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 & More Latest News

On July 15, 2022, this report was posted on-line as an MMWR Early Release.

Ruth Link-Gelles, PhD1; Matthew E. Levy, PhD2; Manjusha Gaglani, MBBS3,4; Stephanie A. Irving, MHS5; Melissa Stockwell, MD6,7,8; Kristin Dascomb, MD, PhD9; Malini B. DeSilva, MD10; Sarah E. Reese, PhD2; I-Chia Liao, MPH3; Toan C. Ong, PhD11; Shaun J. Grannis, MD12,13; Charlene McEvoy, MD10; Palak Patel, MBBS1; Nicola P. Klein, MD, PhD14; Emily Hartmann, MPP15; Edward Stenehjem, MD9; Karthik Natarajan, PhD8,16; Allison L. Naleway, PhD5; Kempapura Murthy, MBBS3; Suchitra Rao, MBBS11; Brian E. Dixon, PhD12,17; Anupam B. Kharbanda, MD18; Akintunde Akinseye, MSPH2; Monica Dickerson1; Ned Lewis, MPH14; Nancy Grisel, MPP9; Jungmi Han16; Michelle A. Barron, MD11; William F. Fadel, PhD12,17; Margaret M. Dunne, MSc2; Kristin Goddard, MPH14; Julie Arndorfer, MPH9; Deepika Konatham3; Nimish R. Valvi, DrPH, MBBS12; J. C. Currey15; Bruce Fireman, MA14; Chandni Raiyani, MPH3; Ousseny Zerbo, PhD14; Chantel Sloan-Aagard, PhD15,19; Sarah W. Ball, ScD2; Mark G. Thompson, PhD1; Mark W. Tenforde, MD, PhD1 (View writer affiliations)

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Summary

What is already identified about this matter?

Little is thought about COVID-19 vaccine effectiveness (VE) throughout the Omicron variant BA.2/BA.2.12.2–predominant interval or VE of a fourth COVID-19 vaccine dose in individuals aged ≥50 years.

What is added by this report?

VE throughout the BA.2/BA.2.12.2 interval was decrease than that throughout the BA.1 interval. A 3rd vaccine dose offered extra safety in opposition to reasonable and extreme COVID-19–related sickness in all age teams, and a fourth dose offered extra safety in eligible adults aged ≥50 years.

What are the implications for public well being follow?

Immunocompetent individuals ought to obtain advisable COVID-19 booster doses to stop reasonable to extreme COVID-19, together with a primary booster dose for all eligible individuals and second dose for adults aged ≥50 years at the very least 4 months after an preliminary booster dose. Booster doses ought to be obtained instantly when individuals turn into eligible.

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The Omicron variant (B.1.1.529) of SARS-CoV-2, the virus that causes COVID-19, was first recognized within the United States in November 2021, with the BA.1 sublineage (together with BA.1.1) inflicting the most important surge in COVID-19 circumstances to this point. Omicron sublineages BA.2 and BA.2.12.1 emerged later and by late April 2022, accounted for many circumstances.* Estimates of COVID-19 vaccine effectiveness (VE) may be diminished by newly rising variants or sublineages that evade vaccine-induced immunity (1), safety from earlier SARS-CoV-2 an infection in unvaccinated individuals (2), or rising time since vaccination (3). Real-world information evaluating VE throughout the intervals when the BA.1 and BA.2/BA.2.12.1 predominated (BA.1 interval and BA.2/BA.2.12.1 interval, respectively) are restricted. The VISION community examined 214,487 emergency division/pressing care (ED/UC) visits and 58,782 hospitalizations with a COVID-19–like sickness§ prognosis amongst 10 states throughout December 18, 2021–June 10, 2022, to judge VE of 2, 3, and 4 doses of mRNA COVID-19 vaccines (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) in contrast with no vaccination amongst adults with out immunocompromising circumstances. VE in opposition to COVID-19–related 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, throughout the BA.1 interval, in contrast with 69% (95% CI = 58%–76%) and 52% (95% CI = 44%–59%), respectively, throughout the BA.2/BA.2.12.1 interval. Patterns had been comparable for ED/UC encounters. Among adults aged ≥50 years, VE in opposition to COVID-19–related 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%) throughout BA.2/BA.2.12.1 predominance. Immunocompetent individuals ought to obtain advisable COVID-19 booster doses to stop reasonable to extreme COVID-19, together with a primary booster dose for all eligible individuals and second booster dose for adults aged ≥50 years at the very least 4 months after an preliminary booster dose. Booster doses ought to be obtained instantly when individuals turn into eligible.

A 2-dose major COVID-19 mRNA vaccination collection adopted by a 3rd (booster) dose at the very least 5 months after dose 2 is advisable for adults aged ≥18 years with out immunocompromising circumstances. On March 29, 2022, an extra booster dose (dose 4) was approved for immunocompetent adults aged ≥50 years at the very least 4 months after dose 3 (4). The VISION Network evaluated the effectiveness of 2, 3, or 4 mRNA vaccine doses throughout December 2021–June 2022, a interval throughout which totally different sublineages of Omicron circulated within the United States. VISION strategies have been described beforehand (5); briefly, eligible medical encounters embrace ED/UC visits and hospitalizations amongst adults with COVID-19–like sickness and a SARS-CoV-2 molecular check throughout the 14 days earlier than by means of 72 hours after the encounter. Variant predominance was outlined because the interval when a variant accounted for ≥75% of all sequenced specimens at a web site (i.e., BA.1, December 2021–March 2022** and BA.2/BA.2.12.1, March–June 2022††). Dates when the prevalence of BA.1 declined to <75% of sequenced specimens and the prevalence of BA.2/BA.2.12.1 had not but reached 75% had been thought of a “washout” interval; encounters by means of June 10, 2022, had been included until BA.2/BA.2.12.1 prevalence declined to <75% at a web site earlier than that date. Patients had been excluded if 1) a medical occasion occurred throughout the washout interval; 2) a possible immunocompromising situation was current; 3) an mRNA vaccine dose was obtained earlier than it was advisable§§; 4) any doses of a non–mRNA vaccine reminiscent of JNJ-78436735 (Janssen [Johnson & Johnson]) had been obtained; 5) <14 days had elapsed since receipt of dose 2 or <7 days since receipt of dose 3 or dose 4; or 6) a earlier SARS-CoV-2 an infection was documented within the affected person’s medical report earlier than the index encounter (to scale back the affect of safety from earlier an infection).¶¶ VE was estimated utilizing a test-negative case-control design, evaluating the chances of being vaccinated (receipt of 2 doses ≥14 days earlier than the encounter, 3 doses ≥7 days earlier than the encounter, or 4 doses ≥7 days earlier than the encounter) versus being unvaccinated (zero doses obtained) between individuals with constructive and unfavorable SARS-CoV-2 check outcomes, utilizing multivariable logistic regression, weighted for inverse propensity to be vaccinated, and adjusted for age, calendar time of index date (days since January 1, 2021),*** examine web site, and native virus circulation. VE for 4 vaccine doses was assessed just for adults aged ≥50 years throughout the BA.2/BA.2.12.1 interval, aligning with the March 29, 2022, authorization for the fourth dose. Nonoverlapping 95% CIs had been thought of statistically important. Analyses had been carried out utilizing R software program (model 4.1.2; R Foundation). The examine was reviewed and permitted by institutional evaluate boards at taking part websites or underneath reliance settlement with the institutional evaluate board of Westat, Inc. This exercise was carried out according to relevant federal regulation and CDC coverage.†††

