Document text
Effectiveness of COVID -19 vaccines
Ruth Link -Gelles, PhD, MPH
CDR, US Public Health Service
Vaccine Effectiveness Program LeadCoronavirus and Other Respiratory Viruses DivisionCenters for Disease Control and Prevention October 23, 2024National Center for Immunization and Respiratory Diseases
•VE data to inform need for:
-Additional doses in immunocompromised
•What’s known about VE in immunocompromised vs. non-
immunocompromised adults, including waning by time since dose
-Additional dose for adults ≥65 years
•What’s known about waning of a single dose in healthy adults ≥65 years, including against more severe outcomes
•Benefits of an additional dose in past seasonsAgenda – COVID -19 vaccine effectiveness (VE)
1. Time since dose impacts protection
-How much and over what time period?
2. SARS -CoV-2 variants change over time
-Variant/vaccine match may impact effectiveness
3. Surges in disease, seroprevalence, and time since last SARS -CoV-2
infection impact measured VE
Difficult to disentangle time since dose (true “waning”) vs. impact of
changes in variants vs. impact of time since prior infectionSome key issues in COVID- 19 vaccine effectiveness (VE)
•High rates of SARS -CoV-2 infection -induced immunity by July – August 2023.*Context for interpreting COVID -19 VE across age groups: SARS -CoV-2
seroprevalence before 2023 -2024 respiratory virus season
* Internal CDC data. Data on persons aged ≥16 years is from a longitudinal, national cohort of >35,000 blood donors.
Methods and prior data available at: https://covid.cdc.gov/covid- data- tracker/#nationwide -blood -donor -seroprevalence- 202289%
89%
84%
72%16-29 years
30-49 years
50-64 years
≥65 years
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent with infection- induced immunityPercent of persons with infection -induced immunity,
based on anti -nucleocapsid results from blood donors
VE findings should be interpreted as the added benefit provided by COVID -19 vaccination in a
population with a high prevalence of vaccine - and infection -induced immunity.
Measuring COVID- 19 VE
Measure Definition Example
vaccinated
groupExample comparison group
Absolute VE Compares frequency of health
outcomes in vaccinated and unvaccinated people Received
original
monovalent
COVID -19
vaccineReceived no COVID -19 vaccines ever
Relative VE Compares frequency of health outcomes in people who received one type of vaccine to people who received a different vaccineReceived
bivalent
COVID -19
vaccineEligible for, but did not receive, bivalent COVID -19 vaccine , but received
original monovalent COVID -19
vaccine
VE of 2023 -2024 COVID -
19 vaccinesCompares people who received 2023 -2024 COVID -19 vaccine to
people who did not, regardless of past vaccinationReceived
updated
(2023 -24)
doseEligible for, but did not receive, an
updated (2023 -24) dose , regardless of
past vaccination history
Methods
VISION Multi -Site Network of Electronic Health Records
>300 emergency departments and urgent cares and >200 hospitals
Design: Test-negative design
Population: Adults visiting a participating
emergency department or urgent care (ED/UC) or
hospitalized with COVID -19-like illness (CLI) with a
SARS -CoV-2 NAAT test result within 10 days before
or 72 hours after encounter
−Cases: CLI with positive NAAT for SARS -CoV-2 and no
positive NAAT for RSV or influenza
–Controls: CLI with negative NAAT for SARS -CoV-2 and
no positive NAAT for influenza
Vaccination data: Documented by electronic health records and state and
city registries
IVY Network — 26 hospitals, 20 U.S. States
