Browsing by Author "Levy, Matthew E."

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    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
    (Center for Disease Control, 2022-07-22) Link-Gelles, Ruth; Levy, Matthew E.; Gaglani, Manjusha; Irving, Stephanie A.; Stockwell, Melissa; Dascomb, Kristin; DeSilva, Malini B.; Reese, Sarah E.; Liao, I-Chia; Ong, Toan C.; Grannis, Shaun J.; McEvoy, Charlene; Patel, Palak; Klein, Nicola P.; Hartmann, Emily; Stenehjem, Edward; Natarajan, Karthik; Naleway, Allison L.; Murthy, Kempapura; Rao, Suchitra; Dixon, Brian E.; Kharbanda, Anupam B.; Akinseye, Akintunde; Dickerson, Monica; Lewis, Ned; Grisel, Nancy; Han, Jungmi; Barron, Michelle A.; Fadel, William F.; Dunne, Margaret M.; Goddard, Kristin; Arndorfer, Julie; Konatham, Deepika; Valvi, Nimish R.; Currey, J. C.; Fireman, Bruce; Raiyani, Chandni; Zerbo, Ousseny; Sloan-Aagard, Chantel; Ball, Sarah W.; Thompson, Mark G.; Tenforde, Mark W.; Epidemiology, Richard M. Fairbanks School of Public Health
    The Omicron variant (B.1.1.529) of SARS-CoV-2, the virus that causes COVID-19, was first identified in the United States in November 2021, with the BA.1 sublineage (including BA.1.1) causing the largest surge in COVID-19 cases to date. Omicron sublineages BA.2 and BA.2.12.1 emerged later and by late April 2022, accounted for most cases.* Estimates of COVID-19 vaccine effectiveness (VE) can be reduced by newly emerging variants or sublineages that evade vaccine-induced immunity (1), protection from previous SARS-CoV-2 infection in unvaccinated persons (2), or increasing time since vaccination (3). Real-world data comparing VE during the periods when the BA.1 and BA.2/BA.2.12.1 predominated (BA.1 period and BA.2/BA.2.12.1 period, respectively) are limited. The VISION network† examined 214,487 emergency department/urgent care (ED/UC) visits and 58,782 hospitalizations with a COVID-19-like illness§ diagnosis among 10 states during December 18, 2021-June 10, 2022, to evaluate VE of 2, 3, and 4 doses of mRNA COVID-19 vaccines (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) compared with no vaccination among adults without immunocompromising conditions. VE against COVID-19-associated hospitalization 7-119 days and ≥120 days after receipt of dose 3 was 92% (95% CI = 91%-93%) and 85% (95% CI = 81%-89%), 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.
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    Effectiveness of 2-Dose Vaccination with mRNA COVID-19 Vaccines Against COVID-19–Associated Hospitalizations Among Immunocompromised Adults — Nine States, January–September 2021
    (CDC, 2021-11) Embi, Peter J.; Levy, Matthew E.; Naleway, Allison L.; Patel, Palak; Gaglani, Manjusha; Natarajan, Karthik; Dascomb, Kristin; Ong, Toan C.; Klein, Nicola P.; Liao, I-Chia; Grannis, Shaun J.; Han, Jungmi; Stenehjem, Edward; Dunne, Margaret M.; Lewis, Ned; Irving, Stephanie A.; Rao, Suchitra; McEvoy, Charlene; Bozio, Catherine H.; Murthy, Kempapura; Dixon, Brian E.; Grisel, Nancy; Yang, Duck-Hye; Goddard, Kristin; Kharbanda, Anupam B.; Reynolds, Sue; Raiyani, Chandni; Fadel, William F.; Arndorfer, Julie; Rowley, Elizabeth A.; Fireman, Bruce; Ferdinands, Jill; Valvi, Nimish R.; Ball, Sarah W.; Zerbo, Ousseny; Griggs, Eric P.; Mitchell, Patrick K.; Porter, Rachael M.; Kiduko, Salome A.; Blanton, Lenee; Zhuang, Yan; Steffens, Andrea; Reese, Sarah E.; Olson, Natalie; Williams, Jeremiah; Dickerson, Monica; McMorrow, Meredith; Schrag, Stephanie J.; Verani, Jennifer R.; Fry, Alicia M.; Azziz-Baumgartner, Eduardo; Barron, Michelle A.; Thompson, Mark G.; DeSilva, Malini B.; Medicine, School of Medicine
    What is already known about this topic? Studies suggest that immunocompromised persons who receive COVID-19 vaccination might not develop high neutralizing antibody titers or be as protected against severe COVID-19 outcomes as are immunocompetent persons. What is added by this report? Effectiveness of mRNA vaccination against laboratory-confirmed COVID-19–associated hospitalization was lower (77%) among immunocompromised adults than among immunocompetent adults (90%). Vaccine effectiveness varied considerably among immunocompromised patient subgroups. What are the implications for public health practice? Immunocompromised persons benefit from COVID-19 mRNA vaccination but are less protected from severe COVID-19 outcomes than are immunocompetent persons. Immunocompromised persons receiving mRNA COVID-19 vaccines should receive 3 doses and a booster, consistent with CDC recommendations, practice nonpharmaceutical interventions, and, if infected, be monitored closely and considered early for proven therapies that can prevent severe outcomes.
