive mechanical ventilation by day 28 was associated with decreased likelihood of vaccination 
    • Cases: 12.0% vaccinated 
    • Controls: 24.7% vaccinated 
    • aOR 0.33 (95% CI, 0.19 to 0.58) 

CONCLUSION: 

  • mRNA-based COVID-19 vaccination was less likely among hospitalized patients with COVID-19 vs patients hospitalized for other conditions 
  • Death and mechanical ventilation were also associated with a decreased likelihood of vaccination among those hospitalized 
  • The authors state 

These findings are consistent with risk reduction of developing severe COVID-19 among patients with vaccine breakthrough infections compared with absence of vaccination 

Learn More – Primary Sources: 

Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity 

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Related ObG Topics:

Breakthrough COVID-19 Following Vaccination: What are the Risk Factors?
How does Vaccination Impact Viral Load and Duration of Illness in Those with Breakthrough SARS-CoV-2 Infection?
Real World Data: COVID-19 Vaccination and Reduction in Risk for Reinfection

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