Among 214,487 ED/UC encounters with a COVID-19–like sickness prognosis that met inclusion standards, 124,033 (57.8%) occurred throughout the BA.1 interval, throughout which 40,801 (32.9%) sufferers had a constructive SARS-CoV-2 check end result; 90,454 (42.2%) occurred throughout the BA.2/BA.2.12.1 interval, throughout which 10,177 (11.3%) had a constructive SARS-CoV-2 check end result. During the BA.1 interval, 51,359 (41.4%) ED/UC sufferers had been unvaccinated, 40,026 (32.3%) had obtained 2 mRNA vaccine doses, and 32,648 (26.3%) had obtained 3 doses (Table 1). During the BA.2/BA.2.12.1 interval, 27,907 (30.9%) ED/UC sufferers had been unvaccinated; 22,657 (25.0%) had obtained 2 mRNA vaccine doses, 35,796 (39.6%) had obtained 3 doses; and 4,094 (4.5%) had obtained 4 doses. Receipt of 3 versus 2 doses was related to a better VE in opposition to an ED/UC encounter throughout each intervals, and VE was increased throughout the BA.1 interval than the BA.2/BA.2.12.1 interval (Table 2). During the BA.1 interval, VE declined to 73% ≥120 days (median = 132 days) after the third vaccine dose; throughout the BA.2/BA.12.1 interval, VE declined to 26% at ≥120 days (median = 166 days) after the third dose.

Among 58,782 hospitalizations with a COVID-19–like sickness prognosis that met inclusion standards, 35,399 (60.2%) occurred throughout the BA.1 interval, throughout which 10,534 (29.8%) sufferers had a constructive SARS-CoV-2 check end result; 23,383 (17.9%) occurred throughout the BA.2/BA.2.12.1 interval, throughout which 1,564 (6.7%) sufferers had a constructive check end result (Table 3). During the BA.1 interval, 14,742 (41.6%) sufferers hospitalized with COVID-19–like sickness had been unvaccinated, 10,086 (28.5%) had obtained 2 mRNA vaccine doses, and 10,571 (29.9%) had obtained 3 doses. During the BA.2/BA.2.12.1 interval, 6,682 (28.6%) sufferers hospitalized with COVID-19–like sickness had been unvaccinated, and 5,461 (23.4%), 10,036 (42.9%), and 1,204 (5.1%) had obtained 2, 3, and 4 mRNA vaccine doses, respectively. VE in opposition to COVID-19–related hospitalization was 61% ≥150 days after dose 2 throughout the BA.1 interval (median = 289 days) in contrast with 24% throughout the BA.2/BA.2.12.1 interval (median = 371 days) (Table 2). VE related to a 3rd mRNA vaccine dose was increased than that related to a second vaccine dose however declined throughout each intervals at ≥120 days to 85% throughout the BA.1 interval (median = 132 days) and 52% throughout the BA.2/BA.2.12.1 interval (median = 168 days).

Among adults aged ≥50 years eligible to obtain a fourth mRNA vaccine dose, VE for COVID-19–related ED/UC encounters throughout the BA.2/BA.2.12.1 interval was 32% at ≥120 days after the third dose (median interval = 170 days) however elevated to 66% ≥7 days after the fourth dose (median interval = 28 days). VE in opposition to COVID-19–related hospitalization was 55% ≥120 days after the third dose however elevated to 80% ≥7 days after the fourth dose.

Discussion

Data from the Omicron BA.1 sublineage surge within the United States throughout December 2021–February 2022 decided that VE was diminished in contrast with that throughout the earlier Delta-predominant interval (6). To date, estimates of variations in VE between the Omicron BA.1 and subsequent BA.2/BA.2.12.1 sublineage intervals have been restricted. In this estimate of VE in opposition to ED/UC visits and hospitalizations throughout the BA.1 and BA.2/BA.2.12.1 intervals, VE declined throughout each intervals ≥150 days after the second vaccine dose, highlighting the necessity for a 3rd dose (i.e., the primary booster) for eligible adults. Recent receipt of a 3rd dose elevated VE; nevertheless, some decline was noticed ≥120 days after receipt of the dose. Among eligible adults aged ≥50 years, a fourth vaccine dose ≥120 days after receipt of the third dose improved VE throughout the BA.2/BA.2.12.1 interval, though follow-up time after dose 4 was restricted. These findings spotlight the significance of staying updated with COVID-19 vaccination, together with advisable booster doses.

Although information on neutralizing antibodies have discovered BA.1 and BA.2 to be comparable, latest information point out barely extra immune escape for BA.2.12.1 (1). Data reported on Omicron sublineage VE have been restricted. A examine within the United Kingdom discovered inconsistent variations in VE for symptomatic COVID-19 and COVID-19–related hospitalization, with increased VE in opposition to symptomatic COVID-19 however bigger declines in VE in opposition to hospitalization noticed throughout a interval of BA.2 predominance versus a interval of BA.1 predominance beginning 10–14 weeks after a 3rd COVID-19 vaccine dose (7). A examine in Qatar discovered that after a second or third mRNA vaccine dose, declines in VE in opposition to symptomatic COVID-19 throughout BA.1 and BA.2 intervals had been comparable, however the examine didn’t determine sufficient extreme circumstances to separate VE estimates by predominant variant (8). Differences between the present examine and earlier research, together with variations in proportions of individuals with earlier SARS-CoV-2 an infection and the absence of BA.2.12.1 infections exterior the United States may account for some variability in findings. After the BA.1 surge within the United States, a bigger proportion of adults had been discovered to have skilled a latest SARS-CoV-2 an infection throughout the BA.2/BA.2.12.1 interval, with antibody proof of SARS-CoV-2 an infection rising from 33.5% in December 2021 to 57.7% by February 2022 (9). Unvaccinated individuals had been used as a referent group in VE analyses. If unvaccinated individuals had been extra prone to have skilled latest an infection, and infection-induced immunity gives some safety in opposition to re-infection, this might lead to decrease VE noticed throughout the BA.2/BA.2.12.1 interval. Although adults with documented previous SARS-CoV-2 an infection had been excluded, infections are prone to be considerably underascertained as a result of of lack of testing or elevated at-home testing (10). In addition, though time since receipt of the second or third vaccine dose was stratified by time intervals, on common the time since vaccination was longer throughout the BA.2/BA.2.12.1 interval. These variations had been significantly pronounced within the evaluation of ≥150 days after the second vaccine dose (median 289 days for hospitalized adults throughout the BA.1 interval in comparison with 371 days throughout the BA.2/BA.2.12.1 interval), which might account for some variations in VE estimates and highlights the significance of a 3rd dose (first booster) for many who haven’t but obtained it.

The findings on this evaluation are topic to at the very least 4 limitations. First, earlier SARS-CoV-2 an infection was seemingly underascertained and may differentially have an effect on noticed VE throughout the BA.1 and BA.2/BA.2.12.1 intervals. Second, residual confounding in VE estimates is feasible. Third, no genetic characterization was out there for SARS-CoV-2–constructive specimens; subsequently, date of testing was used to ascribe seemingly sublineage, and BA.2 and BA.2.12.1 sublineages had been mixed, given their overlap in circulation. Finally, this report didn’t assess VE in opposition to essentially the most extreme COVID-19–related illness (e.g., respiratory failure) as a result of of smaller numbers of these circumstances.

