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The average age of decedents was 83.3 years. These trends could result in epidemic phase bias if infection severity is correlated with time from infection to test. This case-positive, control-test-negative design also referred to as the test-negative design (TND) has often been used in studies of vaccine effectiveness. These findings are consistent with estimates of booster effectiveness against symptomatic Omicron infection using healthcare ascertainment. Among fully vaccinated people without a booster, rates were lower at 3,355.5 per 100,000 for COVID-19 cases and 35.4 per 100,000 for hospitalizations. Weekly COVID-19-associated hospitalization rates among U.S. infants and children aged 0-4 years have declined since the peak of January 8, 2022; however, peak rates during Omicron predominance were approximately five times those of the peak during Delta predominance. Starting the week ending December 4, 2021, Maryland data are not included in weekly rate calculations but are included in previous weeks. Objectives To develop and implement a scoring tool to identify COVID-19 patients that are at risk for severe illness during the Omicron wave. Durability of anti-spike antibodies in infants after maternal COVID-19 vaccination or natural infection. Open 5, e2232760 (2022). Background: Risk stratification models have been developed to identify patients that are at a higher risk of COVID-19 infection and severe illness. Among the infants in the cohort, 19,418 (64.06%) of the mothers were unvaccinated during pregnancy, 1138 (3.75%) of the mothers received one dose of an mRNA COVID-19 vaccine and 9755 (32.18%) received 2 doses during pregnancy (Table1). Like influenza and Tdap vaccines15,16, data suggest that vaccination during pregnancy may protect infants who are not old enough to be vaccinated against COVID-19. Hospitalization rates and characteristics of children aged <18 years hospitalized with laboratory-confirmed COVID-19COVID-NET, 14 States, March 1-July 25, 2020. Pregnant women were excluded because their reasons for hospital admission (4) might differ from those for nonpregnant persons. Other studies found similarly decreased proportions of severe outcomes among hospitalized patients with COVID-19 during this period (6).. We ran separate models on the time periods associated with the Delta (7/01/2021 to 12/20/2021) and Omicron variants (12/21/2021 to 5/31/2022). part 46, 21 C.F.R. Structural changes in the brain may explain the persistent fatigue and neuropsychiatric complications tied to long COVID. The results were unchanged when no adjustments for covariates were made (Supplemental Table3). No other potential conflicts of interest were disclosed. Vaccine 35, 72977301 (2017). Buchan, S. A. et al. Adults who received booster doses were classified as those who completed the primary series and received an additional or booster dose on or after August 13, 2021, at any time after completion of the primary series, and 14 days before a positive test result for SARS-CoV-2, as COVID-19associated hospitalizations are a lagging indicator and time passed after receipt of a booster dose has been shown to be associated with reduced rates of COVID-19 infection (https://www.nejm.org/doi/full/10.1056/NEJMoa2114255). Access your favorite topics in a personalized feed while you're on the go. Blakeway, H. et al. E.L. coordinated administrative tasks. Thank you for visiting nature.com. Methods: One hundred and . BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting. 45 C.F.R. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. In-hospital death status was missing in 1.4% (weighted) of hospitalizations; these hospitalizations are otherwise included elsewhere in the analysis. This can lead to overestimates of first doses and underestimates of subsequent doses, and underestimates of hospitalization rates in persons who received additional or booster doses. Delta period: July 1, 2021December 18, 2021, reflects the time when Delta was the predominant circulating variant; Omicron period: December 19, 2021January 31, 2022, reflects the time when Omicron was the predominant circulating variant. Morb. SARS-CoV-2 infections can result in COVID-19associated hospitalizations, even among vaccinated persons. It showed that boosters further reduced the risk of hospitalization. Vaccinated patients during the Delta wave were 37% (over with two doses), while during the Omicron wave they were 57%. JAMA 326, 16291631 (2021). All adjustment variables were selected a priori based on prior work36. The remaining authors declare no competing interests. TN and NMF validated the data. GD declares that his employer UK Health Security Agency (previously operating as Public Health England) received funding from GlaxoSmithKline for a research project related to influenza antiviral treatment. N. Engl. They, as well as vaccinated people who are immunocompromised and at higher risk of severe COVID-19, are still vulnerable to being infected by a vaccinated person. Morb. the date of publication. 