Effectiveness of 2, 3, and 4 COVID-19 mRNA Vaccine Doses Among Immunocompetent Adults During Periods when SARS-CoV-2 Omicron BA.1 and BA.2/BA.2.12.1 Sublineages Predominated - VISION Network, 10 States, December 2021-June 2022

Ruth Link-Gelles, Matthew E Levy, Manjusha Gaglani, Stephanie A Irving, Melissa Stockwell, Kristin Dascomb, Malini B DeSilva, Sarah E Reese, I-Chia Liao, Toan C Ong, Shaun J Grannis, Charlene McEvoy, Palak Patel, Nicola P Klein, Emily Hartmann, Edward Stenehjem, Karthik Natarajan, Allison L Naleway, Kempapura Murthy, Suchitra Rao, Brian E Dixon, Anupam B Kharbanda, Akintunde Akinseye, Monica Dickerson, Ned Lewis, Nancy Grisel, Jungmi Han, Michelle A Barron, William F Fadel, Margaret M Dunne, Kristin Goddard, Julie Arndorfer, Deepika Konatham, Nimish R Valvi, J C Currey, Bruce Fireman, Chandni Raiyani, Ousseny Zerbo, Chantel Sloan-Aagard, Sarah W Ball, Mark G Thompson, Mark W Tenforde
MMWR. Morbidity and Mortality Weekly Report 2022 July 22, 71 (29): 931-939
The Omicron variant (B.1.1.529) of SARS-CoV-2, the virus that causes COVID-19, was first identified in the United States in November 2021, with the BA.1 sublineage (including BA.1.1) causing the largest surge in COVID-19 cases to date. Omicron sublineages BA.2 and BA.2.12.1 emerged later and by late April 2022, accounted for most cases.* Estimates of COVID-19 vaccine effectiveness (VE) can be reduced by newly emerging variants or sublineages that evade vaccine-induced immunity (1), protection from previous SARS-CoV-2 infection in unvaccinated persons (2), or increasing time since vaccination (3). Real-world data comparing VE during the periods when the BA.1 and BA.2/BA.2.12.1 predominated (BA.1 period and BA.2/BA.2.12.1 period, respectively) are limited. The VISION network† examined 214,487 emergency department/urgent care (ED/UC) visits and 58,782 hospitalizations with a COVID-19-like illness§ diagnosis among 10 states during December 18, 2021-June 10, 2022, to evaluate VE of 2, 3, and 4 doses of mRNA COVID-19 vaccines (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) compared with no vaccination among adults without immunocompromising conditions. VE against COVID-19-associated hospitalization 7-119 days and ≥120 days after receipt of dose 3 was 92% (95% CI = 91%-93%) and 85% (95% CI = 81%-89%), respectively, during the BA.1 period, compared with 69% (95% CI = 58%-76%) and 52% (95% CI = 44%-59%), respectively, during the BA.2/BA.2.12.1 period. Patterns were similar for ED/UC encounters. Among adults aged ≥50 years, VE against COVID-19-associated hospitalization ≥120 days after receipt of dose 3 was 55% (95% CI = 46%-62%) and ≥7 days (median = 27 days) after a fourth dose was 80% (95% CI = 71%-85%) during BA.2/BA.2.12.1 predominance. Immunocompetent persons should receive recommended COVID-19 booster doses to prevent moderate to severe COVID-19, including a first booster dose for all eligible persons and second booster dose for adults aged ≥50 years at least 4 months after an initial booster dose. Booster doses should be obtained immediately when persons become eligible.¶ .

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