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Vaccination and COVID-19 severity

 mRNA Vaccination and COVID hospitalization and disease severity

    Messenger RNA (mRNA) COVID-19 vaccines, such as those developed by the companies Moderna and Pfizer-BioNTech, are highly effective for preventing SARS-CoV-2 infections and COVID-19 hospitalizations. However, there have been reports of breakthrough COVID-19 cases, or COVID-19 infections among those who are fully vaccinated. Once hospitalized, patients with COVID-19 can progress to more severe infection, including respiratory failure and death. SARS-CoV-2 infection in vaccinated persons is expected to trigger memory antibody and cellular responses owing to prior vaccination; these immune responses could mitigate disease progression, possibly preventing life-threatening organ failure and death. However, the association between prior vaccination and disease progression to the most severe forms of COVID-19 is not well understood. A recent study published in The Journal of the American Medical Association, investigates the relationship between vaccination and COVID-19 disease severity.

About the study

    To estimate the benefits of mRNA vaccination against severe COVID-19, the study examined the association between prior vaccination and hospitalization for COVID-19, as well as the association between prior vaccination and progression to death or invasive mechanical ventilation among patients hospitalized for COVID-19. A total of 4513 patients hospitalized in the United States between March 11 and August 15, 2021 were included. Among the participants, 1,983 cases were COVID-19 cases and 2,530 acted as controls. (Of the 2,530 cases, 1359 were test-negative controls and 1171 were syndrome-negative controls). Data on 28-day outcomes after hospitalization were analyzed. For patients hospitalized with COVID-19, the association between COVID-19 disease progression and prior vaccination with an mRNA vaccine was assessed.

Study Results

Overall, unvaccinated patients accounted for 84.2% (1669/1983) of COVID-19 hospitalizations. Hospitalization for COVID-19 was significantly associated with decreased likelihood of vaccination, including for SARS-CoV-2 Alpha, Delta and other variants. More specifically,
  1. This association was stronger for immunocompetent patients than immunocompromised patients.
  2. When the Moderna and Pfizer vaccines were compared, estimated vaccine effectiveness was similar within 120 days of vaccination. However, beyond 120 days, the Moderna vaccine had an estimated effectiveness of 85% and the Pfizer vaccine and an estimated effectiveness of 64% against COVID-19 hospitalization.
  3. COVID-19 mRNA vaccines may attenuate disease severity among patients who develop COVID-19 despite vaccination. Compared with unvaccinated cases (1055), vaccine breakthrough cases (142) less commonly received ICU-level care (24.6% vs 40.1%) and invasive mechanical ventilation (7.7% vs 23.0%)
  4. Among patients hospitalized with COVID-19, death or invasive mechanical ventilation by day 28 was associated with decreased likelihood of vaccination.

In summary, vaccination with an mRNA COVID-19 vaccine corresponds to a significantly decreased risk of hospitalization and disease progression to death or mechanical ventilation. These findings are consistent with risk reduction among vaccine breakthrough infections compared with absence of vaccination.

Impact and Significance

Data from this study confirms that COVID vaccination not only prevents SARS-CoV-2 infections and hospitalizations, but also reduces the risk of severe COVID-19, including death. The association between mRNA vaccination and reduced risk of COVID-19 hospitalization was substantially weaker in the immunocompromised population than the immunocompetent one, supporting recent recommendations for additional vaccine doses among immunocompromised persons. In addition, vaccine breakthrough COVID-19 hospitalization appeared to be more common with the Pfizer vaccine than the Moderna vaccine in this analysis. The association between vaccination with Pfizer and reduced risk of COVID-19 hospitalization declined 4 months after vaccination,  indicating waning protection over time. Booster shots are a good way to combat this problem, especially for individuals who received a Pfizer vaccine over 4 months ago. The recent surges of COVID-19 case are a sign that pandemic is not over yet- vaccination still continues to be one of the most important tools to stop the pandemic.

Sources

1. Tenforde, Mark W., et al. “Association between Mrna Vaccination and COVID-19 Hospitalization and Disease Severity.” JAMA, 4 Nov. 2021, https://doi.org/10.1001/jama.2021.19499.

Comments

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