VE ought to proceed to be monitored within the setting of newly rising sublineages and variants, together with Omicron sublineages BA.4 and BA.5, which grew to become predominant within the United States in late June 2022. Eligible adults ought to keep updated with advisable COVID-19 vaccinations, together with a primary booster dose for all eligible individuals and second booster dose for adults aged ≥50 years. Booster doses ought to be obtained instantly when individuals turn into eligible.

Acknowledgments

Rebecca Kondor, Manish Patel, Tamara Pilishvili, Heather Scobie, CDC.


1CDC COVID-19 Emergency Response Team; 2Westat, Rockville, Maryland.; 3Baylor Scott & White Health, Temple, Texas; 4Texas A&M University College of Medicine, Temple, Texas; 5Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon; 6Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; 7Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York; 8New York Presbyterian Hospital, New York, New York; 9Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah; 10HealthPartners Institute, Minneapolis, Minnesota; 11School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; 12Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana; 13School of Medicine, Indiana University, Indianapolis, Indiana; 14Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California; 15Paso Del Norte Health Information Exchange, El Paso, Texas; 16Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York; 17Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana; 18Children’s Minnesota, Minneapolis, Minnesota; 19Brigham Young University Department of Public Health, Provo, Utah.

References

  1. Hachmann NP, Miller J, Collier AY, et al. Neutralization escape by SARS-CoV-2 Omicron subvariants BA.2.12.1, BA.4, and BA.5. N Engl J Med 2022;387:86–8. https://doi.org/10.1056/NEJMc2206576
  2. Altarawneh HN, Chemaitelly H, Hasan MR, et al. Protection in opposition to the Omicron variant from earlier SARS-CoV-2 an infection. N Engl J Med 2022;386:1288–90. https://doi.org/10.1056/NEJMc2200133
  3. Feikin DR, Higdon MM, Abu-Raddad LJ, et al. Duration of effectiveness of vaccines in opposition to SARS-CoV-2 an infection and COVID-19 illness: outcomes of a scientific evaluate and meta-regression. Lancet 2022;399:924–44. https://doi.org/10.1016/S0140-6736(22)00152-0
  4. Food and Drug Administration. Coronavirus (COVID-19) replace: FDA authorizes second booster dose of two COVID-19 vaccines for older and immunocompromised people. Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2022. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-second-booster-dose-two-covid-19-vaccines-older-and
  5. Thompson MG, Stenehjem E, Grannis S, et al. Effectiveness of Covid-19 vaccines in ambulatory and inpatient care settings. N Engl J Med 2021;385:1355–71. https://doi.org/10.1056/NEJMoa2110362
  6. Thompson MG, Natarajan Okay, Irving SA, et al. Effectiveness of a 3rd dose of mRNA vaccines in opposition to COVID-19–related emergency division and pressing care encounters and hospitalizations amongst adults during times of Delta and Omicron variant predominance—VISION Network, 10 States, August 2021–January 2022. MMWR Morb Mortal Wkly Rep 2022;71:139–45. https://doi.org/10.15585/mmwr.mm7104e3
  7. Kirsebom FCM, Andrews N, Stowe J, et al. COVID-19 vaccine effectiveness in opposition to the omicron (BA.2) variant in England. Lancet Infect Dis 2022;22:931–3. https://doi.org/10.1016/S1473-3099(22)00309-7
  8. Chemaitelly H, Ayoub HH, AlMukdad S, et al. Duration of mRNA vaccine safety in opposition to SARS-CoV-2 Omicron BA.1 and BA.2 subvariants in Qatar. Nat Commun 2022;13:3082. https://doi.org/10.1038/s41467-022-30895-3
  9. Clarke KEN, Jones JM, Deng Y, et al. Seroprevalence of infection-induced SARS-CoV-2 antibodies—United States, September 2021–February 2022. MMWR Morb Mortal Wkly Rep 2022;71:606–8. https://doi.org/10.15585/mmwr.mm7117e3
  10. Rader B, Gertz A, Iuliano AD, et al. Use of at-home COVID-19 checks—United States, August 23, 2021–March 12, 222. MMWR Morb Mortal Wkly Rep 2022;71:489–94. https://doi.org/10.15585/mmwr.mm7113e1
(*10*)Characteristic
TABLE 1. Characteristics of emergency division and pressing care encounters amongst adults aged ≥18 years with COVID-19–like sickness,* by Omicron subvariant–predominant interval,,§ mRNA COVID-19 vaccination standing, and SARS-CoV-2 check end result — 10 states, December 2021–June 2022Return to your place in the text
Total no. (column %) mRNA COVID-19 vaccination standing Positive check end result*
No. (row %) SMD** No. (row %) SMD**
Unvaccinated 2 doses 3 doses 4 doses
14–149 days earlier ≥150 days earlier 7–119 days earlier ≥120 days earlier ≥7 days earlier
Omicron BA.1predominant interval
All ED or UC occasions 124,033 (100.0) 51,359 (41.4) 7,286 (5.9) 32,740 (26.4) 29,333 (23.6) 3,315 (2.7) N/A 40,801 (32.9)
Site
Baylor Scott & White Health 29,978 (24.2) 17,365 (57.9) 1,544 (5.2) 7,799 (26.0) 2,970 (9.9) 300 (1.0) 0.745 13,279 (44.3) 0.342
Columbia University 3,116 (2.5) 1,600 (51.3) 333 (10.7) 740 (23.7) 432 (13.9) 11 (0.4) 956 (30.7)
HealthPartners 12,579 (10.1) 3,435 (27.3) 730 (5.8) 3,247 (25.8) 4,720 (37.5) 447 (3.6) 3,820 (30.4)
Intermountain Healthcare 26,950 (21.7) 9,717 (36.1) 2,020 (7.5) 7,398 (27.5) 6,844 (25.4) 971 (3.6) 6,696 (24.8)