•Design : Test-negative, case -control design
•Population: Adults aged ≥18 years hospitalized with COVID -
like illness (CLI)* and SARS -CoV-2 test results within 10 days of
illness onset and 3 days of admission
–Cases: CLI and test positive for SARS -CoV-2 by NAAT or antigen
–Controls: CLI and test negative for SARS -CoV-2 and influenza by
RT-PCR
•Vaccination data: Electronic medical records (EMR), state and
city registries, and plausible self -report
•Specimens: Nasal swabs obtained on all patients for central
RT-PCR testing and whole genome sequencing
*CLI is defined as presence of any one of the following: fever, cough, shortness of breath, chest imaging consistent with pneumoni a, or hypoxemia
*Data sources included Medicare Enrollment Database (EDB) and Common Medicare Environment (CME), Common Working File (CWF) and S hared System Data (SSD) Medicare Parts A/B claims data, Minimum Data Set (MDS), and CDC/ATSDR
Social Vulnerability Index (SVI). Events identified from Medicare claims data using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD -10 CM) and common procedural terminology (CPT) codes. Medicare data
• Design: Retrospective cohort
• Data source: Medicare fee- for-service claims data*
• Population: Persons aged ≥65
• Censoring events:
– COVID -19-related thromboembolic event
– Death
– Disenrollment in Medicare Parts A/B
– Enrollment in Medicare Part C
– Nursing home stay lasting ≥100 days
– Admission to hospice facility
– Dialysis encounter
– Receipt of multiple bivalent booster doses
– Bivalent booster dose < 60 days from the last COVID -19 vaccine
dose
– End of study period
• VE = (1 - adjusted hazard ratio) x 100%
where adjusted hazard ratio = 𝑟𝑟𝑟𝑟𝑟𝑟𝑟𝑟 𝑜𝑜𝑜𝑜 𝑅𝑅𝑅𝑅𝑅𝑅 ℎ𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑟𝑟𝑟𝑟𝑜𝑜𝑜𝑜𝑜𝑜𝑟𝑟𝑟𝑟𝑜𝑜𝑜𝑜𝑜𝑜𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣
𝑟𝑟𝑟𝑟𝑟𝑟𝑟𝑟 𝑜𝑜𝑜𝑜 𝑅𝑅𝑅𝑅𝑅𝑅 ℎ𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑜𝑟𝑟𝑟𝑟𝑜𝑜𝑜𝑜𝑜𝑜𝑟𝑟𝑟𝑟𝑜𝑜𝑜𝑜𝑜𝑜𝑢𝑢𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣𝑣COVID -19 hospitalizationOther Censoring Event
Unvaccinated person- time
Vaccinated person- time
COVID -19 VE data to inform need for
additional doses in persons with
immunocompromise
Adjusted VE% (95% CI)
Vaccination
status/days since doseImmunocompromised Not immunocompromised
2 doses
14-59 days 38 (-25-71) 81 (70- 88)
60-119 days 27 (-7-51) 74 (66- 80)
120-179 days 33 (6- 52) 64 (56- 71)
180-239 days 35 (13- 51) 60 (53- 61)
240-299 days 39 (27- 50) 57 (53- 61)
300+ days 42 (29- 52) 66 (62- 69)
3 doses
14-59 days 81 (75- 85) 93 (91- 94)
60-119 days 74 (68- 78) 91 (90- 92)
120-179 days 49 (37- 58) 84 (81- 87)VISION: Original monovalent vs. unvaccinated mRNA VE for COVID -19-associated hospitalization by
number of doses and time since last dose receipt for adults ≥50 years, Dec 2021– Mar 2022, by
immunocompromised status
Adapted from Britton et al. MMWR: https://www.cdc.gov/mmwr/volumes/71/wr/mm7142a4.htm . Individuals with prior infections excluded. Logistic regression conditioned on calendar
week and geographic area, and adjusted for age, sex, race, ethnicity, local virus circulation, respiratory or nonrespiratory underlying medical conditions, and propensity to be vaccinated 11-40 -20 0 20 40 60 80 100
Vaccine E ff ectiveness (%) Immunocompromised Not immunocompromised
VE of original mRNA doses vs. unvaccinated persons during Delta and early Omicron was higher among non -immunocompromised adults. An
additional dose restored/increased protection in immunocompromise and non -immunocompromised, with some waning apparent.
