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Clinical Severity and mRNA Vaccine Effectiveness for Omicron, Delta, and Alpha SARS-CoV-2 Variants in the United States: A Prospective Observational Study.

Authors :
Lauring AS
Tenforde MW
Chappell JD
Gaglani M
Ginde AA
McNeal T
Ghamande S
Douin DJ
Talbot HK
Casey JD
Mohr NM
Zepeski A
Shapiro NI
Gibbs KW
Files DC
Hager DN
Shehu A
Prekker ME
Erickson HL
Exline MC
Gong MN
Mohamed A
Johnson NJ
Srinivasan V
Steingrub JS
Peltan ID
Brown SM
Martin ET
Monto AS
Khan A
Hough CL
Busse LW
Ten Lohuis CC
Duggal A
Wilson JG
Gordon AJ
Qadir N
Chang SY
Mallow C
Rivas C
Babcock HM
Kwon JH
Halasa N
Grijalva CG
Rice TW
Stubblefield WB
Baughman A
Womack KN
Rhoads JP
Lindsell CJ
Hart KW
Zhu Y
Adams K
Schrag SJ
Olson SM
Kobayashi M
Verani JR
Patel MM
Self WH
Source :
MedRxiv : the preprint server for health sciences [medRxiv] 2022 Feb 07. Date of Electronic Publication: 2022 Feb 07.
Publication Year :
2022

Abstract

Objectives: To characterize the clinical severity of COVID-19 caused by Omicron, Delta, and Alpha SARS-CoV-2 variants among hospitalized adults and to compare the effectiveness of mRNA COVID-19 vaccines to prevent hospitalizations caused by each variant.<br />Design: A case-control study of 11,690 hospitalized adults.<br />Setting: Twenty-one hospitals across the United States.<br />Participants: This study included 5728 cases hospitalized with COVID-19 and 5962 controls hospitalized without COVID-19. Cases were classified into SARS-CoV-2 variant groups based on viral whole genome sequencing, and if sequencing did not reveal a lineage, by the predominant circulating variant at the time of hospital admission: Alpha (March 11 to July 3, 2021), Delta (July 4 to December 25, 2021), and Omicron (December 26, 2021 to January 14, 2022).<br />Main Outcome Measures: Vaccine effectiveness was calculated using a test-negative design for COVID-19 mRNA vaccines to prevent COVID-19 hospitalizations by each variant (Alpha, Delta, Omicron). Among hospitalized patients with COVID-19, disease severity on the WHO Clinical Progression Ordinal Scale was compared among variants using proportional odds regression.<br />Results: Vaccine effectiveness of the mRNA vaccines to prevent COVID-19-associated hospitalizations included: 85% (95% CI: 82 to 88%) for 2 vaccine doses against Alpha; 85% (95% CI: 83 to 87%) for 2 doses against Delta; 94% (95% CI: 92 to 95%) for 3 doses against Delta; 65% (95% CI: 51 to 75%) for 2 doses against Omicron; and 86% (95% CI: 77 to 91%) for 3 doses against Omicron. Among hospitalized unvaccinated COVID-19 patients, severity on the WHO Clinical Progression Scale was higher for Delta than Alpha (adjusted proportional odds ratio [aPOR] 1.28, 95% CI: 1.11 to 1.46), and lower for Omicron than Delta (aPOR 0.61, 95% CI: 0.49 to 0.77). Compared to unvaccinated cases, severity was lower for vaccinated cases for each variant, including Alpha (aPOR 0.33, 95% CI: 0.23 to 0.49), Delta (aPOR 0.44, 95% CI: 0.37 to 0.51), and Omicron (aPOR 0.61, 95% CI: 0.44 to 0.85).<br />Conclusions: mRNA vaccines were highly effective in preventing COVID-19-associated hospitalizations from Alpha, Delta, and Omicron variants, but three vaccine doses were required to achieve protection against Omicron similar to the protection that two doses provided against Delta and Alpha. Among adults hospitalized with COVID-19, Omicron caused less severe disease than Delta, but still resulted in substantial morbidity and mortality. Vaccinated patients hospitalized with COVID-19 had significantly lower disease severity than unvaccinated patients for all the variants.

Details

Language :
English
Database :
MEDLINE
Journal :
MedRxiv : the preprint server for health sciences
Accession number :
35169811
Full Text :
https://doi.org/10.1101/2022.02.06.22270558