KPNC 20,383 (16.4) 3,862 (18.9) 1,274 (6.3) 5,952 (29.2) 8,411 (41.3) 884 (4.3) 5,252 (25.8)
KPNW 7,929 (6.4) 2,417 (30.5) 385 (4.9) 2,166 (27.3) 2,544 (32.1) 417 (5.3) 2,686 (33.9)
PHIX 1,243 (1.0) 647 (52.1) 54 (4.3) 322 (25.9) 196 (15.8) 24 (1.9) 318 (25.6)
Regenstrief Institute 14,003 (11.3) 8,007 (57.2) 682 (4.9) 2,968 (21.2) 2,213 (15.8) 133 (0.9) 4,986 (35.6)
University of Colorado 7,852 (6.3) 4,309 (54.9) 264 (3.4) 2,148 (27.4) 1,003 (12.8) 128 (1.6) 2,808 (35.8)
Age group, yrs
18–49 63,406 (51.1) 33,003 (52.1) 4,909 (7.7) 16,313 (25.7) 8,755 (13.8) 426 (0.7) 0.678 23,073 (36.4) 0.219
50–65 24,832 (20.0) 9,229 (37.2) 1,415 (5.7) 7,458 (30.0) 6,305 (25.4) 425 (1.7) 8,460 (34.1)
65–74 15,978 (12.9) 4,646 (29.1) 507 (3.2) 3,901 (24.4) 5,953 (37.3) 971 (6.1) 4,459 (27.9)
75–84 12,584 (10.1) 2,940 (23.4) 302 (2.4) 3,205 (25.5) 5,179 (41.2) 958 (7.6) 3,224 (25.6)
≥85 7,233 (5.8) 1,541 (21.3) 153 (2.1) 1,863 (25.8) 3,141 (43.4) 535 (7.4) 1,585 (21.9)
Sex
Male 50,479 (40.7) 22,531 (44.6) 2,536 (5.0) 12,433 (24.6) 11,574 (22.9) 1,405 (2.8) 0.107 17,286 (34.2) 0.051
Female 73,554 (59.3) 28,828 (39.2) 4,750 (6.5) 20,307 (27.6) 17,759 (24.1) 1,910 (2.6) 23,515 (32.0)
Race or ethnicity
White, NH 74,613 (60.2) 28,365 (38.0) 3,746 (5.0) 19,754 (26.5) 20,145 (27.0) 2,603 (3.5) 0.356 21,430 (28.7) 0.255
Black, NH 15,395 (12.4) 8,547 (55.5) 1,295 (8.4) 3,505 (22.8) 1,902 (12.4) 146 (0.9) 6,529 (42.4)
Hispanic 19,508 (15.7) 8,893 (45.6) 1,451 (7.4) 5,489 (28.1) 3,446 (17.7) 229 (1.2) 7,481 (38.3)
Other,†† NH 9,368 (7.6) 2,802 (29.9) 522 (5.6) 2,754 (29.4) 3,011 (32.1) 279 (3.0) 3,061 (32.7)
Unknown 5,149 (4.2) 2,752 (53.4) 272 (5.3) 1,238 (24.0) 829 (16.1) 58 (1.1) 2,300 (44.7)
Chronic respiratory situation at discharge§§
No 103,754 (83.7) 43,204 (41.6) 6,287 (6.1) 27,363 (26.4) 24,303 (23.4) 2,597 (2.5) 0.065 34,674 (33.4) 0.054
Yes 20,279 (16.3) 8,155 (40.2) 999 (4.9) 5,377 (26.5) 5,030 (24.8) 718 (3.5) 6,127 (30.2)
Chronic nonrespiratory situation at discharge¶¶
No 91,182 (73.5) 38,741 (42.5) 5,749 (6.3) 24,157 (26.5) 20,551 (22.5) 1,984 (2.2) 0.145 31,826 (34.9) 0.154
Yes 32,851 (26.5) 12,618 (38.4) 1,537 (4.7) 8,583 (26.1) 8,782 (26.7) 1,331 (4.1) 8,975 (27.3)
Omicron BA.2/BA.2.12.1–predominant interval§
All ED or UC occasions 90,454 (100.0) 27,907 (30.9) 1,774 (2.0) 20,883 (23.1) 9,142 (10.1) 26,654 (29.5) 4,094 (4.5) 10,177 (11.3)
Site
Baylor Scott & White Health 12,976 (14.3) 6,786 (52.3) 188 (1.4) 3,687 (28.4) 501 (3.9) 1,720 (13.3) 94 (0.7) 0.925 1,155 (8.9) 0.296
Columbia University 3,430 (3.8) 1,452 (42.3) 130 (3.8) 937 (27.3) 344 (10.0) 551 (16.1) 16 (0.5) 232 (6.8)
HealthPartners 15,234 (16.8) 3,269 (21.5) 346 (2.3) 2,868 (18.8) 1,821 (12.0) 5,944 (39.0) 986 (6.5) 2,057 (13.5)
Intermountain Healthcare 17,134 (18.9) 5,262 (30.7) 469 (2.7) 4,359 (25.4) 1,654 (9.7) 4,986 (29.1) 404 (2.4) 2,318 (13.5)
KPNC 20,732 (22.9) 2,531 (12.2) 374 (1.8) 4,114 (19.8) 3,278 (15.8) 8,446 (40.7) 1,989 (9.6) 1,670 (8.1)
KPNW 7,211 (8.0) 1,588 (22.0) 110 (1.5) 1,464 (20.3) 894 (12.4) 2,695 (37.4) 460 (6.4) 1,084 (15.0)
PHIX 709 (0.8) 338 (47.7) 13 (1.8) 176 (24.8) 59 (8.3) 113 (15.9) 10 (1.4) 43 (6.1)
Regenstrief Institute 6,064 (6.7) 3,188 (52.6) 95 (1.6) 1,299 (21.4) 341 (5.6) 1,103 (18.2) 38 (0.6) 575 (9.5)
University of Colorado 6,964 (7.7) 3,493 (50.2) 49 (0.7) 1,979 (28.4) 250 (3.6) 1,096 (15.7) 97 (1.4) 1,043 (15.0)
Age group, yrs
18–49 42,569 (47.1) 18,429 (43.3) 1,192 (2.8) 11,203 (26.3) 4,132 (9.7) 7,613 (17.9) 0 (0.0) 0.778 5,074 (11.9) 0.099
50–65 17,598 (19.5) 4,755 (27.0) 317 (1.8) 4,253 (24.2) 2,232 (12.7) 5,355 (30.4) 686 (3.9) 2,087 (11.9)
65–74 12,909 (14.3) 2,271 (17.6) 137 (1.1) 2,437 (18.9) 1,185 (9.2) 5,542 (42.9) 1337 (10.4) 1,253 (9.7)
75–84 11,032 (12.2) 1,591 (14.4) 71 (0.6) 1,902 (17.2) 994 (9.0) 5,130 (46.5) 1344 (12.2) 1,174 (10.6)
≥85 6,346 (7.0) 861 (13.6) 57 (0.9) 1,088 (17.1) 599 (9.4) 3,014 (47.5) 727 (11.5) 589 (9.3)
Sex
Male 36,191 (40.0) 11,836 (32.7) 631 (1.7) 8,014 (22.1) 3,406 (9.4) 10,449 (28.9) 1,855 (5.1) 0.090 4,091 (11.3) 0.004
Female 54,263 (60.0) 16,071 (29.6) 1,143 (2.1) 12,869 (23.7) 5,736 (10.6) 16,205 (29.9) 2,239 (4.1) 6,086 (11.2)
Race or ethnicity
White, NH 55,447 (61.3) 15,386 (27.7) 799 (1.4) 12,474 (22.5) 5,296 (9.6) 18,410 (33.2) 3,082 (5.6) 0.361 6,471 (11.7) 0.128
Black, NH 9,797 (10.8) 4,405 (45.0) 368 (3.8) 2,272 (23.2) 898 (9.2) 1,644 (16.8) 210 (2.1) 1,033 (10.5)
Hispanic 13,939 (15.4) 4,780 (34.3) 396 (2.8) 3,693 (26.5) 1,642 (11.8) 3,076 (22.1) 352 (2.5) 1,217 (8.7)
Other,†† NH 8,040 (8.9) 1,769 (22.0) 160 (2.0) 1,670 (20.8) 1,096 (13.6) 2,927 (36.4) 418 (5.2) 1,003 (12.5)
Unknown 3,231 (3.6) 1,567 (48.5) 51 (1.6) 774 (24.0) 210 (6.5) 597 (18.5) 32 (1.0) 453 (14.0)
Chronic respiratory situation at discharge§§
No 75,947 (84.0) 23,604 (31.1) 1,474 (1.9) 17,438 (23.0) 7,708 (10.1) 22,242 (29.3) 3,481 (4.6) 0.024 9,149 (12.0) 0.197
Yes 14,507 (16.0) 4,303 (29.7) 300 (2.1) 3,445 (23.7) 1,434 (9.9) 4,412 (30.4) 613 (4.2) 1,028 (7.1)
Chronic nonrespiratory situation at discharge¶¶
No 67,691 (74.8) 21,424 (31.6) 1,359 (2.0) 15,621 (23.1) 6,903 (10.2) 19,378 (28.6) 3,006 (4.4) 0.050 8,549 (12.6) 0.255
Yes 22,763 (25.2) 6,483 (28.5) 415 (1.8) 5,262 (23.1) 2,239 (9.8) 7,276 (32.0) 1,088 (4.8) 1,628 (7.2)

