1. Hospitalized Patients With Severe Coronavirus Disease 2019 During the Omicron Wave in Israel: Benefits of a Fourth Vaccine Dose.
- Author
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Brosh-Nissimov, Tal, Hussein, Khetam, Wiener-Well, Yonit, Orenbuch-Harroch, Efrat, Elbaz, Meital, Lipman-Arens, Shelly, Maor, Yasmin, Yagel, Yael, Chazan, Bibiana, Hershman-Sarafov, Mirit, Rahav, Galia, Zimhony, Oren, Shimshovitz, Adi Zaidman, and Chowers, Michal
- Subjects
PREVENTION of epidemics ,RESEARCH ,CHRONIC kidney failure ,COVID-19 ,GENETIC mutation ,CONFIDENCE intervals ,COVID-19 vaccines ,ANTIVIRAL agents ,IMMUNOSUPPRESSION ,TREATMENT effectiveness ,ARTIFICIAL respiration ,HOSPITAL mortality ,SEX distribution ,HOSPITAL care ,DEMENTIA ,DESCRIPTIVE statistics ,LOGISTIC regression analysis ,VACCINATION status ,ODDS ratio ,DATA analysis software ,LONGITUDINAL method - Abstract
Background Waning immunity and an increased incidence of coronavirus disease 2019 (COVID-19) during the Omicron outbreak led the Israeli Ministry of Health to recommend a fourth vaccine dose for high-risk individuals. In this study, we assessed its effect for hospitalized patients with severe breakthrough COVID-19. Methods In this multicenter cohort study of hospitalized adults with severe COVID-19 in Israel, from 15 to 31 January 2022, cases were divided according to the number of vaccinations received. Poor outcome was defined as mechanical ventilation or in-hospital death and was compared between 3- and 4-dose vaccinees using logistic regression. Results Included were 1049 patients, median age 80 years. Among them, 394 were unvaccinated, 386 and 88 had received 3 or 4 doses, respectively. The 3-dose group was older, included more males, and immunosuppressed patients but with similar outcomes, 49% vs 51% compared with unvaccinated patients (P =.72). Patients who received 4 doses were similarly older and immunosuppressed but had better outcomes compared with unvaccinated patients, 34% vs 51% (P <.01). We examined independent predictors for poor outcome in patients who received either 3 or 4 doses a median of 161 days or 14 days before diagnosis, respectively. Receipt of the fourth dose was associated with protection (odds ratio, 0.51; 95% confidence interval,.3–.87), as was remdesivir. Male sex, chronic renal failure, and dementia were associated with poor outcomes. Conclusions Among hospitalized patients with severe breakthrough COVID-19, a recent fourth dose was associated with significant protection against mechanical ventilation or death compared with 3 doses. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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