Adjusted VE% (95% CI)
Vaccination
status/days since doseImmunocompromised Not immunocompromised
2 doses
14-59 days 38 (-25-71) 81 (70- 88)
60-119 days 27 (-7-51) 74 (66- 80)
120-179 days 33 (6- 52) 64 (56- 71)
180-239 days 35 (13- 51) 60 (53- 61)
240-299 days 39 (27- 50) 57 (53- 61)
300+ days 42 (29- 52) 66 (62- 69)
3 doses
14-59 days 81 (75- 85) 93 (91- 94)
60-119 days 74 (68- 78) 91 (90- 92)
120-179 days 49 (37- 58) 84 (81- 87)VISION: Original monovalent vs. unvaccinated mRNA VE for COVID -19-associated hospitalization by
number of doses and time since last dose receipt for adults ≥50 years, Dec 2021– Mar 2022, by
immunocompromised status
Adapted from Britton et al. MMWR: https://www.cdc.gov/mmwr/volumes/71/wr/mm7142a4.htm . Individuals with prior infections excluded. Logistic regression conditioned on calendar
week and geographic area, and adjusted for age, sex, race, ethnicity, local virus circulation, respiratory or nonrespiratory underlying medical conditions, and propensity to be vaccinated 12-40 -20 0 20 40 60 80 100
Vaccine E ff ectiveness (%) Immunocompromised Not immunocompromised
VE of original mRNA doses vs. unvaccinated persons during Delta and early Omicron was higher among non -immunocompromised adults. An
additional dose restored/increased protection in immunocompromise and non -immunocompromised, with some waning apparent.
IVY: Original monovalent and bivalent vs. unvaccinated mRNA VE against COVID -19-associated
hospitalization by time since last dose receipt for adults ≥18 years, September 2022 –August
2023, by immunocompromised status
DeCuir J. medRxiv 2024.01.07.24300910; doi:https://doi.org/10.1101/2024.01.07.24300910
A dose of bivalent vaccine added protection among those >1 year from their last original monovalent dose during Omicron predo minance.
IVY: Original monovalent and bivalent vs. unvaccinated mRNA VE against COVID -19-associated
hospitalization by time since last dose receipt for adults ≥18 years, September 2022 –August
2023, by immunocompromised status
DeCuir J. medRxiv 2024.01.07.24300910; doi:https://doi.org/10.1101/2024.01.07.24300910
A dose of bivalent vaccine added protection among those >1 year from their last original monovalent dose during Omicron predo minance.
IVY: Original monovalent and bivalent vs. unvaccinated mRNA VE against COVID -19-associated
hospitalization by time since last dose receipt for adults ≥18 years, September 2022 –August
2023, by immunocompromised status
DeCuir J. medRxiv 2024.01.07.24300910; doi:https://doi.org/10.1101/2024.01.07.24300910
A dose of bivalent vaccine added protection among those >1 year from their last original monovalent dose during Omicron predo minance.
VISION: VE of 2023 -2024 vs. no 2023 -2024 COVID -19 vaccine against COVID -19-associated
hospitalization among adults aged ≥18 years, by immunocompromise status
September 2023 – August 2024
16Adjusted VE% (95% CI)
Days since
vaccinationImmunocompromised Not immunocompromised
7-59 days 36 (22- 48) 51 (45- 56)
60-119 days 23 (6- 36) 42 (35- 48)
120-179 days 1 (-28-23)* 15 (3- 26)
-40 -20 0 20 40 60 80 100
Vaccine E ff ectiveness (%) Immunocompromised Not immunocompromised
During the 2023- 2024 season, VE appeared somewhat lower in immunocompromised individuals, though waning
patterns were similar to those in non- immunocompromised individuals.
CDC, preliminary unpublished data. Individuals with prior infections excluded. Logistic regression conditioned on calendar we ek and geographic area, and adjusted for age,
sex, race, ethnicity, local virus circulation, respiratory or nonrespiratory underlying medical conditions, and propensity to be vaccinated
Conclusions: VE among those with
immunocompromising conditions
•COVID -19 vaccines provided protection for both persons with and without
immunocompromise.
•Patterns of COVID -19 VE in immunocompromised were different season- to-season, with
generally lower VE compared to non- immunocompromised, but inconsistent waning
patterns.
-During 2023- 2024, VE against hospitalization in immunocompromised waned to 0 by ~4 -6
months.
•This inconsistency is likely multifactorial, including:
-Heterogeneity among those classified as immunocompromised
-Variation in underlying immunity and response to prior infection
-Differing health behav iors (e.g., masking, social distancing) over time and by immunocompromise status
17
COVID -19 VE data to inform need for an
additional COVID -19 vaccine dose for
adults aged ≥65 years
COVID -19 VE against COVID- 19-associated hospitalization wanes over time, but is more
sustained against COVID -19-associated critical illness , though some waning is evident
Data from VISION and IVY showing VE by vaccine formulation of most recent dose.