Abbreviations: ED = emergency division; ICD-9 = International Classification of ailments, Ninth Revision; ICD-10 = International Classification of ailments, Tenth Revision; KPNC = Kaiser Permanente Northern California; KPNW = Kaiser Permanente Northwest; N/A = not relevant; NH = non-Hispanic; PHIX = Paso del Norte Health Information Exchange; RT-PCR = reverse transcription–polymerase response; SMD = standardized imply or proportion distinction; UC = pressing care.
* Medical occasions with a discharge code according to COVID-19–like sickness had been included; utilizing ICD-9 and ICD-10 codes, COVID-19–like sickness diagnoses included acute respiratory sickness (e.g., respiratory failure or pneumonia) or associated indicators or signs (e.g., cough, fever, dyspnea, vomiting, or diarrhea). Clinician-ordered molecular assays (e.g., real-time RT-PCR) for SARS-CoV-2 occurring ≤14 days earlier than to <72 hours after the encounter date had been included.
Partners contributing information on medical occasions throughout dates of estimated ≥75% Omicron BA.1 predominance had been in California (Dec 21, 2021–Mar 6, 2022), Colorado (Dec 25, 2021–Mar 12, 2022), Indiana (Dec 31, 2021–Mar 4, 2022), Minnesota and Wisconsin (Jan 1–Mar 5, 2022), New York (Dec 18, 2021–Feb 26, 2022), Oregon and Washington (Jan 1–Mar 12, 2022), Texas (Baylor Scott & White Health [Dec 18, 2021–Mar 5, 2022] and PHIX [Jan 8–Mar 19, 2022]), and Utah (Dec 27, 2021–Mar 19, 2022).
§ Partners contributing information on medical occasions throughout dates of estimated ≥75% Omicron BA.2/BA.2.12.1 predominance had been in California (Mar 25–Jun 10, 2022), Colorado (Apr 9–Jun 4, 2022), Indiana (Mar 19–Jun 10, 2022), Minnesota and Wisconsin (Apr 9–Jun 4, 2022), New York (Mar 26–Jun 10, 2022), Oregon and Washington (Apr 9–Jun 10, 2022), Texas (Baylor Scott & White Health [Mar 26–Jun 4, 2022] and PHIX [Apr 23–Jun 10, 2022]), and Utah (Mar 28–Jun 10, 2022).
Vaccination was outlined as having obtained the listed quantity of doses of an mRNA-based COVID-19 vaccine throughout the specified vary of quantity of days earlier than the medical occasion index date, which was the date of respiratory specimen assortment related to the latest constructive or unfavorable SARS-CoV-2 check end result earlier than the medical occasion or the admission date if testing solely occurred after the admission.
** An absolute SMD ≥0.20 signifies a nonnegligible distinction in variable distributions between medical occasions for vaccinated versus unvaccinated sufferers or for sufferers with SARS-CoV-2–constructive check end result versus these with SARS-CoV-2–unfavorable outcomes. For mRNA COVID-19 vaccination standing, a single SMD was calculated by averaging absolutely the SMDs obtained from pairwise comparisons of every vaccinated class versus unvaccinated; extra particularly as the typical of absolutely the worth of the SMDs for 1) vaccinated with 2 doses 14–149 days earlier versus unvaccinated, 2) vaccinated with 2 doses ≥150 days earlier versus unvaccinated, 3) vaccinated with 3 doses 7–119 days earlier versus unvaccinated, 4) vaccinated with 3 doses ≥120 days earlier versus unvaccinated, and 5) vaccinated with 4 doses ≥7 days earlier versus unvaccinated.
†† Other race consists of Asian, Native Hawaiian or different Pacific islander, American Indian or Alaska Native, Other, and a number of races.
§§ Chronic respiratory situation was outlined because the presence of discharge code for bronchial asthma, continual obstructive pulmonary illness, or different lung illness utilizing ICD-9 or ICD-10 prognosis codes.
¶¶ Chronic nonrespiratory situation was outlined because the presence of discharge code for coronary heart failure, ischemic coronary heart illness, hypertension, different coronary heart illness, stroke, different cerebrovascular illness, diabetes kind I or II, different diabetes, metabolic illness, medical weight problems, clinically underweight, renal illness, liver illness, blood dysfunction, immunosuppression, organ transplant, most cancers, dementia, neurologic dysfunction, musculoskeletal dysfunction, or Down syndrome utilizing ICD-9 and ICD-10 prognosis codes.

