Estimates of Bivalent mRNA Vaccine Durability in Preventing COVID-19–Associated Hospitalization and Critical Illness Among Adults with and Without Immunocompromising Conditions — VISION Network, September 2022–April 2023
Ruth Link‐Gelles, Zachary A. Weber, Sarah E. Reese, Amanda B. Payne, Manjusha Gaglani, Katherine Adams, Anupam B. Kharbanda, Karthik Natarajan, Malini B. DeSilva, Kristin Dascomb, Stephanie A. Irving, Nicola P. Klein, Shaun J. Grannis, Toan C. Ong, Peter J. Embí, Margaret M. Dunne, Monica Dickerson, Charlene McEvoy, Julie Arndorfer, Allison L. Naleway, Kristin Goddard, Brian E. Dixon, Eric P. Griggs, John Hansen, Nimish R. Valvi, Morgan Najdowski, Julius Timbol, Colin Rogerson, Bruce Fireman, William F. Fadel, Palak Patel, Caitlin Ray, Ryan E. Wiegand, Sarah W. Ball, Mark W. Tenforde
Abstract
On September 1, 2022, CDC's Advisory Committee on Immunization Practices (ACIP) recommended a single bivalent mRNA COVID-19 booster dose for persons aged ≥12 years who had completed at least a monovalent primary series. Early vaccine effectiveness (VE) estimates among adults aged ≥18 years showed receipt of a bivalent booster dose provided additional protection against COVID-19-associated emergency department and urgent care visits and hospitalizations compared with that in persons who had received only monovalent vaccine doses (1); however, insufficient time had elapsed since bivalent vaccine authorization to assess the durability of this protection. The VISION Network* assessed VE against COVID-19-associated hospitalizations by time since bivalent vaccine receipt during September 13, 2022-April 21, 2023, among adults aged ≥18 years with and without immunocompromising conditions. During the first 7-59 days after vaccination, compared with no vaccination, VE for receipt of a bivalent vaccine dose among adults aged ≥18 years was 62% (95% CI = 57%-67%) among adults without immunocompromising conditions and 28% (95% CI = 10%-42%) among adults with immunocompromising conditions. Among adults without immunocompromising conditions, VE declined to 24% (95% CI = 12%-33%) among those aged ≥18 years by 120-179 days after vaccination. VE was generally lower for adults with immunocompromising conditions. A bivalent booster dose provided the highest protection, and protection was sustained through at least 179 days against critical outcomes, including intensive care unit (ICU) admission or in-hospital death. These data support updated recommendations allowing additional optional bivalent COVID-19 vaccine doses for certain high-risk populations. All eligible persons should stay up to date with recommended COVID-19 vaccines.