Effectiveness of COVID-19 Vaccines in Preventing SARS-CoV-2
During December 14, 2020–April 10, 2021, data from the HEROES-RECOVER Cohorts,* a network of prospective cohorts among frontline workers, showed that the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines were approximately 90% effective in preventing symptomatic and asymptomatic infection with SARS-CoV-2, the virus that causes COVID-19, in real-world conditions (1,2). This report updates vaccine effectiveness (VE) estimates including all COVID-19 vaccines available through August 14, 2021, and examines whether VE differs for adults with increasing time since completion of all recommended vaccine doses. VE before and during SARS-CoV-2 B.1.617.2 (Delta) variant predominance, which coincided with an increase in reported COVID-19 vaccine breakthrough infections, were compared (3,4).
Methods for the HEROES-RECOVER Cohorts have been published previously (1,2,5). Health care personnel, first responders, and other essential and frontline workers in eight U.S. locations across six states were tested weekly for SARS-CoV-2 infection by reverse transcription–polymerase chain reaction (RT-PCR)† and upon the onset of any COVID-19–like illness. Weeks when the Delta variant accounted for ≥50% of viruses sequenced, based on data from each respective location, were defined as weeks of Delta variant predominance. Vaccination was documented by self-report and verified by provision of vaccine cards or extraction from electronic medical records or state immunization registries. Among 4,217 participants, 3,483 (83%) were vaccinated; 2,278 (65%) received Pfizer-BioNTech, 1,138 (33%) Moderna, and 67 (2%) Janssen (Johnson & Johnson) COVID-19 vaccines. Cox proportional hazards models were used to calculate ratios of unvaccinated to fully vaccinated (≥14 days after receipt of all recommended COVID-19 vaccine doses) infection rates, adjusted for occupation, site, and local viral circulation (6), and weighted for inverse probability of vaccination using sociodemographic characteristics, health information, frequency of close social contact, and mask use. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.§
During the 35-week study period, 4,136 participants with no previous laboratory-documented SARS-CoV-2 infection contributed a median of 20 unvaccinated days per participant (interquartile range [IQR] = 8–45 days; total = 181,357 days), during which 194 SARS-CoV-2 infections were identified; 89.7% of these infections were symptomatic. A total of 2,976 participants contributed a median of 177 fully vaccinated days (IQR = 115–195 days; total = 455,175 days) with 34 infections, 80.6% of which were symptomatic. Adjusted VE against SARS-CoV-2 infection was 80% (95% confidence interval [CI] = 69%–88%). The VE point estimate was 85% among participants for whom <120 days had elapsed since completion of full vaccination compared with 73% among those for whom ≥150 days had elapsed; however the VE 95% CI were overlapping, indicating the difference was not statistically significant (Table).