Effectiveness of mRNA Booster Vaccine Against Coronavirus Disease 2019 Infection and Severe Outcomes Among Persons With and Without Immune Dysfunction: A Retrospective Cohort Study of National Electronic Medical Record Data in the United States

Jing Sun, Qulu Zheng, Alfred J. Anzalone, Alison G. Abraham, Amy L. Olex, Yifan Zhang, Jomol Mathew, Nasia Safdar, Melissa A. Haendel, Dorry Segev, Jessica Y. Islam, Jasvinder A. Singh, Roslyn B. Mannon, Christopher G. Chute, Rena C. Patel, Gregory D. Kirk

Research output: Contribution to journalArticlepeer-review

Abstract

Background. Real-world evidence of coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) booster effectiveness among patients with immune dysfunction are limited. Methods. We included data from patients in the United States National COVID Cohort Collaborative (N3C) who completed ≥2 doses of mRNA vaccination between 10 December 2020 and 27 May 2022. Immune dysfunction conditions included human immunodeficiency virus infection, solid organ or bone marrow transplant, autoimmune diseases, and cancer. We defined incident COVID-19 BTI as positive results from laboratory tests or diagnostic codes 14 days after at least 2 doses of mRNA vaccination; and severe COVID-19 BTI as hospitalization, invasive cardiopulmonary support, and/or death. We used propensity scores to match boosted versus nonboosted patients and evaluated hazards of incident and severe COVID-19 BTI using Cox regression after matching. Results. Among patients without immune dysfunction, the relative effectiveness of booster (3 doses) after 6 months from the primary (2 doses) vaccination against BTI ranged from 69% to 81% during the Delta-predominant period and from 33% to 39% during the Omicron-predominant period. Relative effectiveness against BTI was lower among patients with immune dysfunction but remained statistically significant in both periods. Boosted patients had lower risk of COVID-19–related hospitalization (hazard ratios [HR] ranged from 0.5 [95% confidence interval {CI}, .48–.53] to 0.63 [95% CI, .56–.70]), invasive cardiopulmonary support, or death (HRs ranged from 0.46 [95% CI, .41–.52] to 0.63 [95% CI, .50–.79]) during both periods. Conclusions. Booster vaccines remain effective against severe COVID-19 BTI throughout the Delta- and Omicron-predominant periods, regardless of patients’ immune status.

Original languageEnglish (US)
Article numberofae019
JournalOpen Forum Infectious Diseases
Volume11
Issue number2
DOIs
StatePublished - Feb 1 2024

Keywords

  • COVID-19 vaccination
  • immune dysfunction
  • people with HIV
  • real-world evidence
  • solid organ transplant

ASJC Scopus subject areas

  • Oncology
  • Infectious Diseases

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