-20020406080100
7-59 or 14-59 60-119 120-179 180-239* 240-299* 300-364* 365+Vaccine effectiveness (%)
Days since last dose
Recipients of bivalent and 2023 -2024 doses included in this analysis received a single dose of the most recent formulation.
Sources: DeCuir, et al., MMWR 2023/ Lin k-Gelles, ACIP Slides, April 20, 2022 ; CDC unpublished data updated from Link -Gelles, ACIP Slides, June 23, 2023 ; CDC unpublished data updated from: Link -Gelles, ACIP Slides, June 27, 2024
* For original monovalent doses, VE for hospitalization was for 180 -364 days from last dose combined. For 2023- 2024 doses, VE fo r hospitalization was for ≥180 days combined, with a median of 228 days (IQR: 202 -259).Hosp italization Critical illness
Original monovalent (adults aged 50+; ref: unvaccinated)
Bivalent (adults aged 18+; ref: unvaccinated)
2023- 2024 (adults aged 18+; ref: no 2023- 2024 dose)
SARS -CoV-2 variant period/
mRNA dosage pattern/
days since doseMedian (IQR) days
from last doseVaccinated
case-patients
no./total no. (%)Vaccinated
control -patients,
no./total no. (%)Adjusted VE (95% CI) s
BA.1/BA.2 period
2 original monovalent doses
14-150 days 111 (87 –130) 62/771 (8) 79/514 (15) 63 (46 –75)
>150 days 290 (241 –351) 471/1,180 (40) 404/839 (48) 34 (20 –46)
3 original monovalent doses
7-120 days 80 (55 –100) 167/876 (19) 393/828 (47) 79 (74 –84)
>120 days 180 (154 –208) 265/974 (27) 301/736 (41) 41 (23 –55)
BA.4/BA.5 period
2 original monovalent doses
14-150 days 102 (77 –123) 3/189 (2) 13/168 (8) 83 (35 –96)
>150 days 430 (329 –471) 128/314 (41) 168/323 (52) 37 (12 –55)
3 original monovalent doses
7-120 days 74 (33 –110) 13/199 (7) 24/179 (13) 60 (12 –81)
>120 days 237 (204 –269) 219/405 (54) 208/363 (57) 29 (3 –48)IVY: Original monovalent vs. unvaccinated VE against COVID -19-associated hospitalization
among immunocompetent adults ≥18 years, by Omicron sublineage period
December 2021- August 2022
Surie and Bonnell, et al. MMWR, https://www.cdc.gov/mmwr/volumes/71/wr/mm7142a3.htm 200 20 40 60 80 100
VE of an additional original monovalent dose provided increased protection during Omicron with similar waning patterns for 2 and 3 doses.
SARS -CoV-2 variant period/
mRNA dosage pattern/
days since doseTotalSARS -CoV-2-
test-positive,
N (%)Median interval
since last dose,
days (IQR)Adjusted VE (95% CI)
BA.4/BA.5 period
Unvaccinated (ref) 2,971 743 (25) --
2 original monovalent doses
14-149 days 77 14 (18) 80 (57- 105) --
≥150 days 2828 556 (20) 473 (422- 503) 31 (21- 39)
3 original monovalent doses
7-119 days 289 26 (9) 72 (42- 98) 73 (55 -84)
≥120 days 4838 913 (19) 240 (211- 266) 38 (30- 46)
4 original monovalent doses
7-59 days 765 89 (12) 38 (23- 50) 66 (53 -75)
≥60 days 1549 210 (14) 88 (75- 105) 57 (44 -66)VISION: Original monovalent vs. unvaccinated VE against COVID- 19-
associated hospitalization among immunocompetent adults ≥65 years
June -August 2022
Link-Gelles, et al. JAMA Network Open, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802473 , 2023 210 20 40 60 80 100
VE of an additional original monovalent dose provided increased protection during Omicron with similar waning patterns for 2 and 3 doses.
