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Thursday, January 20, 2022

Effectiveness of COVID-19 Vaccines over a 9 Month Period in North Carolina NEJM

study population

Demographic characteristics of the North Carolina population according to vaccine uptake and clinical outcomes from December 11, 2020 to September 8, 2021.

Summarizes the demographic characteristics of the North Carolina population, along with vaccine intake and clinical outcomes in the state from December 11, 2020 to September 8, 2021 Table 1, North Carolina has a diverse population that mirrors the age and sex distribution of the United States, although the percentage of black individuals is higher and the percentage of individuals who identify as Hispanic and Asian or Pacific Islander is lower than the national average.

Vaccination rates were highest among older adults, female individuals, white individuals, and individuals who identified as Asian or Pacific Islander. BNT162b2 was the most commonly administered vaccine, followed by mRNA-1273. For both vaccines, injection of the first dose began in mid-December 2020, and approximately 89% of recipients received two doses. The median time between the first and second doses was 21 days for BNT162b2 and 28 days for mRNA-1273, with 95% and 96% of recipients, respectively, receiving the second dose within a week before or after the recommended date. Ad26.COV2.S was administered to only a small percentage of the population, and was not administered until early March of 2021.

From December 11, 2020 to September 8, 2021, a total of 812,494 cases of Covid-19 were confirmed, of which 20,232 were known to be hospitalized and 7461 were known to cause death. However, hospitalization was known to account for only about 40% of Covid-19 cases and survival for 60%. Thus, the actual number of hospitalizations and deaths was significantly higher.

Vaccine effectiveness against covid-19

Effectiveness of COVID-19 Vaccines over a 9 Month Period in North Carolina NEJMThe effectiveness of the BNT162b2, mRNA-1273, and Ad26.COV2.S vaccines against COVID-19, hospitalization, and death.

Estimates of vaccine effectiveness in reducing current risks of COVID-19 (Panel A), hospitalization due to severe COVID-19 (Panel B), and death due to COVID-19 (Panel C) with two-dose Diet has been shown. One-dose doses of BNT162b2 and mRNA-1273 and Ad26.COV2.S. Shaded bands indicate 95% confidence intervals.

Effectiveness of COVID-19 Vaccines over a 9 Month Period in North Carolina NEJMEffectiveness of BNT162b2, mRNA-1273, and Ad26.COV2.S vaccines against covid-19, hospitalization, and death, as a function of time elapsed since first dose.

Estimates of vaccine effectiveness in reducing current risk of COVID-19 show Figure 1a And Table 2, For the BNT162b2 two-dose regimen, vaccine effectiveness reached a peak level of 94.5% (95% confidence interval) [CI], 94.1 to 94.9) 2 months after the first dose. Effectiveness began to decline after 2 months and decreased to 66.6% (95% CI, 65.2 to 67.8) at 7 months.

For the mRNA-1273 two-dose regimen, vaccine effectiveness reached a peak level of 95.9% (95% CI, 95.5 to 96.2) at 2 months. Effectiveness began to decline after 2 months and remained at 80.3% (95% CI, 79.3 to 81.2) at 7 months. The difference in effectiveness between the mRNA-1273 and BNT162b2 vaccines at 4, 5, 6, 7, and 8 months was 7.4 percentage points (95% CI, 6.6 to 8.2), 7.2 percentage points (95% CI, 6.4 to 8.0). , 7.5 percentage points (95% CI, 6.4 to 8.6), 13.7 percentage points (95% CI, 12.1 to 15.3), and 10.0 percentage points (95% CI, 7.3 to 12.7), respectively.

For a single-dose dose of Ad26.COV2.S, vaccine effectiveness reached a peak level of 74.8% (95% CI, 72.5 to 76.9) at 1 month. Effectiveness began to decline after 1 month and decreased to 59.4% (95% CI, 57.2 to 61.5) at 5 months. Since Ad26.COV2.S was not implemented until March 2021, information on its effectiveness after 5 months is limited.

We performed sensitivity analysis by placing change points every 2 weeks instead of every month. The results are shown in Figure S1 in the Supplementary Appendix. The patterns were similar to those observed in the main analysis (Figure 1a) curve was slightly less smooth, with a peak for BNT162b2 at 1.5 months after the first dose, and the confidence interval was slightly wider.

Effectiveness of COVID-19 Vaccines over a 9 Month Period in North Carolina NEJMEffectiveness of BNT162b2, mRNA-1273, and Ad26.COV2.S vaccines against Covid-19 by age group.

Estimates of the vaccine’s effectiveness in reducing the current risk of COVID-19 with two-dose doses of BNT162B2 (panel A) and mRNA-1273 (panel B) and a single-dose dose of Ad26.COV2.S (panel C) shown for. ) shaded bands indicate 95% confidence intervals.