40, e137e145 (2021). Article Our additional supplemental analysis suggests that pregnant persons who received at least one vaccine dose before pregnancy should complete their vaccination series during pregnancy to provide protection to their children during the first 6 months of life. Risk of hospital admission for patients with SARS-CoV-2 variant B.1.1.7: cohort analysis. Wkly. During the period of Omicron predominance, hospitalization rates increased most sharply among Black adults in the United States relative to all other racial and ethnic groups examined and reached the highest rate observed among all racial and ethnic groups since the beginning of the pandemic. Adults whose vaccination status had not yet been verified using the immunization information system data were considered to have unknown vaccination status and were included in total proportions but not stratified by vaccination status. Additional COVID-NET methods for determining vaccination status have been described previously. Maternal SARS-CoV-2 vaccination and infant protection against SARS-CoV-2 during the first six months of life. Gordon, N. & Lin, T. The Kaiser Permanente Northern California adult member health survey. Infections are rare and can be severe or fatal, but so far scientists don't see genetic changes that pose an increased threat to people. 385, 13551371 (2021). In our primary analysis, we implemented a cohort study design where we used Cox proportional hazards models that allow for time-varying covariates to estimate the SARS-CoV-2 infection hazard ratio (HR) in infants of mothers vaccinated with at least 2 doses of mRNA COVID-19 vaccines during pregnancy and 1 dose only versus mothers who were unvaccinated during pregnancy. JAMA Netw. A study from the U.K. government, published last week, found that three doses of vaccine. "The high hospitalization rates in unvaccinated compared with vaccinated persons with and without a booster dose underscores the importance of COVID-19 vaccinations in preventing hospitalizations and suggests that increasing vaccination coverage, including booster dose coverage, can prevent hospitalizations, serious illness, and death," the researchers wrote. A free-text field for other types of residences was examined; patients with an LTCF-type residence were also categorized as LTCF residents. Hospitalisation associated with SARS-CoV-2 delta variant in Denmark. Clinical information was abstracted for 5,681 adults with COVID-19associated hospitalization during July 1, 2021January 31, 2022 (Table). Data from the COVID-19Associated Hospitalization Surveillance Network (COVID-NET) were analyzed to compare COVID-19associated hospitalization rates among adults aged 18 years during B.1.617.2 (Delta; July 1December 18, 2021) and Omicron (December 19, 2021January 31, 2022) variant predominance, overall and by race/ethnicity and vaccination status. Rep. 70, 895899 (2021). Still, even with a smaller percentage of people getting severely ill during the Omicron wave, a large number of cases over a short time can lead to a spike in people being hospitalized or admitted . adjudicated chart reviews. The study setting was Kaiser Permanente Northern California (KPNC), an integrated healthcare delivery organization that provides comprehensive healthcare to ~4.4 million members as of 2019. Hospitalization rates among non-Hispanic Black adults increased more than rates in other racial/ethnic groups. CAS The findings in this report are subject to at least four limitations. Article Vaccine effectiveness for 1 dose during the first 6 months of life was 68% (95% CI: 12, 88) (Table2). and statistical significance was assessed at two-sided p0.05. Author's reply, Efficacy, safety, and immunogenicity of the DNA SARS-CoV-2 vaccine (ZyCoV-D): the interim efficacy results of a phase 3, randomised, double-blind, placebo-controlled study in India, Centers for Disease Control and Prevention, MRC Biostatistics Unit COVID-19 Working Group, Cases, hospital admissions, and hospital attendances in those with delta and omicron SARS-CoV-2 variants, between Nov 29, 2021, and