IVY: Original monovalent and bivalent vs. unvaccinated VE against COVID -19-
associated severe in -hospital outcomes among adults aged ≥18 years without
immunocompromising conditions
DeCuir et al., 2024, under reviewVE of COVID -19 vaccines was most durable against the most severe outcomes.
mRNA Dosage Pattern/time since doseNo. of
beneficiariesNo. of
COVID -19
related TETotal no. of
person -daysMedian follow-
up days
contributed to
categoryAdjusted VE (95% CI)
Original monovalent vaccine dose (ref) 7,022,968 17,746 1,505,533,898 181 Ref
Bivalent dose 5,683,208 4,255 694,184,995 130 47 (45– 49)
Bivalent dose 7 -59 days earlier 350,021 1,492 294,516,234 53 54 (51– 56)
Bivalent dose ≥60 days earlier 5,333,187 2,763 399,668,761 77 42 (39– 45)
0 20 40 60 80 100
Vaccine Effectiveness (%)Medicare: VE of bivalent vs. original monovalent COVID -19 vaccine
against COVID- 19-related thromboembolic events among
immuno competent Medicare beneficiaries aged ≥65 years
September 2022 – March 2023
VE estimates adjusted for age, sex, race and ethnicity, geographic region, and calendar time. Updated from: Link -Gelles et al., MMWR,
https://www.cdc.gov/mmwr/volumes/72/wr/mm7221a3.htm
TE = thromboembolic event*A COVID -19–related thromboembolic event was defined as presence of an International Classification of Disease, 10th
Edition (ICD -10) or common procedural terminology (CPT) code indicating ischemic stroke, venous thromboembolism, or
myocardial infarction from 7 days before through 30 days after a medical claim indicating a COVID –19 diagnosis.
VISION: VE of 2 vs. 1 bivalent doses against COVID- 19-associated
hospitalization among immuno competent adults aged ≥65 years
September 2022 – September 2023
• VE estimates adjusted for age, sex, race and ethnicity, geographic region, and calendar time. Updated from: Link -Gelles et al., MMWR, https://www.cdc.gov/mmwr/volumes/72/wr/mm7221a3.htm
CDC unpublished datamRNA Dosage PatternTotal
encountersSARS -CoV-2-
test-positive,
N (%)Median interval
since last dose,
days (IQR)Adjusted VE
(95% CI)
Hospitalization, 2 vs. 1 bivalent doses (at least 4 months apart)
1 bivalent dose (ref) 21,825 1,894 (8) -- Ref
2 bivalent doses 599 50 (8) 50 (26- 76) 20 (-9 to 41)
-20 0 20 40 60 80 100
Vaccine Effectiveness (%)
VE of an additional bivalent dose at least 4 months after the original bivalent dose appeared to provide some
protection, though the confidence interval was wide and crossed 0.
Age group/2023 -2024 COVID -19 vaccination
status/days since doseTotal
encountersSARS -CoV-2-
test-positive,
N (%)Median interval since
last dose among
vaccinated, days (IQR) Adjusted VE (95% CI)
≥18 years
No 2023 -2024 COVID -19 dose (ref) 266,148 29,492 (11) 750 (534 -912) Ref
2023 -2024 COVID -19 dose , 7-299 days earlier 59,366 5,079 (9) 115 (60 -185) 25 (22 to 28)
2023 -2024 COVID -19 dose , 7-59 days earlier 14,801 1,112 (8) 34 (21 -47) 48 (45 to 52)
2023 -2024 COVID -19 dose , 60-119 days earlier 16,101 1,338 (8) 88 (73 -103) 28 (23 to 32)
2023 -2024 COVID -19 dose , 120 -179 days earlier 12,636 766 (6) 147 (133 -163) 17 (10 to 23)
2023 -2024 COVID -19 dose , 180-299 days earlier 15,828 1,863 (12) 229 (203 -258) -5 (-11 to 1)
18-64 years
No 2023- 2024 COV I D -19 dose (ref) 189,980 19,809 (10) 783 (617 -928) Ref
2023 -2024 COVID -19 dose , 7-299 days earlier 20,563 1,545 (8) 112 (58 -182) 25 (21 to 29)
2023 -2024 COVID -19 dose , 7-59 days earlier 5,341 318 (6) 34 (20 -47) 54 (49 to 59)
2023 -2024 COVID -19 dose , 60-119 days earlier 5,566 366 (7) 88 (74 -104) 32 (25 to 39)
2023 -2024 COVID -19 dose , 120 -179 days earlier 4,387 227 (5) 147 (133 -163) 16 (4 to 27)
