mRNA Vaccine Effectiveness Against Coronavirus Disease 2019 Hospitalization Among Solid Organ Transplant Recipients
Jennie H. Kwon, Mark W. Tenforde, Manjusha Gaglani, H. Keipp Talbot, Adit A. Ginde, Tresa McNeal, Shekhar Ghamande, David J. Douin, Jonathan D. Casey, Nicholas M. Mohr, Anne Zepeski, Nathan I. Shapiro, Kevin W. Gibbs, D. Clark Files, David N. Hager, Arber Shehu, Matthew E. Prekker, Sean Caspers, Matthew C. Exline, Mena Botros, Michelle N. Gong, Alex Li, Amira Mohamed, Nicholas J. Johnson, Vasisht Srinivasan, Jay S. Steingrub, Ithan D. Peltan, Samuel M. Brown, Emily T. Martin, Akram Khan, Catherine L. Hough, Laurence W. Busse, Abhijit Duggal, Jennifer G. Wilson, Cynthia Pérez, Steven Y. Chang, Christopher Mallow, R. Rovinski, Hilary M. Babcock, Adam S. Lauring, Laura E Felley, Natasha Halasa, James D. Chappell, Carlos G. Grijalva, Todd W. Rice, Kelsey N. Womack, Christopher J. Lindsell, Kimberly W. Hart, Adrienne Baughman, Samantha M. Olson, Stephanie J. Schrag, Miwako Kobayashi, Jennifer R. Verani, Manish M. Patel, Wesley H. Self
Abstract
BACKGROUND: The study objective was to evaluate 2- and 3-dose coronavirus disease 2019 (COVID-19) mRNA vaccine effectiveness (VE) in preventing COVID-19 hospitalization among adult solid organ transplant (SOT) recipients. METHODS: We conducted a 21-site case-control analysis of 10 425 adults hospitalized in March to December 2021. Cases were hospitalized with COVID-19; controls were hospitalized for an alternative diagnosis (severe acute respiratory syndrome coronavirus 2-negative). Participants were classified as follows: SOT recipient (n = 440), other immunocompromising condition (n = 1684), or immunocompetent (n = 8301). The VE against COVID-19-associated hospitalization was calculated as 1-adjusted odds ratio of prior vaccination among cases compared with controls. RESULTS: Among SOT recipients, VE was 29% (95% confidence interval [CI], -19% to 58%) for 2 doses and 77% (95% CI, 48% to 90%) for 3 doses. Among patients with other immunocompromising conditions, VE was 72% (95% CI, 64% to 79%) for 2 doses and 92% (95% CI, 85% to 95%) for 3 doses. Among immunocompetent patients, VE was 88% (95% CI, 87% to 90%) for 2 doses and 96% (95% CI, 83% to 99%) for 3 doses. CONCLUSIONS: Effectiveness of COVID-19 mRNA vaccines was lower for SOT recipients than immunocompetent adults and those with other immunocompromising conditions. Among SOT recipients, vaccination with 3 doses of an mRNA vaccine led to substantially greater protection than 2 doses.