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Cited by 126SARS-CoV-2 and COVID-19 ResearchCOVID-19 epidemiological studiesVaccine Coverage and Hesitancy

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

Open access
Link-Gelles, Ruth, Levy, Matthew E., Gaglani, Manjusha, Irving, Stephanie A., Stockwell, Melissa, Dascomb, Kristin, DeSilva, Malini B., Reese, Sarah E. +34 more·2022·MMWR. Morbidity and Mortality Weekly Report
DOI 10.15585/mmwr.mm7129e1PMC PMC9310634
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Abstract

§ Medical events with a discharge code consistent with COVID-19-like illness were included.COVID-19-like illness diagnoses included acute respiratory illness (e.g., respiratory failure or pneumonia) or related signs or symptoms (e.g., cough, fever, dyspnea, vomiting, or diarrhea) using diagnosis codes from the International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision.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.¶ A 2-dose primary COVID-19 mRNA vaccination series followed by a third (booster) dose at least 5 months after dose 2 is recommended for adults aged ≥18 years without immunocompromising conditions.On March 29, 2022, an additional booster dose (dose 4) was authorized for immunocompetent adults aged ≥50 years at least 4 months after dose 3 (4).The VISION Network evaluated the effectiveness of 2, 3, or 4 mRNA vaccine doses during December 2021-June 2022, a period during which different sublineages of Omicron circulated in the United States.VISION methods have been described previously (5); briefly, eligible medical encounters include ED/UC visits and hospitalizations among adults with COVID-19-like illness and a SARS-CoV-2 molecular test during the 14 days before through 72 hours after the encounter.Variant predominance was defined as the period when a variant accounted for ≥75% of ¶ https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim- considerations-us.html

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  • Of three studies assessing VE against infection/symptomatic disease during both BA.2 and BA.4/BA.5 periods, all showed similar VE estimates or estimates with overlapping 95 % confidence intervals against both subvariants.

    “Of three studies assessing VE against infection/symptomatic disease during both BA.2 and BA.4/BA.5 periods, all showed similar VE estimates or estimates with overlapping 95 % confidence intervals against both subvariants [25,26,31-33].”

    From Assessing COVID-19 vaccine effectiveness against Omicron subvariants: Report from a meeting of the World Health Organization (2023) · cites this paper as [26]

    The paper examines vaccine effectiveness during BA.1 and BA.2/BA.2.12.1 periods against COVID-19–associated ED/UC visits and hospitalizations, not infection or symptomatic disease across BA.2 and BA.4/BA.5 periods (opening section). The Discussion says effectiveness against BA.4 and BA.5 should be monitored as those sublineages emerged; it does not report the comparison attributed to it. (LLM, conf=0.90)

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  • Of two studies reporting primary series VE against hospitalization/severe disease against BA.1, BA.2, and BA.4/5, one reported lower VE against BA.2 and BA.4/5 than BA.1, while the other showed no statistically significant differences.

    “Of two studies reporting primary series VE against hospitalization/severe disease against BA.1, BA.2, and BA.4/5, one reported lower VE against BA.2 and BA.4/5 than BA.1, while the other showed no statistically significant differences [25,26,31,32].”

    From Assessing COVID-19 vaccine effectiveness against Omicron subvariants: Report from a meeting of the World Health Organization (2023) · cites this paper as [26]

    The Results (page not specified) report lower primary-series VE against hospitalization during the BA.2/BA.2.12.1 period than during the BA.1 period. The paper does not estimate VE against BA.4/BA.5, and its Discussion says it did not assess the most severe COVID-19–associated disease; it therefore cannot support the full comparison in the citing sentence. (LLM, conf=0.88)

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  • For several studies that evaluated median time since last dose, time since last dose was longer for BA.4/5 compared to BA.1.

    “For several studies that evaluated the median time since last dose, indeed the time since last dose was longer for BA.4/5 compared to BA.1 [25,26,30].”