TABLE 2. mRNA COVID-19 vaccine effectiveness* in opposition to laboratory-confirmed COVID-19–related emergency division and pressing care encounters and hospitalizations amongst adults aged ≥18 years, by Omicron–predominant interval, age group, quantity and timing of vaccine doses,§ and median interval since final dose — VISION Network, 10 states, December 2021–June 2022Return to your place in the text
Encounter kind Omicron BA.1–predominant interval Omicron BA.2/BA.2.12.1–predominant interval**
Total No. (%) of constructive check outcomes Median interval since final dose,
days (IQR)
VE
%* (95% CI)
Total No. (%) of constructive check outcomes Median interval since final dose
days (IQR)
VE
%* (95% CI)
ED or UC, age group (days since final dose)
All ages, yrs
Unvaccinated (Ref) 51,359 23,175 (45.1) 27,907 3,501 (12.6)
2 doses (14–149) 7,286 2,377 (32.6) 107 (76–129) 47 (44–50) 1,774 110 (6.2) 104 (71–128) 51 (38–60)
2 doses (≥150) 32,740 11,365 (34.7) 267 (232–306) 39 (37–41) 20,883 2,584 (12.4) 352 (278–398) 12 (7–17)
3 doses (7–119) 29,333 3,667 (12.5) 66 (41–89) 84 (83–85) 9,142 441 (4.8) 94 (72–108) 56 (51–61)
3 doses (≥120) 3,315 217 (6.5) 132 (125–142) 73 (68–77) 26,654 3,186 (11.9) 166 (145–190) 26 (21–30)
18–49 yrs
Unvaccinated (Ref) 33,003 14,236 (43.1) 18,429 2,269 (12.3)
2 doses (14–149) 4,909 1,621 (33.0) 106 (76–129) 40 (36–44) 1,192 75 (6.3) 105 (72–129) 47 (31–60)
2 doses (≥150) 16,313 5,918 (36.3) 252 (220–288) 24 (21–28) 11,203 1,427 (12.7) 332 (254–379) 7 (0–14)
3 doses (7–119) 8,755 1,259 (14.4) 55 (33–79) 76 (75–78) 4,132 207 (5.0) 91 (69–107) 55 (47–62)
3 doses (≥120) 426 39 (9.2) 130 (124–141) 29 (−1–50) 7,613 1,096 (14.4) 159 (140–182) 17 (10–25)
≥50 yrs
Unvaccinated (Ref) 18,356 8,939 (48.7) 9,478 1,232 (13.0)
2 doses (14–149) 2,377 756 (31.8) 109 (77–129) 59 (54–63) 582 35 (6.0) 102 (68–128) 59 (40–71)
2 doses (≥150) 16,427 5,447 (33.2) 283 (248–316) 52 (50–54) 9,680 1,157 (11.9) 376 (319–414) 18 (10–26)
3 doses (7–119) 20,578 2,408 (11.7) 71 (46–93) 87 (86–88) 5,010 234 (4.7) 96 (73–109) 58 (51–64)
3 doses (≥120) 2,889 178 (6.2) 133 (125–143) 81 (77–84) 19,041 2,090 (11.0) 170 (147–193) 32 (26–38)
4 doses (≥7)†† N/A 4,094 355 (8.7) 28 (17–42) 66 (60–71)
Hospitalization, age group (days since final dose)
All ages, yrs
Unvaccinated (Ref) 14,742 6,829 (46.3) 6,682 494 (7.4)
2 doses (14–149) 1,236 297 (24.0) 105 (73–129) 68 (63–73) 343 12 (3.5) 102 (71–128) 57 (19–77)
2 doses (≥150) 8,850 2,542 (28.7) 289 (252–322) 61 (58–63) 5,118 393 (7.7) 371 (308–413) 24 (12–35)
3 doses (7–119) 9,146 786 (8.6) 72 (47–93) 92 (91–93) 2,350 72 (3.1) 94 (74–108) 69 (58–76)
3 doses (≥120) 1,425 80 (5.6) 132 (125–142) 85 (81–89) 7,686 519 (6.8) 168 (146–191) 52 (44–59)
18–49 yrs§§
Unvaccinated (Ref) 4,057 1,515 (37.3)
2 doses (14–149) 392 83 (21.2) 101 (67–127) 64 (52–73)
2 doses (≥150) 1,304 329 (25.2) 258 (226–294) 52 (43–59)
3 doses (7–119) 812 53 (6.5) 57 (36–81) 91 (87–94)
3 doses (≥120) 56 1 (1.8) 133 (126–142) 94 (62–99)
≥50 yrs§§
Unvaccinated (Ref) 10,685 5,314 (49.7) 4,595 393 (8.6)
2 doses (14–149) 844 214 (25.4) 108 (76–129) 71 (65–75)
2 doses (≥150) 7,546 2,213 (29.3) 294 (259–325) 63 (60–66) 4,139 352 (8.5) 381 (325–418) 22 (8–34)
3 doses (7–119) 8,334 733 (8.8) 73 (49–94) 92 (91–93) 1,957 57 (2.9) 95 (74–108) 73 (63–81)
3 doses (≥120) 1,369 79 (5.8) 132 (125–142) 86 (82–89) 7,113 480 (6.8) 169 (147–191) 55 (46–62)
4 doses (≥7)†† N/A 1,204 74 (6.2) 27 (17–41) 80 (71–85)

Abbreviations: ED = emergency division; ICD-9 = International Classification of Diseases, Ninth Revision; ICD-10 = International Classification of Diseases, Tenth Revision; N/A = not relevant; PHIX = Paso Del Norte Health Information Exchange; Ref = referent group; RT-PCR = reverse transcription–polymerase chain response; UC = pressing care; VE = vaccine effectiveness.
* VE was calculated as ([1−odds ratio] x 100%), estimated utilizing a test-negative design, adjusted for age, geographic area, calendar time (days since January 1, 2021), and native virus circulation (proportion of SARS-CoV-2–constructive outcomes from testing throughout the counties surrounding the ability on the date of the encounter) and weighted for inverse propensity to be vaccinated or unvaccinated (calculated individually for every set of VE estimates amongst ED or UC encounters and hospitalizations by Omicron–predominant interval and age group). Generalized boosted regression timber had been used to estimate the propensity to be vaccinated primarily based on sociodemographic traits, underlying medical circumstances, and facility traits.
Medical occasions with a discharge code according to COVID-19–like sickness had been included. COVID-19–like sickness diagnoses included acute respiratory sickness (e.g., respiratory failure or pneumonia) or associated indicators or signs (e.g., cough, fever, dyspnea, vomiting, or diarrhea) utilizing ICD-9 and ICD-10 codes. Clinician-ordered molecular assays (e.g., real-time RT-PCR) for SARS-CoV-2 occurring ≤14 days earlier than to <72 hours after the encounter date had been included.
§ Vaccination was outlined as having obtained the listed quantity of doses of an mRNA-based COVID-19 vaccine throughout the specified vary of quantity of days earlier than the medical occasion index date, which was the date of respiratory specimen assortment related to the latest constructive or unfavorable SARS-CoV-2 check end result earlier than the medical occasion or the admission date if testing solely occurred after the admission.
Partners contributing information on medical occasions throughout dates of estimated ≥75% Omicron BA.1 predominance had been in California (Dec 21, 2021–Mar 6, 2022), Colorado (Dec 25, 2021–Mar 12, 2022), Indiana (Dec 31, 2021–Mar 4, 2022), Minnesota and Wisconsin (Jan 1–Mar 5, 2022), New York (Dec 18, 2021–Feb 26, 2022), Oregon and Washington (Jan 1–Mar 12, 2022), Texas (Baylor Scott & White Health [Dec 18, 2021–Mar 5, 2022] and PHIX [Jan 8–Mar 19, 2022]), and Utah (Dec 27, 2021–Mar 19, 2022).
** Partners contributing information on medical occasions throughout dates of estimated ≥75% Omicron BA.2/BA.2.12.1 predominance had been in California (Mar 25–Jun 10, 2022), Colorado (Apr 9–Jun 4, 2022), Indiana (Mar 19–Jun 10, 2022), Minnesota and Wisconsin (Apr 9–Jun 4, 2022), New York (Mar 26–Jun 10, 2022), Oregon and Washington (Apr 9–Jun 10, 2022), Texas (Baylor Scott & White Health [Mar 6–Jun 4, 2022 and PHIX [Apr 23–Jun 10, 2022]), and Utah (Mar 28–Jun 10, 2022).
†† For estimation of 4-dose mRNA VE amongst sufferers aged ≥50 years throughout the Omicron BA.2/BA.2.12.1–predominant interval, unvaccinated sufferers whose medical occasion index date was earlier than Apr 5, 2022 had been excluded from the referent group (1,836 ED or UC encounters and 999 hospitalizations excluded amongst unvaccinated sufferers) as a result of the earliest medical occasion index date included amongst 4-dose mRNA-vaccinated sufferers was 7 days after Mar 29, 2022 when a second booster mRNA vaccine dose (fourth dose) was first included in suggestions for adults aged ≥50 years (at the very least 4 months after receiving a 3rd mRNA dose).
§§ VE estimates with 95% CIs >50 proportion factors aren’t proven as a result of of imprecision.