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    Effectiveness of a Third Dose of mRNA Vaccines Against COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance — VISION Network, 10 States, August 2021–January 2022
    (U.S. Department of Health & Human Services, 2022-01-28) Thompson, Mark G.; Natarajan, Karthik; Irving, Stephanie A.; Rowley, Elizabeth A.; Griggs, Eric P.; Gaglani, Manjusha; Klein, Nicola P.; Grannis, Shaun J.; DeSilva, Malini B.; Stenehjem, Edward; Reese, Sarah E.; Dickerson, Monica; Naleway, Allison L.; Han, Jungmi; Konatham, Deepika; McEvoy, Charlene; Rao, Suchitra; Dixon, Brian E.; Dascomb, Kristin; Lewis, Ned; Levy, Matthew E.; Patel, Palak; Liao, I-Chia; Kharbanda, Anupam B.; Barron, Michelle A.; Fadel, William F.; Grisel, Nancy; Goddard, Kristin; Yang, Duck-Hye; Wondimu, Mehiret H.; Murthy, Kempapura; Valvi, Nimish R.; Arndorfer, Julie; Fireman, Bruce; Dunne, Margaret M.; Embi, Peter; Azziz-Baumgartner, Eduardo; Zerbo, Ousseny; Bozio, Catherine H.; Reynolds, Sue; Ferdinands, Jill; Williams, Jeremiah; Link-Gelles, Ruth; Schrag, Stephanie J.; Verani, Jennifer R.; Ball, Sarah; Ong, Toan C.; Family Medicine, School of Medicine
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    Effectiveness of COVID-19 mRNA Vaccines Against COVID-19–Associated Hospitalizations Among Immunocompromised Adults During SARS-CoV-2 Omicron Predominance — VISION Network, 10 States, December 2021—August 2022
    (U.S. Department of Health & Human Services, 2022-10-21) Britton, Amadea; Embi, Peter J.; Levy, Matthew E.; Gaglani, Manjusha; DeSilva, Malini B.; Dixon, Brian E.; Dascomb, Kristin; Patel, Palak; Schrader, Kristin E.; Klein, Nicola P.; Ong, Toan C.; Natarajan, Karthik; Hartmann, Emily; Kharbanda, Anupam B.; Irving, Stephanie A.; Dickerson, Monica; Dunne, Margaret M.; Raiyani, Chandni; Grannis, Shaun J.; Stenehjem, Edward; Zerbo, Ousseny; Rao, Suchitra; Han, Jungmi; Sloan-Aagard, Chantel; Griggs, Eric P.; Weber, Zachary A.; Murthy, Kempapura; Fadel, William F.; Grisel, Nancy; McEvoy, Charlene; Lewis, Ned; Barron, Michelle A.; Nanez, Juan; Reese, Sarah E.; Mamawala, Mufaddal; Valvi, Nimish R.; Arndorfer, Julie; Goddard, Kristin; Yang, Duck-Hye; Fireman, Bruce; Ball, Sarah W.; Link-Gelles, Ruth; Naleway, Allison L.; Tenforde, Mark W.; Biomedical Engineering and Informatics, Luddy School of Informatics, Computing, and Engineering
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    Effectiveness of COVID-19 vaccines at preventing emergency department or urgent care encounters and hospitalizations among immunocompromised adults: An observational study of real-world data across 10 US states from August-December 2021
    (Elsevier, 2023) Embi, Peter J.; Levy, Matthew E.; Patel, Palak; DeSilva, Malini B.; Gaglani, Manjusha; Dascomb, Kristin; Dunne, Margaret M.; Klein, Nicola P.; Ong, Toan C.; Grannis, Shaun J.; Natarajan, Karthik; Yang, Duck-Hye; Stenehjem, Edward; Zerbo, Ousseny; McEvoy, Charlene; Rao, Suchitra; Thompson, Mark G.; Konatham, Deepika; Irving, Stephanie A.; Dixon, Brian E.; Han, Jungmi; Schrader, Kristin E.; Grisel, Nancy; Lewis, Ned; Kharbanda, Anupam B.; Barron, Michelle A.; Reynolds, Sue; Liao, I-Chia; Fadel, William F.; Rowley, Elizabeth A.; Arndorfer, Julie; Goddard, Kristin; Murthy, Kempapura; Valvi, Nimish R.; Weber, Zachary A.; Fireman, Bruce; Reese, Sarah E.; Ball, Sarah W.; Naleway, Allison L.; Medicine, School of Medicine
    Background: Immunocompromised (IC) persons are at increased risk for severe COVID-19 outcomes and are less protected by 1-2 COVID-19 vaccine doses than are immunocompetent (non-IC) persons. We compared vaccine effectiveness (VE) against medically attended COVID-19 of 2-3 mRNA and 1-2 viral-vector vaccine doses between IC and non-IC adults. Methods: Using a test-negative design among eight VISION Network sites, VE against laboratory-confirmed COVID-19-associated emergency department (ED) or urgent care (UC) events and hospitalizations from 26 August-25 December 2021 was estimated separately among IC and non-IC adults and among specific IC condition