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Effectiveness of mRNA Vaccination in Preventing COVID-19–Associated Invasive Mechanical Ventilation and Death — United States, March 2021–January 2022
Open accessAbstract
COVID-19 mRNA vaccines (BNT162b2 [Pfizer-BioNTech] and mRNA-1273 [Moderna]) are effective at preventing COVID-19-associated hospitalization (1-3). However, how well mRNA vaccines protect against the most severe outcomes of these hospitalizations, including invasive mechanical ventilation (IMV) or death is uncertain. Using a case-control design, mRNA vaccine effectiveness (VE) against COVID-19-associated IMV and in-hospital death was evaluated among adults aged ≥18 years hospitalized at 21 U.S. medical centers during March 11, 2021-January 24, 2022. During this period, the most commonly circulating variants of SARS-CoV-2, the virus that causes COVID-19, were B.1.1.7 (Alpha), B.1.617.2 (Delta), and B.1.1.529 (Omicron). Previous vaccination (2 or 3 versus 0 vaccine doses before illness onset) in prospectively enrolled COVID-19 case-patients who received IMV or died within 28 days of hospitalization was compared with that among hospitalized control patients without COVID-19. Among 1,440 COVID-19 case-patients who received IMV or died, 307 (21%) had received 2 or 3 vaccine doses before illness onset. Among 6,104 control-patients, 4,020 (66%) had received 2 or 3 vaccine doses. Among the 1,440 case-patients who received IMV or died, those who were vaccinated were older (median age = 69 years), more likely to be immunocompromised* (40%), and had more chronic medical conditions compared with unvaccinated case-patients (median age = 55 years; immunocompromised = 10%; p<0.001 for both). VE against IMV or in-hospital death was 90% (95% CI = 88%-91%) overall, including 88% (95% CI = 86%-90%) for 2 doses and 94% (95% CI = 91%-96%) for 3 doses, and 94% (95% CI = 88%-97%) for 3 doses during the Omicron-predominant period. COVID-19 mRNA vaccines are highly effective in preventing COVID-19-associated death and respiratory failure treated with IMV. CDC recommends that all persons eligible for vaccination get vaccinated and stay up to date with COVID-19 vaccination (4).
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“These findings support the durability of vaccine protection against COVID-19 hospitalization and death for at least several months after receiving the second dose,13,14,23”
From Duration of mRNA vaccine protection against SARS-CoV-2 Omicron BA.1 and BA.2 subvariants in Qatar (2022) · cites this paper as [23]
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Feikin, D. R., Higdon, M. M., Abu-Raddad, L. J., Andrews, N., Araos, R., Goldberg, Y., Groome, M. J., Huppert, A., O'Brien, K. L., Smith, P. G., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)00152-0 · Cited by 1,237
Self-citationAssociation Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity
Tenforde, M. W., Self, W. H., Adams, K., Gaglani, M., Ginde, A. A., McNeal, T., Ghamande, S., Douin, D. J., Talbot, H. K., Casey, J. D., et al. (2021) · JAMA · doi:10.1001/jama.2021.19499 · Cited by 633
Self-citationEffectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings
Thompson, M. G., Stenehjem, E. A., Grannis, S. J., Ball, S. W., Naleway, A. L., Ong, T. C., DeSilva, M. B., Natarajan, K., Bozio, C. H., Lewis, N., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2110362 · Cited by 467
Self-citationVaccines elicit highly conserved cellular immunity to SARS-CoV-2 Omicron
Liu, J., Chandrashekar, A., Sellers, D., Barrett, J., Jacob-Dolan, C., Lifton, M. A., McMahan, K., Sciacca, M., VanWyk, H., Wu, C., et al. (2022) · Nature · doi:10.1038/s41586-022-04465-y · Cited by 449
Ferdinands, J. M., Rao, S., Dixon, B. E., Mitchell, P. K., DeSilva, M. B., Irving, S. A., Lewis, N., Natarajan, K., Stenehjem, E., Grannis, S. J., et al. (2022) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7107e2 · Cited by 435
Self-citationBritton, A., Fleming-Dutra, K. E., Shang, N., Smith, Z., Dorji, T., Derado, G., Accorsi, E. K., Ajani, U. A., Miller, J., Schrag, S. J., et al. (2022) · JAMA · doi:10.1001/jama.2022.2068 · Cited by 84
Immune-mediated attenuation of influenza illness after infection: opportunities and challenges
Patel, M. M., York, I. A., Monto, A. S., Thompson, M. G., & Fry, A. M. (2021) · The Lancet Microbe · doi:10.1016/s2666-5247(21)00180-4 · Cited by 57
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McMenamin, M. E., Nealon, J., Lin, Y., Wong, J. Y., Cheung, J. K., Lau, E. H. Y., Wu, P., Leung, G. M., & Cowling, B. J. (2022) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(22)00345-0 · Cited by 360
Duration of mRNA vaccine protection against SARS-CoV-2 Omicron BA.1 and BA.2 subvariants in Qatar
