Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Apr 20, 2022
Date Accepted: Oct 18, 2022
Date Submitted to PubMed: Oct 20, 2022
Risk of hospitalization and mortality after breakthrough SARS-CoV-2 infection by vaccine type : Observational study of medical claims data
ABSTRACT
Background:
Understanding the severity of SARS-CoV-2 breakthrough infections by vaccine type is important for making policy decisions regarding booster vaccinations that is dependent on the vaccine
Objective:
To compare the risks of hospitalization and mortality in severe breakthrough SARS-CoV-2 infections that happened in fully vaccinated individuals across the three vaccines: Pfizer, Moderna or Janssen.
Methods:
Using medical claims data from Change Healthcare, consisting of all SARS-CoV-2 positive patients we identify a cohort of 19,815 patients who were fully vaccinated between Mar 10th, 2021 and April 27th, 2021 and follow them up to Oct 14th, 2021. We use ICD-10 diagnosis and procedure codes to identify hospitalizations (n=1140) and mortality (n=159), where the primary diagnosis was COVID-19. Cox regression analysis comparing the three vaccines’ effectiveness against severe breakthrough infections was performed, with covariates including demographic variables and comorbidities.
Results:
We find lower hazard ratios for those receiving the Moderna vaccine and Pfizer vaccine (the lowest hazard rates being for Moderna), as compared to those who received the Janssen vaccine. Further, individuals who had a SARS-CoV-2 infection prior to vaccination had some increased protection, over and above the protection already provided by the vaccines, from the risk of hospitalization (P<0.001) and mortality (P<0.05), independent of age, sex, comorbidities, and vaccine type.
Conclusions:
Individuals who received the Janssen vaccine are at risk of more severe SARS-CoV-2 breakthrough infections which reinforces the need for booster vaccination shots in those receiving a primary dose of the Janssen vaccine. Beyond the benefits offered by vaccination, a SARS-CoV-2 infection prior to vaccination also provides further protection against severe disease following breakthrough infection independent of vaccine type.
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.