TABLE 3. Characteristics of hospitalizations amongst adults aged ≥18 years with COVID-19–like sickness,* by Omicron subvariant–predominant interval, mRNA COVID-19 vaccination standing, and SARS-CoV-2 check end result — 10 states, December 2021–June 2022Return to your place in the text
Characteristic Total no. (column %) mRNA COVID-19 vaccination standing, no. of doses obtained Positive check end result*
No. (row %) SMD** No. (row %) SMD**
Unvaccinated Days since final dose 4 doses
2 doses 3 doses
14–149 ≥150 7–119 ≥120 ≥7
Omicron BA.1predominant interval
All hospitalizations 35,399 (100.0) 14,742 (41.6) 1,236 (3.5) 8,850 (25.0) 9,146 (25.8) 1,425 (4.0) N/A 10,534 (29.8)
Site
Baylor Scott& White Health 8,697 (24.6) 4,480 (51.5) 324 (3.7) 2,528 (29.1) 1,190 (13.7) 175 (2.0) 0.551 2,904 (33.4) 0.218
Columbia University 1,419 (4.0) 668 (47.1) 94 (6.6) 367 (25.9) 274 (19.3) 16 (1.1) 536 (37.8)
HealthPartners 1,334 (3.8) 378 (28.3) 40 (3.0) 262 (19.6) 586 (43.9) 68 (5.1) 322 (24.1)
Intermountain Healthcare 3,224 (9.1) 1,159 (35.9) 148 (4.6) 701 (21.7) 985 (30.6) 231 (7.2) 756 (23.4)
KPNC 6,911 (19.5) 1,501 (21.7) 219 (3.2) 1,748 (25.3) 3,036 (43.9) 407 (5.9) 1,940 (28.1)
KPNW 1,480 (4.2) 539 (36.4) 56 (3.8) 288 (19.5) 478 (32.3) 119 (8.0) 360 (24.3)
PHIX 96 (0.3) 64 (66.7) 1 (1.0) 19 (19.8) 11 (11.5) 1 (1.0) 45 (46.9)
Regenstrief Institute 8,980 (25.4) 4,398 (49.0) 276 (3.1) 1,969 (21.9) 2,076 (23.1) 261 (2.9) 2,937 (32.7)
University of Colorado 3,258 (9.2) 1,555 (47.7) 78 (2.4) 968 (29.7) 510 (15.7) 147 (4.5) 734 (22.5)
Age group, yrs
18–49 6,621 (18.7) 4,057 (61.3) 392 (5.9) 1,304 (19.7) 812 (12.3) 56 (0.8) 0.540 1,981 (29.9) 0.126
50–65 7,783 (22.0) 3,847 (49.4) 328 (4.2) 2,008 (25.8) 1,470 (18.9) 130 (1.7) 2,664 (34.2)
65–74 8,073 (22.8) 3,059 (37.9) 233 (2.9) 2,041 (25.3) 2,325 (28.8) 415 (5.1) 2,370 (29.4)
75–84 7,654 (21.6) 2,329 (30.4) 178 (2.3) 2,054 (26.8) 2,609 (34.1) 484 (6.3) 2,137 (27.9)
≥85 5,268 (14.9) 1,450 (27.5) 105 (2.0) 1,443 (27.4) 1,930 (36.6) 340 (6.5) 1,382 (26.2)
Sex
Male 17,164 (48.5) 7,549 (44.0) 529 (3.1) 4,075 (23.7) 4,308 (25.1) 703 (4.1) 0.098 5,428 (31.6) 0.087
Female 18,235 (51.5) 7,193 (39.4) 707 (3.9) 4,775 (26.2) 4,838 (26.5) 722 (4.0) 5,106 (28.0)
Race or ethnicity
White, NH 22,967 (64.9) 8,837 (38.5) 697 (3.0) 5,843 (25.4) 6,479 (28.2) 1,111 (4.8) 0.285 6,224 (27.1) 0.199
Black, NH 4,214 (11.9) 2,279 (54.1) 212 (5.0) 976 (23.2) 676 (16.0) 71 (1.7) 1,474 (35.0)
Hispanic 3,781 (10.7) 1,801 (47.6) 188 (5.0) 960 (25.4) 759 (20.1) 73 (1.9) 1,491 (39.4)
Other,†† NH 2,601 (7.3) 893 (34.3) 81 (3.1) 628 (24.1) 880 (33.8) 119 (4.6) 760 (29.2)
Unknown 1,836 (5.2) 932 (50.8) 58 (3.2) 443 (24.1) 352 (19.2) 51 (2.8) 585 (31.9)
Chronic respiratory situation at discharge§§
No 14,763 (41.7) 6,116 (41.4) 555 (3.8) 3,693 (25.0) 3,818 (25.9) 581 (3.9) 0.023 3,482 (23.6) 0.254
Yes 20,636 (58.3) 8,626 (41.8) 681 (3.3) 5,157 (25.0) 5,328 (25.8) 844 (4.1) 7,052 (34.2)
Chronic nonrespiratory situation at discharge¶¶
No 4,685 (13.2) 2,516 (53.7) 166 (3.5) 958 (20.4) 949 (20.3) 96 (2.0) 0.200 1,522 (32.5) 0.050
Yes 30,714 (86.8) 12,226 (39.8) 1,070 (3.5) 7,892 (25.7) 8,197 (26.7) 1,329 (4.3) 9,012 (29.3)
Omicron BA.2/BA.2.12.1–predominant interval§
All hospitalizations 23,383 (100.0) 6,682 (28.6) 343 (1.5) 5,118 (21.9) 2,350 (10.1) 7,686 (32.9) 1,204 (5.1) 1,564 (6.7)
Site
Baylor Scott & White Health 4,686 (20.0) 2,128 (45.4) 55 (1.2) 1,417 (30.2) 227 (4.8) 813 (17.3) 46 (1.0) 0.945 196 (4.2) 0.268
Columbia University 1,413 (6.0) 491 (34.7) 48 (3.4) 316 (22.4) 169 (12.0) 375 (26.5) 14 (1.0) 81 (5.7)
HealthPartners 1,758 (7.5) 329 (18.7) 37 (2.1) 261 (14.8) 204 (11.6) 760 (43.2) 167 (9.5) 120 (6.8)
Intermountain Healthcare 2,023 (8.7) 571 (28.2) 35 (1.7) 446 (22.0) 179 (8.8) 733 (36.2) 59 (2.9) 167 (8.3)
KPNC 6,866 (29.4) 677 (9.9) 87 (1.3) 1,164 (17.0) 1,095 (15.9) 3,105 (45.2) 738 (10.7) 584 (8.5)
KPNW 1,326 (5.7) 356 (26.8) 17 (1.3) 210 (15.8) 165 (12.4) 488 (36.8) 90 (6.8) 86 (6.5)
PHIX 12 (0.1) 7 (58.3) 0 (0.0) 3 (25.0) 0 (0.0) 2 (16.7) 0 (0.0) 1 (8.3)
Regenstrief Institute 3,947 (16.9) 1,600 (40.5) 48 (1.2) 869 (22.0) 246 (6.2) 1,128 (28.6) 56 (1.4) 235 (6.0)
University of Colorado 1,352 (5.8) 523 (38.7) 16 (1.2) 432 (32.0) 65 (4.8) 282 (20.9) 34 (2.5) 94 (7.0)
Age group, yrs
18–49 4,162 (17.8) 2,087 (50.1) 130 (3.1) 979 (23.5) 393 (9.4) 573 (13.8) 0 (0.0) 0.585 199 (4.8) 0.340
50–65 4,613 (19.7) 1,621 (35.1) 78 (1.7) 1,171 (25.4) 527 (11.4) 1,077 (23.3) 139 (3.0) 220 (4.8)
65–74 5,171 (22.1) 1,258 (24.3) 63 (1.2) 1,098 (21.2) 506 (9.8) 1,929 (37.3) 317 (6.1) 277 (5.4)
75–84 5,539 (23.7) 1,059 (19.1) 34 (0.6) 1,114 (20.1) 520 (9.4) 2,379 (42.9) 433 (7.8) 468 (8.4)
≥85 3,898 (16.7) 657 (16.9) 38 (1.0) 756 (19.4) 404 (10.4) 1,728 (44.3) 315 (8.1) 400 (10.3)
Sex
Male 10,979 (47.0) 3,304 (30.1) 149 (1.4) 2,315 (21.1) 1044 (9.5) 3,553 (32.4) 614 (5.6) 0.080 796 (7.3) 0.085
Female 12,404 (53.0) 3,378 (27.2) 194 (1.6) 2,803 (22.6) 1306 (10.5) 4,133 (33.3) 590 (4.8) 768 (6.2)
Race or ethnicity
White, NH 14,772 (63.2) 3,817 (25.8) 162 (1.1) 3,236 (21.9) 1,367 (9.3) 5,304 (35.9) 886 (6.0) 0.362 1,076 (7.3) 0.199
Black, NH 2,690 (11.5) 1,157 (43.0) 73 (2.7) 598 (22.2) 266 (9.9) 525 (19.5) 71 (2.6) 117 (4.3)
Hispanic 2,708 (11.6) 815 (30.1) 57 (2.1) 648 (23.9) 353 (13.0) 736 (27.2) 99 (3.7) 139 (5.1)
Other,†† NH 2,115 (9.0) 425 (20.1) 40 (1.9) 376 (17.8) 298 (14.1) 842 (39.8) 134 (6.3) 172 (8.1)
Unknown 1,098 (4.7) 468 (42.6) 11 (1.0) 260 (23.7) 66 (6.0) 279 (25.4) 14 (1.3) 60 (5.5)
Chronic respiratory situation at discharge§§
No 10,015 (42.8) 3,085 (30.8) 147 (1.5) 2,179 (21.8) 980 (9.8) 3,142 (31.4) 482 (4.8) 0.092 604 (6.0) 0.092
Yes 13,368 (57.2) 3,597 (26.9) 196 (1.5) 2,939 (22.0) 1,370 (10.2) 4,544 (34.0) 722 (5.4) 960 (7.2)
Chronic nonrespiratory situation at discharge¶¶
No 3,010 (12.9) 1,243 (41.3) 53 (1.8) 690 (22.9) 226 (7.5) 748 (24.9) 50 (1.7) 0.242 174 (5.8) 0.058
Yes 20,373 (87.1) 5,439 (26.7) 290 (1.4) 4,428 (21.7) 2,124 (10.4) 6,938 (34.1) 1154 (5.7) 1,390 (6.8)