Jan 9, 2022, Risk of hospitalisation and mortality for COVID-19 cases with omicron compared with delta, overall and by age group, Estimated HRs for vaccination categories, secondary analysis. Selected counties in California, Colorado, Connecticut, Georgia, Iowa, Maryland, Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah (https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm). Data among adults over 50 showed that a booster shot gave even stronger protection. Abbreviation: COVID-NET = COVID-19Associated Hospitalization Surveillance Network. Among nonpregnant and pregnant adults aged 18 years, hospitalization rates were calculated overall, and by race/ethnicity and COVID-19 vaccination status. Using Cox regression, the effectiveness of 2 doses of COVID-19 vaccine received during pregnancy was 84% (95% confidence interval [CI]: 66, 93), 62% (CI: 39, 77) and 56% (CI: 34,71) during months 02, 04 and 0- 6 of a childs life, respectively, in the Delta variant period. The cumulative monthly age-adjusted hospitalization rate during January 2022 among unvaccinated adults (528.2) was 12 times the rates among those who had received a booster or additional dose (45.0) and four times the rates among adults who received a primary series, but no booster or additional dose (133.5). "The subpopulations with the highest risk should be considered a priority for COVID-19 therapeutics and further booster doses.". Frequency, characteristics and complications of COVID-19 in hospitalized infants. Iowa does not provide data on vaccination status. Shook, L. L. et al. Vaccination status is based on state immunization information system data. Am. But the average . Effectiveness of Two Doses of BNT162b2 Vaccine before and during Proxy Omicron Period. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. We further classified vaccination status by the trimester within which the second dose or the unique dose (for those who received only one dose) was received. Hospitalization rates during peak Omicron circulation (January 2022) among unvaccinated adults remained 12 times the rates among vaccinated adults who received booster or additional doses and four times the rates among adults who received a primary series, but no booster or additional dose. Includes current treatment or recent diagnosis of an immunosuppressive condition or use of an immunosuppressive therapy during the preceding 12 months. Internet Explorer). part 56; 42 U.S.C. All rights Reserved. It is critical that nursing home residents stay up to date with CO VID-19 vaccines and receive a bivalent booster dose to maximize protection against COVID-19. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. https://www.cdc.gov/nchs/nvss/bridged_race.htm, ** https://www.medrxiv.org/content/10.1101/2021.08.27.21262356v1, On August 13, 2021, CDCs Advisory Committee on Immunization Practices (ACIP) issued the first of several recommendations for additional or booster doses of COVID-19 vaccine. During Omicron predominance, shortly after the Food and Drug Administration authorized COVID-19 vaccination for this age group, population-based hospitalization rates among unvaccinated children were twice as high as were those among vaccinated children. Jackson, M. L. & Nelson, J. C. The test-negative design for estimating influenza vaccine effectiveness. To obtain The population of unvaccinated adults is determined by subtracting the number of adults who received any dose of vaccine, as previously defined, from the population. SARS-CoV-2 delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness. Chi-square tests were used to compare differences between the Delta- and Omicron-predominant periods; p-values <0.05 were considered statistically significant. PubMed Central And in a second large study during the Omicron period, older people, men, and residents of nursing homes or in low-income areas were most at risk for post-booster COVID-19 death in England, but the risk was very low. Individual and neighborhood factors associated with failure to vaccinate against influenza during pregnancy. However, vaccination during pregnancy was less effective at protecting infants against SARS-CoV-2 infection during the Omicron period. Graff, K. et al. For children whose mothers received one dose before pregnancy and two doses during pregnancy, VE against infection was 89% during the first 2 months of life, 73% during the first 4 months of life, and 48% up to 6 months of life. Morb. In supplemental analyses by trimester of vaccination, receipt of the second dose during the second and third trimesters reduced