2023 -2024 COVID -19 dose , 180-299 days earlier 5,269 634 (12) 228 (202 -256) -19 (-30 to -8)
≥65 years
No 2023- 2024 COV I D -19 dose (ref) 76,168 9,683 (13) 661 (431 -860) Ref
2023 -2024 COVID -19 dose , 7-299 days earlier 38,803 3,534 (9) 116 (61 -187) 25 (22 to 28)
2023 -2024 COVID -19 dose , 7-59 days earlier 9,460 794 (8) 34 (21 -47) 45 (40 to 49)
2023 -2024 COVID -19 dose , 60-119 days earlier 10,535 972 (9) 88 (73 -103) 25 (20 to 31)
2023 -2024 COVID -19 dose , 120 -179 days earlier 8,249 539 (7) 148 (133 -163) 20 (11 to 27)
2023 -2024 COVID -19 dose , 180-299 days earlier 10,559 1,229 (12) 230 (203 -259) 1 (-7 to 8)VISION: VE of 2023 -2024 COVID -19 vaccine against COVID -19-associated ED/UC
encounters among immunocompetent adults aged ≥18 years, by age group
September 2023 – August 2024
https://www.cdc.gov/mmwr/volumes/73/wr/mm7308a5.htm (Results updated with additional data since publication.) VE was calculated as (1 − odds ratio) x 100%, estimated using a tes t-negative case- control
design, with the odds ratio adjusted for age, sex, race and ethnicity, geographic region, and calendar time. -40 -20 0 20 40 60 80 100
VISION: VE of 2023- 2024 COVID -19 vaccine against COVID -19-associated
hospitalization among immunocompetent adults aged ≥18 years, by age group
September 2023 – August 2024
*Some estimates are imprecise, which might be due to a relatively small number of persons in each level of vaccination or case status. This imprecision indicates that the actual VE could be substantially different from the point estimate shown, and estim ates
should therefore be interpreted with caution. Additional data accrual could increase precision and allow more precise interpr etation.
https://www.cdc.gov/mmwr/volumes/73/wr/mm7308a5.htm (Results updated with additional data since publication.) VE was calculated as (1 − odds ratio) x 100%, estimated using a tes t-negative case -control design, adjusted for age, sex, race and ethnicity,
geographic region, and calendar time.Age group/2023 -2024 COVID -19 vaccination
status/days since doseTotal
encountersSARS -CoV-2-
test-positive,
N (%)Median interval since
last dose among
vaccinated, days (IQR) Adjusted VE (95% CI)
≥18 years
No 2023 -2024 COVID -19 dose (ref) 83,596 8,025 (10) 728 (499 -911) Ref
2023 -2024 COVID -19 dose , 7-299 days earlier 21,468 1,664 (8) 120 (62 -189) 30 (25 to 34)
2023 -2024 COVID -19 dose , 7-59 days earlier 5,095 382 (8) 34 (21 -47) 50 (44 to 55)
2023 -2024 COVID -19 dose , 60-119 days earlier 5,623 431 (8) 88 (74 -104) 38 (31 to 44)
2023 -2024 COVID -19 dose , 120 -179 days earlier 4,754 268 (6) 148 (134 -164) 21 (10 to 31)
2023 -2024 COVID -19 dose , 180-299 days earlier 5,996 583 (10) 227 (202 -257) -8 (-19 to 3)
18-64 years
No 2023 -2024 COVID -19 dose (ref) 33,335 2,076 (6) 783 (600 -934) Ref
2023 -2024 COVID -19 dose , 7-299 days earlier 3,694 201 (5) 116 (61 -182) 16 (1 to 28)
2023 -2024 COVID -19 dose , 7-59 days earlier 903 57 (6) 33 (21 -45) 26 (3 to 44)
2023 -2024 COVID -19 dose , 60-119 days earlier 999 47 (5) 89 (75 -104) 34 (11 to 51)
2023 -2024 COVID -19 dose , 120 -179 days earlier 834 26 (3) 148 (135 -164) 28 (-8 to 51)*
2023 -2024 COVID -19 dose , 180-299 days earlier 958 71 (7) 226 (199 -254) -35 (-76 to -4)*
≥65 years
No 2023 -2024 COVID -19 dose (ref) 50,261 5,949 (12) 692 (460 -890) Ref
2023 -2024 COVID -19 dose , 7-299 days earlier 17,774 1463 (8) 121 (63 -190) 31 (27 to 36)
2023 -2024 COVID -19 dose , 7-59 days earlier 4,192 325 (8) 34 (21 -47) 53 (47 to 59)
2023 -2024 COVID -19 dose , 60-119 days earlier 4,624 384 (8) 88 (74 -104) 38 (30 to 44)
2023 -2024 COVID -19 dose , 120 -179 days earlier 3,920 242 (6) 148 (134 -164) 19 (7 to 30)