    From Assessing COVID-19 vaccine effectiveness against Omicron subvariants: Report from a meeting of the World Health Organization (2023) · cites this paper as [26]

    The Discussion reports that median time since vaccination was longer during BA.2/BA.2.12.1 than BA.1, including 371 versus 289 days for hospitalized adults at least 150 days after dose two. It does not report the claimed BA.4/5 comparison; the Discussion mentions BA.4 and BA.5 only as emerging sublineages for which effectiveness should be monitored. (LLM, conf=0.86)

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  • In the US VISION network, for hospitalization, lower vaccine effectiveness and faster waning of vaccine effectiveness were observed for BA.2 and BA.4/5 compared to BA.1, although with wider confidence intervals than for emergency department or urgent care visits.

    “For hospitalization, similar results were observed, with lower VE and faster waning of VE for BA.2 and BA.4/5 compared to BA.1, although with wider confidence intervals than for ED/UC visits.”

    From Assessing COVID-19 vaccine effectiveness against Omicron subvariants: Report from a meeting of the World Health Organization (2023) · cites this paper as [26]

    The hospitalization results report lower vaccine effectiveness during the BA.2/BA.2.12.1 period than during the BA.1 period, with a larger decline between the reported post-dose-3 intervals. The paper does not evaluate BA.4/5, so it cannot support that part of the comparison. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In the US VISION network, differences in vaccine effectiveness by subvariant were larger when more time had elapsed since the last dose, suggestive of faster waning of vaccine effectiveness against BA.2 and BA.4/5.

    “the differences in VE by subvariant were larger when more time had elapsed since the last dose suggestive of faster waning of VE against BA.2 and BA.4/5 [25,26].”

    From Assessing COVID-19 vaccine effectiveness against Omicron subvariants: Report from a meeting of the World Health Organization (2023) · cites this paper as [26]

    The opening summary reports a larger BA.1 versus BA.2/BA.2.12.1 difference in hospitalization VE at ≥120 days after dose 3 than at 7–119 days (33 versus 23 percentage points). However, the Discussion cautions that time since vaccination differed between periods, and the paper did not assess VE against BA.4/BA.5; it calls for future monitoring of those sublineages. The claim’s suggestion of faster waning against BA.4/BA.5 is therefore not supported by this source. (LLM, conf=0.88)

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References 9 · Cited by 126

Authors
Link-Gelles, R., Levy, M. E., Gaglani, M., Irving, S. A., Stockwell, M., Dascomb, K., DeSilva, M. B., Reese, S. E., Liao, I.-C., Ong, T. C., Grannis, S. J., McEvoy, C., Patel, P., Klein, N. P., Hartmann, E., Stenehjem, E., Natarajan, K., Naleway, A. L., Murthy, K., Rao, S., Dixon, B. E., Kharbanda, A. B., Akinseye, A., Dickerson, M., Lewis, N., Grisel, N., Han, J., Barron, M. A., Fadel, W. F., Dunne, M. M., Goddard, K., Arndorfer, J., Konatham, D., Valvi, N. R., Currey, J. C., Fireman, B., Raiyani, C., Zerbo, O., Sloan-Aagard, C., Ball, S. W., Thompson, M. G., & Tenforde, M. W.
Affiliations
  • Intermountain Healthcare (US)
  • Regenstrief Institute (US)
ORCID
Venue
MMWR. Morbidity and Mortality Weekly Report
Publisher
Centers for Disease Control MMWR Office
Published
2022-07-22
Volume
71
Issue
29
Pages
931-939
ISSN
  • 0149-2195 (ISSN-L)
  • 1545-861X
DOI
10.15585/mmwr.mm7129e1
PMC
PMC9310634
OpenAlex
W4285590921
Cited by
126
References
9
Citations by year
2026: 5 · 2025: 19 · 2024: 25 · 2023: 43 · 2022: 33
FWCI
14.67
Type
journal article
Language
en
Open access
Locations
  • MMWR Morbidity and Mortality Weekly Report (publishedVersion)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion, public-domain)
Funders
Centers for Disease Control and Prevention
Topics
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
Keywords
COVID-19 mRNA vaccine, vaccine effectiveness, Omicron BA.1, booster vaccination, immunocompetent adult, COVID-19 hospitalization, emergency department visits, urgent care visits
MeSH terms
COVID-19, SARS-CoV-2, COVID-19 Vaccines, mRNA Vaccines, BNT162 Vaccine, Adult, Humans, Influenza, Human, Influenza Vaccines, United States, Vaccines, Synthetic

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