By Seema Gupta, MD, MSPH
Clinical Assistant Professor, Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV
SYNOPSIS: Using data for more than 1.2 million Americans who completed primary vaccination against COVID-19, severe disease outcomes were rare; however, vaccinated persons aged ≥ 65 years with immunosuppression or other underlying conditions were found to be at higher risk.
SOURCE: Yek C, Warner S, Wiltz JL, et al. Risk factors for severe COVID-19 outcomes among persons aged ≥18 years who completed a primary COVID-19 vaccination series - 465 health care facilities, United States, December 2020-October 2021. MMWR Morb Mortal Wkly Rep 2022;71:19-25.
Data from the CDC show that three out of four Americans in the United States have received at least one dose of a COVID-19 vaccine.1 However, when considering two doses, that number drops to 63% and further falls to 40% when a booster is included.
While vaccination coverage has expanded recently, it remains uneven across the country. The available vaccines against the SARS-CoV-2 virus all are highly effective and substantially reduce the risk of contracting COVID-19, especially severe disease (including death).2,3 Previous studies have demonstrated vaccine effectiveness extends to populations disproportionately affected by SARS-CoV-2 infection and includes those requiring hospitalization, ICU admission, or an ED or urgent care clinic visit.2
Yek et al analyzed data from 465 U.S. facilities to learn more about individuals who completed primary vaccination between December 2020 and October 2021. They assessed the frequency of and risk factors for developing a severe COVID-19 outcome after completing their primary vaccine course (i.e., two doses of either the Pfizer-BioNTech or Moderna vaccine or a single dose of the Johnson & Johnson vaccine ≥ 14 days before illness onset). Severe outcomes for COVID-19 were defined as hospitalization with a diagnosis of acute respiratory failure, need for noninvasive ventilation, admission to an ICU, or death.
Researchers found that among the more than 1.2 million people who completed their primary vaccine course, 2,246 (18 per 10,000 vaccinated people) developed COVID-19 and 189 (1.5 per 10,000) experienced a severe outcome, including 36 who died (0.3 deaths per 10,000). Investigators also found the risk for severe outcomes was higher among patients age 65 years and older, those who were immunosuppressed, or those with at least one of six underlying conditions (cardiac disease, chronic kidney disease, diabetes, liver disease, pulmonary disease, or neurologic disease). In fact, 28 out of 36 people who died had four or more risk factors.
The authors concluded vaccinated people who are older, immunosuppressed, or living with underlying conditions should receive targeted interventions that include managing their chronic medical conditions as well as precautions to reduce exposure. They also recommended considering additional primary and booster vaccine doses as well as effective pharmacological therapy to mitigate risk for severe outcomes.
COMMENTARY
This study provides critical insight into the risk factors associated with severe outcomes among patients who acquire COVID-19 following primary vaccination. It also offers evidence indicating severe COVID-19 outcomes after primary vaccination are rare. Expanding vaccination coverage in this group should be a critical public health priority.
With the continued emergence and spread of variants, unvaccinated patients remain at higher risk for infection, hospitalization, and death. While this study was conducted before the delta variant emerged and then during the delta variant predominance, the findings might not be directly applicable to the omicron variant. Still, this work shows high-risk populations derive the most benefit from a vaccination series against SARS-CoV-2-related severe disease.
The study also demonstrates that a tiny proportion of patients who completed primary vaccination series developed COVID-19. Those who experienced a severe outcome were in an even smaller subgroup. What is even more critical is those with severe disease were age 65 years and older, immunosuppressed, or were living with at least one of six underlying conditions. The few who died were living with several of the six underlying conditions.
Yek et al have provided invaluable data on how better managing chronic medical conditions and encouraging vaccination against SARS-CoV-2 infection can lead to prevention of severe disease and deaths. At a time when this public health crisis has been mired in political debates, taking an evidence-based approach to ensure patients are optimally managing their chronic medical conditions, are fully vaccinated, and are taking reasonable precautions to minimize their exposure may make the difference between life and death.
REFERENCES
- Centers for Disease Control and Prevention. COVID data tracker. COVID-19 vaccinations in the United States. Updated Jan. 24, 2022.
- Thompson MG, Stenehjem E, Grannis S, et al. Effectiveness of COVID-19 vaccines in ambulatory and inpatient care settings. N Engl J Med 2021;385:1355-1371.
- Haas EJ, Angulo FJ, McLaughlin JM, et al. Impact and effectiveness of mRNA BNT162b2 vaccine against SARS-CoV-2 infections and COVID-19 cases, hospitalisations, and deaths following a nationwide vaccination campaign in Israel: An observational study using national surveillance data. Lancet 2021;397:1819-1829.
Using data for more than 1.2 million Americans who completed primary vaccination against COVID-19, severe disease outcomes were rare; however, vaccinated persons aged ≥ 65 years with immunosuppression or other underlying conditions were found to be at higher risk.
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