2023 -2024 COVID -19 dose , 180-299 days earlier 5,038 512 (10) 228 (202 -257) -4 (-16 to 7)
-80 -60 -40 -20 020 40 60 80 100
VISION: VE of 2023- 2024 COVID -19 vaccine against COVID -19-associated
hospitalization and critical illness among adults aged ≥18 years
September 2023 – August 2024
Additional methods, including definition of immunocompromised available: https://www.cdc.gov/mmwr/volumes/73/wr/mm7308a5.htm (Results updated with additional data since publication.) VE was
calculated as (1 − odds ratio) x 100%, estimated using a test -negative case- control design, with odds ratios adjusted for age, s ex, race and ethnicity, geographic region, and calendar time.
* Some estimates are imprecise, which might be due to a relatively small number of persons in each level of vaccination or ca se status. This imprecision indicates that the actual VE could be substantially
different from the point estimate shown, and estimates should therefore be interpreted with caution. Additional data accrual could increase precision and allow more precise interpretation. Age group/2023 -2024 COVID -19 vaccination
status/days since doseTotal
encountersSARS -CoV-2-
test-positive,
N (%)Median interval since
last dose among
vaccinated, days (IQR) Adjusted VE (95% CI)
≥18 years, hospitalization
No 2023 -2024 COVID -19 dose (ref) 83,596 8,025 (10) 728 (499 -911) Ref
2023 -2024 COVID -19 dose , 7-299 days earlier 21,468 1,664 (8) 120 (62 -189) 30 (25 to 34)
2023 -2024 COVID -19 dose , 7-59 days earlier 5,095 382 (8) 34 (21 -47) 50 (44 to 55)
2023 -2024 COVID -19 dose , 60-119 days earlier 5,623 431 (8) 88 (74 -104) 38 (31 to 44)
2023 -2024 COVID -19 dose , 120 -179 days earlier 4,754 268 (6) 148 (134 -164) 21 (10 to 31)
2023 -2024 COVID -19 dose , 180-299 days earlier 5,996 583 (10) 227 (202 -257) -8 (-19 to 3)
≥18 years, critical illness
No 2023 -2024 COVID -19 dose (ref) 76,965 1,394 (2) 730 (503 -913) Ref
2023 -2024 COVID -19 dose , 7-299 days earlier 20,010 206 (1) 119 (62 -187) 50 (42 -58)
2023 -2024 COVID -19 dose , 7-59 days earlier 4,758 45 (1) 34 (21 -46) 67 (55 -75)
2023 -2024 COVID -19 dose , 60-119 days earlier 5,248 56 (1) 89 (74 -104) 56 (42 -67)
2023 -2024 COVID -19 dose , 120 -179 days earlier 4,523 37 (1) 149 (134 -164) 40 (16 -58)
2023 -2024 COVID -19 dose , 180-299 days earlier 5,481 68 (1) 226 (201 -256) 21 (-3-40)
-80 -60 -40 -20 020 40 60 80 100
Outcome Analysis Vaccine effectiveness, % (95% CI)
Thromboembolic events* Medicare, ESKD adults ≥65y, 2023- 2024 vaccine, median follow -up days=74 53 (23 -71)
Death Medicare, E SK D adults ≥65y , 2023- 2024 vaccine, med ian follow -up days=104 47 (15 -67)
ICU admission/deathV ISION, adults ≥65y, 2023- 2024 vaccine, med ian follow -up days=34 69 (57 -78)
V ISION, adults ≥65y, 2023- 2024 vaccine, med ian follow -up days=89 56 (42 -68)
V ISION, adults ≥65y, 2023- 2024 vaccine, med ian follow -up days=149 43 (18 -60)Effectiveness of 2023- 2024 COVID -19 vaccines against COVID -19-associated critical
outcomes in immunocompetent adults ≥65 years, Medicare and VISION data
CDC unpublished data. Medicare analysis includes only Medicare fee -for-service beneficiaries.0 20 40 60 80 100 Abbreviations: ESKD = end stage kidney disease; y = years; IMV = invasive mechanical ventilation; ICU = intensive care unit
*A COVID -19–related thromboembolic event was defined as presence of an International Classification of Disease, 10th
Edition (ICD -10) or common procedural terminology (CPT) code indicating ischemic stroke, venous thromboembolism, or
myocardial infarction from 7 days before through 30 days after a medical claim indicating a COVID –19 diagnosis.