Chemaitelly, H., Ayoub, H. H., AlMukdad, S., Coyle, P., Tang, P., Yassine, H. M., Al-Khatib, H. A., Smatti, M. K., Hasan, M. R., Al-Kanaani, Z., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-30895-3 · Cited by 228
Adjei, S., Hong, K., Molinari, N., Bull–Otterson, L., Ajani, U. A., Gundlapalli, A. V., Harris, A. M., Hsu, J., Kadri, S. S., Starnes, J., et al. (2022) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7137a4 · Cited by 191
Kriss, J. L., Hung, M.-C., Srivastav, A., Black, C. L., Lindley, M. C., Lee, J. T., Koppaka, R., Tsai, Y., Lu, P.-J., Yankey, D., et al. (2022) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7123a2 · Cited by 181
Wang, Y., Kumari, M., Chen, G., Hong, M.-H., Yuan, J. P., Tsai, J.-L., & Wu, H. (2023) · Journal of Biomedical Science · doi:10.1186/s12929-023-00977-5 · Cited by 198
Metadata
- Authors
- Tenforde, M. W., Self, W. H., Gaglani, M., Ginde, A. A., Douin, D. J., Talbot, H. K., Casey, J. D., Mohr, N. M., Zepeski, A., McNeal, T., Ghamande, S., Gibbs, K. W., Files, D. C., Hager, D. N., Shehu, A., Prekker, M. E., Frosch, A. E., Gong, M. N., Mohamed, A., Johnson, N. J., Srinivasan, V., Steingrub, J. S., Peltan, I. D., Brown, S. M., Martin, E. T., Monto, A. S., Khan, A., Hough, C. L., Busse, L. W., Duggal, A., Wilson, J. G., Qadir, N., Chang, S. Y., Mallow, C., Rivas, C., Babcock, H. M., Kwon, J. H., Exline, M. C., Botros, M., Lauring, A. S., Shapiro, N. I., Halasa, N., Chappell, J. D., Grijalva, C. G., Rice, T. W., Jones, I. D., Stubblefield, W. B., Baughman, A., Womack, K. N., Rhoads, J. P., Lindsell, C. J., Hart, K. W., Zhu, Y., Adams, K., Surie, D., McMorrow, M. L., Patel, M. M., & IVY Network
- Affiliations
- University of Iowa (US)
- University of Colorado Anschutz (US)
- Corresponding author
- Tenforde, Mark W.
- ORCID
- Tenforde, Mark W.
- Self, Wesley H.
- Gaglani, Manjusha
- Ginde, Adit A.
- Douin, David J.
- Talbot, H. Keipp
- Casey, Jonathan D.
- Mohr, Nicholas M.
- Zepeski, Anne
- McNeal, Tresa
- Ghamande, Shekhar
- Gibbs, Kevin W.
- Files, D. Clark
- Hager, David N.
- Shehu, Arber
- Prekker, Matthew E.
- Frosch, Anne E.
- Gong, Michelle N.
- Mohamed, Amira
- Johnson, Nicholas J.
- Srinivasan, Vasisht
- Steingrub, Jay S.
- Peltan, Ithan D.
- Brown, Samuel M.
- Martin, Emily T.
- Monto, Arnold S.
- Khan, Akram
- Hough, Catherine L.
- Busse, Laurence W.
- Duggal, Abhijit
- Wilson, Jennifer G.
- Qadir, Nida
- Chang, Steven Y.
- Mallow, Christopher
- Rivas, Carolina
- Babcock, Hilary M.
- Kwon, Jennie H.
- Exline, Matthew C.
- Botros, Mena
- Lauring, Adam S.
- Shapiro, Nathan I.
- Halasa, Natasha
- Chappell, James D.
- Grijalva, Carlos G.
- Rice, Todd W.
- Stubblefield, William B.
- Womack, Kelsey N.
- Rhoads, Jillian P.
- Lindsell, Christopher J.
- Hart, Kimberly W.
- Zhu, Yuwei
- Adams, Katherine
- Surie, Diya
- McMorrow, Meredith L.
- Patel, Manish M.
- Venue
- MMWR. Morbidity and Mortality Weekly Report
- Published
- 2022-03-25
- Volume
- 71
- Issue
- 12
- Pages
- 459-465
- ISSN
- 0149-2195 (ISSN-L)
- 1545-861X
- PMC
- PMC8956334
- OpenAlex
- W4220929994
- Cited by
- 170
- References
- 7
- Citations by year
- 2026: 5 · 2025: 19 · 2024: 36 · 2023: 61 · 2022: 49
- FWCI
- 20.17
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- MMWR Morbidity and Mortality Weekly Report (publishedVersion)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- U.S. Department of Defense
- Eli Lilly and Company
- Pfizer
- Sanofi
- Vanderbilt University
- University of Miami
- Ohio State University
- Medpace
- United Therapeutics Corporation
- Wake Forest University
- University of Washington
- Intermountain Research and Medical Foundation
- Cumberland Pharmaceuticals
- Regeneron Pharmaceuticals
- Vanderbilt University Medical Center
- Marcus Foundation
- National Institutes of Health
- Agency for Healthcare Research and Quality
- University of California, Los Angeles
- National Heart, Lung, and Blood Institute (K23HL153584)
- National Institute of General Medical Sciences (K23GM129661, T32GM135169)
- National Institute of Allergy and Infectious Diseases (K08AI141761)
- National Center for Advancing Translational Sciences
- Janssen Pharmaceuticals
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Keywords
- COVID-19 mRNA vaccine, vaccine effectiveness, invasive mechanical ventilation, in-hospital mortality, BNT162b2, mRNA-1273, hospitalized COVID-19 patients, SARS-CoV-2 variants, Omicron variant, Delta variant, Alpha variant, immunocompromised patients, prior vaccination, SARS-CoV-2 infection prevention, severe COVID-19 outcomes
- MeSH terms
- COVID-19, Vaccine Efficacy, BNT162 Vaccine, 2019-nCoV Vaccine mRNA-1273, Humans, Respiration, Artificial, United States, Hospital Mortality
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