the risk of infants testing SARS-CoV-2 positive during the Delta dominant period by 91% (95% CI: 63, 98) and 85% (95% CI: 50, 96), respectively, during the first 2 months of life, by 59% (95% CI: 21, 79) and 67% (95% CI: 37, 83) during the first 4 months of life and by 64% (95% CI:31, 81) and 53% (95% CI: 24, 71) during the first 6 months of life. When possible, CDC associates a persons primary vaccination series and booster dose with that person. PubMedGoogle Scholar. The study did not adjust for maternal SARS-CoV-2 infections during pregnancy due to the inability of capturing home testing results. During the Omicron-predominant period, peak hospitalization rates among non-Hispanic Black (Black) adults were nearly four times the rate of non-Hispanic White (White) adults and was the highest rate observed among any racial and ethnic group during the pandemic. In this primary design, all eligible infants meeting inclusion criteria were included without sampling which improved power and minimized bias related to selection. In this large study which included >30,000 infants, we found that receipt of at least two doses of mRNA COVID-19 vaccine during pregnancy was associated with a decreased risk of infants testing SARS-CoV-2 positive during their first 6 months of life. 61) indicates a lower risk of hospitalisation with omicron versus delta, averaging over all age groups and vaccination strata. Sect. Maternal vaccination was protective, but protection was lower during the Omicron period than during Delta. URL addresses listed in MMWR were current as of Mortal. Sign up for notifications from Insider! You are using a browser version with limited support for CSS. The difference between the two studies might be due to population characteristics and the timing of follow-up as ours went through May 31, 2022, while the Norwegian study ended in April 2022. PubMed Dis. 139, e20164091 (2017). However, infants aged <6 months are not currently eligible for any currently available COVID-19 vaccines and must rely on placentally acquired immunity from their mothers. Models in this analysis were adjusted for the same covariates included in the primary analysis. Klein, N. P. et al. https://doi.org . As infants aged, protection provided by maternal vaccination decreased during both periods. If material is not included in the articles Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. We excluded these infants because we were primarily interested in estimating the effectiveness of mRNA vaccines received during pregnancy; (7) mothers who received adenovirus vector vaccines or any non-mRNA platform vaccines during pregnancy; (8) mothers who did not receive their mRNA vaccinations in accordance with CDC recommendationse.g., the timing between dose 1 and dose 2 was not within the recommended intervals; and (9) infants who did not become KPNC members within two calendar months of their birth. 386, 15321546 (2022). Pre-Omicron versions of Covid, in. 387, 227236 (2022). ICU admission status was missing in 1.3% (weighted) of hospitalizations; these hospitalizations are included in other analyses. N. Engl. N. Engl. A recent study found that the mean titer of maternally derived antibodies in infants of vaccinated mothers were higher at age 2 months compared with antibody titers at age 6 months23. Data about boosters was only available for those over 50. Stay up to date with your COVID-19 vaccines. Persons who received only 1 vaccine dose of a 2-dose series 14 days before the SARS-CoV-2 test date or had received a single dose of either a 1- or 2-dose vaccination series <14 days before the positive SARS-CoV-2 test result were considered partially vaccinated and were not included in rates by vaccination status. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. https://doi.org/10.1016/j.jpeds.2022.09.059 (2022). . Cohen-Stavi, C. J. et al. Dagan, N. et al. N. Engl. ; COVID-NET Surveillance Team. By clicking Sign up, you agree to receive marketing emails from Insider During the Omicron dominant period, maternal vaccination with at least two doses reduced the infants risk of testing SARS-CoV-2 positive by 43% (95% CI: 4, 69) during the first 2 months of life, 36% (95% CI:11, 55) during the first 4 months of life, and 41% (95% CI: 25, 53) during the first 6 months of life (Supplemental Table2). Three recent epidemiological studies found that vaccination during pregnancy was associated with a reduced risk of SARS-CoV-2 infection in infants during their first 4 months of life and a reduced risk of hospitalization during the first 5 months of life17,18,19.