•VE findings should be interpreted as the added benefit provided by COVID -19 vaccination in a population with a
high prevalence of vaccine - and infection- induced immunity at the start of the 2023- 2024 respiratory virus season.
•2023- 2024 COVID -19 vaccination provided increased protection against COVID -19-associated ED/UC visits and
hospitalizations compared to no 2023- 2024 vaccine dose.
-Protection waned to 0 against COVID -19-associated ED/UC visits and hospitalization by ~4 -6 months.
•Waning patterns of 2023- 2024 COVID -19 vaccines appeared similar to previous COVID -19 vaccine formulations;
most durable protection appeared to be for critical illness
-VE against critical illness remained above 40% at 5 months after vaccination among those ≥65 years
•As with previous COVID -19 vaccine formulations, effectiveness was similar across age groups
•Data from prior seasons show that an additional dose of the same formula appeared to provide additional
protection. Conclusions: COVID- 19 VE in adults ≥65 years
Acknowledgements
CDC
Amanda B. Payne
Katherine E. Fleming -Dutra
Lakshmi PanagiotakopoulosLauren Roper
Amadea Britton
Allison CieslaFatimah Dawood
Jennifer DeCuir
Monica Dickerson
Sascha Ellington
Shikha GargAmber Kautz
Nathaniel M. Lewis
Kevin Ma
Josephine Mak
Joe MillerMorgan Najdowski
Zach Smith
Diya Surie
Caitlin Ray
Ryan WiegandVISION Collaborators
WestatSarah Ball
Angela Cheung
Margaret Dunne
Patrick Mitchell
Sarah ReeseElizabeth Rowley
Janet Watts
Zack Weber
Intermountain Health
Kristin Dascomb
Kaiser Permanente Center for Health Research
Stephanie A. Irving
Kaiser Permanente Northern California
Nicola P. Klein
Regenstrief
Shaun J. Grannis
University of Colorado
Toan C. Ong
HealthPartners
Malini B. DeSilva
Columbia University
Karthik NatarajanIVY Collaborators
Cristie Columbus
Laurence W. Busse
Steven Y. Chang
Abhijit Duggal
Matthew C. Exline
Manjusha GaglaniKevin W. Gibbs
Adit A. Ginde
David N. HagerEstelle S. Harris
Cassandra JohnsonNicholas J. Johnson
Akram Khan
Jennie H. KwonAdam S. Lauring
Christopher MallowEmily MartinAmira MohamedNicholas M. Mohr
Jarrod M. Mosier
Ithan D. Peltan
Matthew Prekker
Basmah Safdar
Wesley H. SelfNathan I. Shapiro
Jay S. Steingrub
Ivana A. Vaughn
Jennifer G. Wilson
Yuwei Zhu
CMS Collaborators
CMS
Alia Bayatti
AcumenHeng -Ming Sung
Ivy Zhang
Carla Gomez Victor
Yenlin Lai
Bradley LufkinYoganand Chillarige
+ many more!