Abbreviations: ICD-9 = International Classification of Diseases, Ninth Revision; ICD-10 = International Classification of Diseases, Tenth Revision; KPNC = Kaiser Permanente of Northern California; KPNW = Kaiser Permanente Northwest; N/A = not relevant; NH = non-Hispanic; PHIX = Paso del Norte Health Information Exchange; RT-PCR = reverse transcription–polymerase chain response; SMD = standardized imply or proportion distinction.
* Hospitalizations with a discharge code according to COVID-19–like sickness had been included. COVID-19–like sickness diagnoses included acute respiratory sickness (e.g., respiratory failure or pneumonia) or associated indicators or signs (e.g., cough, fever, dyspnea, vomiting, or diarrhea) utilizing prognosis ICD-9 and ICD-10 codes. Clinician-ordered molecular assays (e.g., real-time RT-PCR) for SARS-CoV-2 occurring ≤14 days earlier than to <72 hours after the encounter date had been included.
Partners contributing information on hospitalizations throughout dates of estimated ≥75% Omicron BA.1 predominance had been in California (Dec 21, 2021–Mar 6, 2022), Colorado (Dec 25, 2021–Mar 12, 2022), Indiana (Dec 31, 2021–Mar 4, 2022), Minnesota and Wisconsin (Jan 1–Mar 5, 2022), New York (Dec 18, 2021–Feb 26, 2022), Oregon and Washington (Jan 1–Mar 12, 2022), Texas (Baylor Scott & White Health [Dec 18, 2021–Mar 5, 2022] and PHIX [Jan 8–Mar 19, 2022]), and Utah (Dec 27, 2021–Mar 19, 2022).
§ Partners contributing information on hospitalizations throughout dates of estimated ≥75% Omicron BA.2/BA.2.12.1 predominance had been in California (Mar 25–Jun 10, 2022), Colorado (Apr 9–Jun 4, 2022), Indiana (Mar 19–Jun 10, 2022), Minnesota and Wisconsin (Apr 9–Jun 4, 2022), New York (Mar 26–Jun 10, 2022), Oregon and Washington (Apr 9–Jun 10, 2022), Texas (Baylor Scott & White Health [Mar 26–Jun 4, 2022] and PHIX [Apr 23–Jun 10, 2022]), and Utah (Mar 28–Jun 10, 2022).
Vaccination was outlined as having obtained the listed quantity of doses of an mRNA-based COVID-19 vaccine throughout the specified vary of quantity of days earlier than the hospitalization index date, which was the date of respiratory specimen assortment related to the latest constructive or unfavorable SARS-CoV-2 check end result earlier than the hospitalization or the admission date if testing solely occurred after the admission.
** An absolute SMD ≥0.20 signifies a nonnegligible distinction in variable distributions between hospitalizations for vaccinated versus unvaccinated sufferers or for sufferers with SARS-CoV-2–constructive outcomes versus these with SARS-CoV-2–unfavorable outcomes. For mRNA COVID-19 vaccination standing, a single SMD was calculated by averaging absolutely the SMDs obtained from pairwise comparisons of every vaccinated class versus unvaccinated; extra particularly, as the typical of absolutely the worth of the SMDs for 1) vaccinated with 2 doses 14–149 days earlier versus unvaccinated, 2) vaccinated with 2 doses ≥150 days earlier versus unvaccinated, 3) vaccinated with 3 doses 7–119 days earlier versus unvaccinated, 4) vaccinated with 3 doses ≥120 days earlier versus unvaccinated, and 5) vaccinated with 4 doses ≥7 days earlier versus unvaccinated.
†† Other race consists of Asian, Native Hawaiian or different Pacific islander, American Indian or Alaska Native, Other, and a number of races.
§§ Chronic respiratory situation was outlined because the presence of discharge code for bronchial asthma, continual obstructive pulmonary illness, or different lung illness utilizing ICD-9 and ICD-10 prognosis codes.
¶¶ Chronic nonrespiratory situation was outlined because the presence of discharge code for coronary heart failure, ischemic coronary heart illness, hypertension, different coronary heart illness, stroke, different cerebrovascular illness, diabetes kind I or II, different diabetes, metabolic illness, medical weight problems, clinically underweight, renal illness, liver illness, blood dysfunction, immunosuppression, organ transplant, most cancers, dementia, neurologic dysfunction, musculoskeletal dysfunction, or Down syndrome utilizing ICD-9 and ICD-10 prognosis.

Suggested quotation for this text: Link-Gelles R, Levy ME, Gaglani M, et al. 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. MMWR Morb Mortal Wkly Rep 2022;71:931–939. DOI: http://dx.doi.org/10.15585/mmwr.mm7129e1


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