Estimates of vaccine effectiveness for different age groups have been shown in Figure 2 and Table S1. For all three vaccines, ramp-up and waning patterns were similar in all age groups, but effectiveness in adults 65 years of age or older was lower than in younger age groups. For all three vaccines, ramp-up and waning trends were similar in subgroups defined according to other demographic variables (gender, race or ethnic group, geographic region, and county-level vaccination rates), with noticeable differences in decreasing levels . in some subgroups (Fig. S2 to S5).

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Effectiveness of COVID-19 Vaccines over a 9 Month Period in North Carolina NEJMEfficacy of BNT162b2, mRNA-1273, and Ad26.COV2.S vaccines against Covid-19 according to date of first dose.

Estimates of the vaccine’s effectiveness in reducing the current risk of COVID-19 with two-dose doses of BNT162B2 (panel A) and mRNA-1273 (panel B) and a single-dose dose of Ad26.COV2.S (panel C) shown for. ), with the spread of type B.1.617.2 (delta) in all cases of Covid-19 (grey shaded area). Shaded bands indicate 95% confidence intervals.

Estimates of vaccine effectiveness by date of first dose shown in Figure 3, For each vaccine, the curves of vaccine effectiveness as a function of time since vaccination were similar between individuals who were vaccinated on different dates. This finding suggests that the decrease in vaccine effectiveness was primarily due to a decline in immunity over time. In early recipients of BNT162b2 and mRNA-1273 (those who received the first dose before March 2021), there was a reduction in effectiveness by about 15 and 10 percentage points from mid-June to mid-July, when the delta variant was on the rise. (Figure 3 and S6). This finding suggests that the emergence of the delta variant further reduced vaccine effectiveness in people with vaccine-induced immune decline.

Vaccine effectiveness against hospitalization and death

Many individuals with COVID-19 were not contacted for information on clinical outcomes. Therefore, a high percentage of data regarding hospitalization and death was missing. The percentage of individuals arriving for interviews varied over time and was generally low during the peak of COVID-19 activity. In addition, there were often significant delays in the reporting of data regarding hospitalization and death. Thus, the percentage of missing data was higher in winter and highest during the last 2 months of the study period (Fig. However, the percentage of missing records of hospitalization and death among vaccinated individuals was similar to that of unvaccinated individuals (Fig.

We made multiple imputations of missing data by randomly treating individuals with unknown hospitalization or survival status according to the observed rate of hospitalization or death, which depends on both the date of infection and the time since vaccination. Was.17 Estimates of the vaccine’s effectiveness in reducing the current risk of hospitalization due to severe COVID-19 are shown in Figure 1B And Table 2, For the BNT162b2 two-dose regimen, vaccine effectiveness peaked at 96.4% (95% CI, 95.1 to 97.4) at 2 months and remained at 88.7% (95% CI, 86.9 to 90.3) at 7 months. For the mRNA-1273 two-dose regimen, vaccine effectiveness peaked at 97.2% (95% CI, 96.1 to 98.0) at 2 months and remained at 94.1% (95% CI, 92.7 to 95.2) at 7 months doing. For a single-dose dose of Ad26.COV2.S, vaccine effectiveness reached a peak level of 85.8% (95% CI, 74.9 to 91.9) at 2 months and was greater than 80% during 6 months.

For all three vaccines, ramp-up and decreasing trends were similar across demographic subgroups (Fig. S8 to S12), and effectiveness in adults 65 years of age or older was lower than in younger age groups (Fig. S8 and Table S2) Was. ) a decrease in effectiveness from June to July was noted in early recipients of BNT162b2 and mRNA-1273 (Fig. S13).

Estimates of vaccine effectiveness in reducing current risk of death due to COVID-19 are shown in Figure 1c And Table 2, For the BNT162b2 two-dose regimen, vaccine effectiveness reached 98.0% (95% CI, 95.5 to 99.1) at 2 months and remained at 90.5% (95% CI, 87.0 to 93.1) at 7 months. For the mRNA-1273 two-dose regimen, vaccine effectiveness reached 98.6% (95% CI, 97.3 to 99.3) at 2 months and remained at 95.5% (95% CI, 93.4 to 96.9) at 7 months. For Ad26.COV2.S one-dose, vaccine effectiveness reached 85.9% (95% CI, 49.3 to 96.1) at 3 months and was mostly over 70% through 6 months, with wide confidence intervals. For all three vaccines, effectiveness was lower in adults 65 years of age or older than in adults aged 18 to 64 years (Fig. S14 and Table S3).

We performed sensitivity analysis by finding a 20% increase in the incidence rate among vaccinated individuals. The resulting estimates of vaccine effectiveness were slightly lower than the original estimates (Figure S15A). We performed a further sensitivity analysis by increasing the incidence rate by 50% among vaccinated individuals, and the resulting effectiveness estimates remained high (Fig. S15B).

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