subgroups. Vaccination status was defined using number and timing of doses. VE for each status (versus unvaccinated) was adjusted for age, geography, time, prior positive test result, and local SARS-CoV-2 circulation. Results: We analyzed 8,848 ED/UC events and 18,843 hospitalizations among IC patients and 200,071 ED/UC events and 70,882 hospitalizations among non-IC patients. Among IC patients, 3-dose mRNA VE against ED/UC (73% [95% CI: 64-80]) and hospitalization (81% [95% CI: 76-86]) was lower than that among non-IC patients (ED/UC: 94% [95% CI: 93-94]; hospitalization: 96% [95% CI: 95-97]). Similar patterns were observed for viral-vector vaccines. Transplant recipients had lower VE than other IC subgroups. Conclusions: During B.1.617.2 (Delta) variant predominance, IC adults received moderate protection against COVID-19-associated medical events from three mRNA doses, or one viral-vector dose plus a second dose of any product. However, protection was lower in IC versus non-IC patients, especially among transplant recipients, underscoring the need for additional protection among IC adults.
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    Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings
    (Massachusetts Medical Society, 2021-10-07) Thompson, Mark G.; Stenehjem, Edward; Grannis, Shaun; Ball, Sarah W.; Naleway, Allison L.; Ong, Toan C.; DeSilva, Malini B.; Natarajan, Karthik; Bozio, Catherine H.; Lewis, Ned; Dascomb, Kristin; Dixon, Brian E.; Birch, Rebecca J.; Irving, Stephanie A.; Rao, Suchitra; Kharbanda, Elyse; Han, Jungmi; Reynolds, Sue; Goddard, Kristin; Grisel, Nancy; Fadel, William F.; Levy, Matthew E.; Ferdinands, Jill; Fireman, Bruce; Arndorfer, Julie; Valvi, Nimish R.; Rowley, Elizabeth A.; Patel, Palak; Zerbo, Ousseny; Griggs, Eric P.; Porter, Rachael M.; Demarco, Maria; Blanton, Lenee; Steffens, Andrea; Zhuang, Yan; Olson, Natalie; Barron, Michelle; Shifflett, Patricia; Schrag, Stephanie J.; Verani, Jennifer R.; Fry, Alicia; Gaglani, Manjusha; Azziz-Baumgartner, Eduardo; Klein, Nicola P.; Family Medicine, School of Medicine
    BACKGROUND There are limited data on the effectiveness of the vaccines against symptomatic coronavirus disease 2019 (Covid-19) currently authorized in the United States with respect to hospitalization, admission to an intensive care unit (ICU), or ambulatory care in an emergency department or urgent care clinic. METHODS We conducted a study involving adults (≥50 years of age) with Covid-19–like illness who underwent molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed 41,552 admissions to 187 hospitals and 21,522 visits to 221 emergency departments or urgent care clinics during the period from January 1 through June 22, 2021, in multiple states. The patients’ vaccination status was documented in electronic health records and immunization registries. We used a test-negative design to estimate vaccine effectiveness by comparing the odds of a positive test for SARS-CoV-2 infection among vaccinated patients with those among unvaccinated patients. Vaccine effectiveness was adjusted with weights based on propensity-for-vaccination scores and according to age, geographic region, calendar time (days from January 1, 2021, to the index date for each medical visit), and local virus circulation. RESULTS The effectiveness of full messenger RNA (mRNA) vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization, 90% (95% CI, 86 to 93) against infection leading to an ICU admission, and 91% (95% CI, 89 to 93) against infection leading to an emergency department or urgent care clinic visit. The effectiveness of full vaccination with respect to a Covid-19–associated hospitalization or emergency department or urgent care clinic visit was similar with the BNT162b2 and mRNA-1273 vaccines and ranged from 81% to 95% among adults 85 years of age or older, persons with chronic medical conditions, and Black or Hispanic adults. The effectiveness of the Ad26.COV2.S vaccine was 68% (95% CI, 50 to 79) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization and 73% (95% CI, 59 to 