COVID-19 Vaccine Effectiveness by Product and Timing in New York State
Abstract
Background
US population-based data on COVID-19 vaccine effectiveness (VE) for the 3 currently FDA-authorized products is limited. Whether declines in VE are due to waning immunity, the Delta variant, or other causes, is debated.
Methods
We conducted a prospective study of 8,834,604 New York adults, comparing vaccine cohorts defined by product, age, and month of full-vaccination to age-specific unvaccinated cohorts, by linking statewide testing, hospital, and vaccine registry databases. VE was estimated from May 1, 2021 for incident laboratory-confirmed COVID-19 cases (weekly life-table hazard rates through September 3) and hospitalizations (monthly incidence rates through August 31).
Results
155,092 COVID-19 cases and 14,862 hospitalizations occurred. Estimated VE for cases declined contemporaneously across age, products, and time-cohorts, from high levels beginning May 1 (1.8% Delta variant prevalence), to a nadir around July 10 (85.3% Delta), with limited changes thereafter (>95% Delta). Decreases were greatest for Pfizer-BioNTech (−24.6%, −19.1%, −14.1% for 18-49, 50-64 years, and ≥65 years, respectively), and similar for Moderna (−18.0%, −11.6%, −9.0%, respectively) and Janssen (−19.2%, −10.8, −10.9%, respectively). VE for hospitalization for adults 18-64 years was >86% across cohorts, without time trend. Among persons ≥65 years, VE declined from May to August for Pfizer-BioNTech (95.0% to 89.2%) and Moderna (97.2% to 94.1%). VE was lower for Janssen, without trend, ranging 85.5%-82.8%.
Conclusions
Declines in VE for cases may have been primarily driven by factors other than waning. VE for hospitalizations remained high, with modest declines limited to Pfizer-BioNTech and Moderna recipients ≥65 years, supporting targeted booster dosing recommendations.
Article activity feed
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SciScore for 10.1101/2021.10.08.21264595: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations: Our estimates of VE may be influenced by unmeasured confounding due to behavioral, medical, or exposure differences between fully-vaccinated and unvaccinated adults.10,11 This potential bias comes in exchange for large sample sizes and outcome …
SciScore for 10.1101/2021.10.08.21264595: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations: Our estimates of VE may be influenced by unmeasured confounding due to behavioral, medical, or exposure differences between fully-vaccinated and unvaccinated adults.10,11 This potential bias comes in exchange for large sample sizes and outcome numbers that exceed those of other nations’ studies and of smaller, more controlled designs.6,7,13,14 Our findings are further strengthened by broad age representation across time-cohorts and the consistency of changes in calendar time. This study did not account for indirect effects (e.g. herd-immunity-type) between groups. The survival analytic approach for cases required persons to have no diagnosis 90 days before May 1, consistent with case-definitions. In this interval between Winter and Summer 2021 COVID-19 waves, under 1% of persons fully-vaccinated through April 30 received a diagnosis before or after vaccination and were excluded initially and throughout the analysis, due to the closed-cohort design. The weekly-calculated conditional hazard function was thus negligibly affected by such persons. Persons who received non-FDA authorized vaccines were excluded from the full vaccination definition and were analytically classified unvaccinated, but comprise an estimated 0.03% of persons fully vaccinated in the registries by May 2021. Finally, it is unclear the extent to which earlier SARS-CoV-2 infection modifies vaccine effectiveness; future research may explore effect modification by prior diagnostic history.30 Conclus...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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