The Lancet Regional Health. Americas (Jul 2023)
Number needed to vaccinate with a COVID-19 booster to prevent a COVID-19-associated hospitalization during SARS-CoV-2 Omicron BA.1 variant predominance, December 2021–February 2022, VISION Network: a retrospective cohort studyResearch in context
- Katherine Adams,
- John J. Riddles,
- Elizabeth A.K. Rowley,
- Shaun J. Grannis,
- Manjusha Gaglani,
- Bruce Fireman,
- Emily Hartmann,
- Allison L. Naleway,
- Edward Stenehjem,
- Alexandria Hughes,
- Alexandra F. Dalton,
- Karthik Natarajan,
- Kristin Dascomb,
- Chandni Raiyani,
- Stephanie A. Irving,
- Chantel Sloan-Aagard,
- Anupam B. Kharbanda,
- Malini B. DeSilva,
- Brian E. Dixon,
- Toan C. Ong,
- Jean Keller,
- Monica Dickerson,
- Nancy Grisel,
- Kempapura Murthy,
- Juan Nanez,
- William F. Fadel,
- Sarah W. Ball,
- Palak Patel,
- Julie Arndorfer,
- Mufaddal Mamawala,
- Nimish R. Valvi,
- Margaret M. Dunne,
- Eric P. Griggs,
- Peter J. Embi,
- Mark G. Thompson,
- Ruth Link-Gelles,
- Mark W. Tenforde
Affiliations
- Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Corresponding author. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-7, Atlanta, GA 30333, USA.
- John J. Riddles
- Westat, Rockville, MD, USA
- Elizabeth A.K. Rowley
- Westat, Rockville, MD, USA
- Shaun J. Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; School of Medicine, Indiana University, Indianapolis, IN, USA
- Manjusha Gaglani
- Baylor Scott & White Health, Temple, TX, USA; Texas A&M University College of Medicine, Temple, TX, USA
- Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
- Emily Hartmann
- Paso del Norte Health Information Exchange (PHIX), El Paso, TX, USA
- Allison L. Naleway
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
- Alexandria Hughes
- Westat, Rockville, MD, USA
- Alexandra F. Dalton
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA
- Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
- Chandni Raiyani
- Baylor Scott & White Health, Temple, TX, USA
- Stephanie A. Irving
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- Chantel Sloan-Aagard
- Paso del Norte Health Information Exchange (PHIX), El Paso, TX, USA; Brigham Young University Department of Public Health, Provo, UT, USA
- Anupam B. Kharbanda
- Children's Minnesota, Minneapolis, MN, USA
- Malini B. DeSilva
- HealthPartners Institute, Minneapolis, MN, USA
- Brian E. Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
- Toan C. Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Jean Keller
- Westat, Rockville, MD, USA
- Monica Dickerson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
- Kempapura Murthy
- Baylor Scott & White Health, Temple, TX, USA
- Juan Nanez
- Paso del Norte Health Information Exchange (PHIX), El Paso, TX, USA
- William F. Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
- Sarah W. Ball
- Westat, Rockville, MD, USA
- Palak Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
- Mufaddal Mamawala
- Baylor Scott & White Health, Temple, TX, USA
- Nimish R. Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
- Margaret M. Dunne
- Westat, Rockville, MD, USA
- Eric P. Griggs
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Westat, Rockville, MD, USA; Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; School of Medicine, Indiana University, Indianapolis, IN, USA; Baylor Scott & White Health, Temple, TX, USA; Texas A&M University College of Medicine, Temple, TX, USA; Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA; Paso del Norte Health Information Exchange (PHIX), El Paso, TX, USA; Kaiser Permanente Center for Health Research, Portland, OR, USA; Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA; Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA; Brigham Young University Department of Public Health, Provo, UT, USA; Children's Minnesota, Minneapolis, MN, USA; HealthPartners Institute, Minneapolis, MN, USA; Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA; School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Vanderbilt University Medical Center, Nashville, TN, USA
- Peter J. Embi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Vanderbilt University Medical Center, Nashville, TN, USA
- Mark G. Thompson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Ruth Link-Gelles
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Westat, Rockville, MD, USA; Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; School of Medicine, Indiana University, Indianapolis, IN, USA; Baylor Scott & White Health, Temple, TX, USA; Texas A&M University College of Medicine, Temple, TX, USA; Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA; Paso del Norte Health Information Exchange (PHIX), El Paso, TX, USA; Kaiser Permanente Center for Health Research, Portland, OR, USA; Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA; Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA; Brigham Young University Department of Public Health, Provo, UT, USA; Children's Minnesota, Minneapolis, MN, USA; HealthPartners Institute, Minneapolis, MN, USA; Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA; School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Vanderbilt University Medical Center, Nashville, TN, USA
- Mark W. Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Journal volume & issue
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Vol. 23
p. 100530
Abstract
Summary: Background: Understanding the usefulness of additional COVID-19 vaccine doses—particularly given varying disease incidence—is needed to support public health policy. We characterize the benefits of COVID-19 booster doses using number needed to vaccinate (NNV) to prevent one COVID-19-associated hospitalization or emergency department encounter. Methods: We conducted a retrospective cohort study of immunocompetent adults at five health systems in four U.S. states during SARS-CoV-2 Omicron BA.1 predominance (December 2021–February 2022). Included patients completed a primary mRNA COVID-19 vaccine series and were either eligible to or received a booster dose. NNV were estimated using hazard ratios for each outcome (hospitalization and emergency department encounters), with results stratified by three 25-day periods and site. Findings: 1,285,032 patients contributed 938 hospitalizations and 2076 emergency department encounters. 555,729 (43.2%) patients were aged 18–49 years, 363,299 (28.3%) 50–64 years, and 366,004 (28.5%) ≥65 years. Most patients were female (n = 765,728, 59.6%), White (n = 990,224, 77.1%), and non-Hispanic (n = 1,063,964, 82.8%). 37.2% of patients received a booster and 62.8% received only two doses. Median estimated NNV to prevent one hospitalization was 205 (range 44–615) and NNV was lower across study periods for adults aged ≥65 years (110, 46, and 88, respectively) and those with underlying medical conditions (163, 69, and 131, respectively). Median estimated NNV to prevent one emergency department encounter was 156 (range 75–592). Interpretation: The number of patients needed to receive a booster dose was highly dependent on local disease incidence, outcome severity, and patient risk factors for moderate-to-severe disease. Funding: Funding was provided by the Centers for Disease Control and Prevention though contract 75D30120C07986 to Westat, Inc. and contract 75D30120C07765 to Kaiser Foundation Hospitals.