82) against infection leading to an emergency department or urgent care clinic visit. CONCLUSIONS Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARS-CoV-2 infection. Methods: We conducted a study involving adults (≥50 years of age) with Covid-19-like illness who underwent molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed 41,552 admissions to 187 hospitals and 21,522 visits to 221 emergency departments or urgent care clinics during the period from January 1 through June 22, 2021, in multiple states. The patients' vaccination status was documented in electronic health records and immunization registries. We used a test-negative design to estimate vaccine effectiveness by comparing the odds of a positive test for SARS-CoV-2 infection among vaccinated patients with those among unvaccinated patients. Vaccine effectiveness was adjusted with weights based on propensity-for-vaccination scores and according to age, geographic region, calendar time (days from January 1, 2021, to the index date for each medical visit), and local virus circulation. Results: The effectiveness of full messenger RNA (mRNA) vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization, 90% (95% CI, 86 to 93) against infection leading to an ICU admission, and 91% (95% CI, 89 to 93) against infection leading to an emergency department or urgent care clinic visit. The effectiveness of full vaccination with respect to a Covid-19-associated hospitalization or emergency department or urgent care clinic visit was similar with the BNT162b2 and mRNA-1273 vaccines and ranged from 81% to 95% among adults 85 years of age or older, persons with chronic medical conditions, and Black or Hispanic adults. The effectiveness of the Ad26.COV2.S vaccine was 68% (95% CI, 50 to 79) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization and 73% (95% CI, 59 to 82) against infection leading to an emergency department or urgent care clinic visit. Conclusions: Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARS-CoV-2 infection. (Funded by the Centers for Disease Control and Prevention.).
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    Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19–Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January–September 2021
    (CDC, 2021-11) Bozio, Catherine H.; Grannis, Shaun J.; Naleway, Allison L.; Ong, Toan C.; Butterfield, Kristen A.; DeSilva, Malini B.; Natarajan, Karthik; Yang, Duck-Hye; Rao, Suchitra; Klein, Nicola P.; Irving, Stephanie A.; Dixon, Brian E.; Dascomb, Kristin; Liao, I.-Chia; Reynolds, Sue; McEvoy, Charlene; Han, Jungmi; Reese, Sarah E.; Lewis, Ned; Fadel, William F.; Grisel, Nancy; Murthy, Kempapura; Ferdinands, Jill; Kharbanda, Anupam B.; Mitchell, Patrick K.; Goddard, Kristin; Embi, Peter J.; Arndorfer, Julie; Raiyani, Chandni; Patel, Palak; Rowley, Elizabeth A.; Fireman, Bruce; Valvi, Nimish R.; Griggs, Eric P.; Levy, Matthew E.; Zerbo, Ousseny; Porter, Rachael M.; Birch, Rebecca J.; Blanton, Lenee; Ball, Sarah W.; Steffens, Andrea; Olson, Natalie; Williams, Jeremiah; Dickerson, Monica; McMorrow, Meredith; Schrag, Stephanie J.; Verani, Jennifer R.; Fry, Alicia M.; Azziz-Baumgartner, Eduardo; Barron, Michelle; Gaglani, Manjusha; Thompson, Mark G.; Stenehjem, Edward; Family Medicine, School of Medicine
    What is already known about this topic? Previous infection with SARS-CoV-2 or COVID-19 vaccination can provide immunity and protection against subsequent SARS-CoV-2 infection and illness. What is added by this report? Among COVID-19–like illness hospitalizations among adults aged ≥18 years whose previous infection or vaccination occurred 90–179 days earlier, the adjusted odds of laboratory-confirmed COVID-19 among unvaccinated adults with previous SARS-CoV-2 infection were 5.49-fold higher than the odds among fully vaccinated recipients of an mRNA COVID-19 vaccine who had no previous documented infection (95% confidence interval = 2.75–10.99). What are the implications for public health practice? All eligible persons should be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2.