Evidence map›Paper›PMID 35264324›Full record

Observational studyBMJ (Clinical research ed.)2022

Clinical severity of, and effectiveness of mRNA vaccines against, covid-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: prospective observational study.

Adam S Lauring, Mark W Tenforde, James D Chappell, Manjusha Gaglani, Adit A Ginde, Tresa McNeal, Shekhar Ghamande, David J Douin, H Keipp Talbot, Jonathan D Casey and 50 more

Open access · bronzeAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ (Clinical research ed.), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 428 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
428citing papers in PubMed, 7 pooled it
66.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

428 citing papers in PubMed, 7 syntheses or guidelines pooled it, 669 citations in OpenAlex.

  1. Pooled it
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  7. Clinical outcomes of the severe acute respiratory syndrome coronavirus 2 Omicron and Delta variant: systematic review and meta-analysis of 33 studies covering 6 037 144 coronavirus disease 2019-positive patients.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2023
    Pooled it
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  17. Integrating Genomic Data into Test-negative Designs for Estimating Lineage-specific COVID-19 Vaccine Effectiveness.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026
    Article
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368 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

60 authors at 20 institutions in 1 country.

Adam S LauringDepartments of Internal Medicine and Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA.
Mark W TenfordeCDC COVID-19 Response Team, Atlanta, GA, USA.
James D ChappellDepartment of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Manjusha GaglaniBaylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, USA.
Adit A GindeDepartment of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Tresa McNealBaylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, USA.
Shekhar GhamandeBaylor Scott and White Health, Texas A&M University College of Medicine, Temple, TX, USA.
David J DouinDepartment of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.
H Keipp TalbotDepartment of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
Jonathan D CaseyDepartment of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Nicholas M MohrDepartment of Emergency Medicine, University of Iowa, Iowa City, IA, USA.
Anne ZepeskiDepartment of Emergency Medicine, University of Iowa, Iowa City, IA, USA.
Nathan I ShapiroDepartment of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Kevin W GibbsDepartment of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
D Clark FilesDepartment of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
David N HagerDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Arber ShehuDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Matthew E PrekkerDepartment of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
Heidi L EricksonDepartment of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
Matthew C ExlineDepartment of Medicine, The Ohio State University, Columbus, OH, USA.
Michelle N GongDepartment of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, NY, USA.
Amira MohamedDepartment of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, NY, USA.
Nicholas J JohnsonDivision of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
Vasisht SrinivasanDepartment of Emergency Medicine, University of Washington, Seattle, WA, USA.
Jay S SteingrubDepartment of Medicine, Baystate Medical Center, Springfield, MA, USA.
Ithan D PeltanDepartment of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, UT, USA.
Samuel M BrownDepartment of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City, UT, USA.
Emily T MartinSchool of Public Health, University of Michigan, Ann Arbor, MI, USA.
Arnold S MontoSchool of Public Health, University of Michigan, Ann Arbor, MI, USA.
Akram KhanDepartment of Medicine, Oregon Health and Sciences University, Portland, OR, USA.
Catherine L HoughDepartment of Medicine, Oregon Health and Sciences University, Portland, OR, USA.
Laurence W BusseDepartment of Medicine, Emory University, Atlanta, GA, USA.
Caitlin C Ten LohuisEmory Critical Care Center, Emory Healthcare, Atlanta, GA, USA.
Abhijit DuggalDepartment of Medicine, Cleveland Clinic, Cleveland, OH, USA.
Jennifer G WilsonDepartment of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Alexandra June GordonDepartment of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Nida QadirDepartment of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
Steven Y ChangDepartment of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
Christopher MallowDepartment of Medicine, University of Miami, Miami, FL, USA.
Carolina RivasDepartment of Medicine, University of Miami, Miami, FL, USA.
Hilary M BabcockDepartment of Medicine, Washington University, St Louis, MI, USA.
Jennie H KwonDepartment of Medicine, Washington University, St Louis, MI, USA.
Natasha HalasaDepartment of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Carlos G GrijalvaDepartment of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
Todd W RiceDepartment of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
William B StubblefieldDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Adrienne BaughmanDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Kelsey N WomackVanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
Jillian P RhoadsVanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
Christopher J LindsellDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Kimberly W HartDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Yuwei ZhuDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Katherine AdamsCDC COVID-19 Response Team, Atlanta, GA, USA.
Stephanie J SchragCDC COVID-19 Response Team, Atlanta, GA, USA.
Samantha M OlsonCDC COVID-19 Response Team, Atlanta, GA, USA.
Miwako KobayashiCDC COVID-19 Response Team, Atlanta, GA, USA.
Jennifer R VeraniCDC COVID-19 Response Team, Atlanta, GA, USA.
Manish M PatelCDC COVID-19 Response Team, Atlanta, GA, USA.
Wesley H SelfDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA wesley.self@vumc.org.ORCID 0000-0002-9300-3045
Influenza and Other Viruses in the Acutely Ill (IVY) Network
Vanderbilt University Medical Center · USCDC Foundation · USBaylor Scott & White Health · USUniversity of Michigan · USAlbert Einstein College of Medicine · USHennepin County Medical Center · USJohns Hopkins University · USOregon Health & Science University · USStanford University · USUniversity of California, Los Angeles · USUniversity of Colorado Denver · USUniversity of Iowa · USUniversity of Miami · USUniversity of Utah · USUniversity of Washington · USWake Forest University · USWashington University in St. Louis · USBaystate Medical Center · USBeth Israel Deaconess Medical Center · USCleveland Clinic · US

Funding

Vanderbilt Institute for Clinical and Translational Research (VICTR) -Identifying correlates of functional immunity in SARS-CoV-2 convalescent plasmaUL1TR002243 · NCATS · VANDERBILT UNIVERSITY MEDICAL CENTER · PI Paul A. Harris, Wesley H Self · 2017 to 2026
$130.7M
Clinical and Translational Training Program in Pulmonary MedicineT32HL087738 · NHLBI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI Lorraine B Ware · 2007 to 2026
$7.0M
Anesthesiology Mentored Research TrainingT32GM135169 · NIGMS · UNIVERSITY OF COLORADO DENVER · PI Susan L Ingram, Vesna Jevtovic-Todorovic · 2021 to 2026
$1.0M
Mentoring in transmission of influenza and strategies for preventionK24AI148459 · NIAID · VANDERBILT UNIVERSITY MEDICAL CENTER · PI GRIJALVA, CARLOS G · 2020 to 2024
$893k
Prehospital Activation of ED Teams to Improve Sepsis CareK23GM129661 · NIGMS · IHC HEALTH SERVICES, INC. · PI PELTAN, ITHAN DANIEL · 2019 to 2023
$786k
NCATS NIH HHS UL1 TR002243NHLBI NIH HHS T32 HL087738NIAID NIH HHS K24 AI148459NIGMS NIH HHS K23 GM129661NIGMS NIH HHS T32 GM135169
6 · The paper itself

Abstract

objectivesTo characterize the clinical severity of covid-19 associated with the alpha, delta, and omicron SARS-CoV-2 variants among adults admitted to hospital and to compare the effectiveness of mRNA vaccines to prevent hospital admissions related to each variant.

designCase-control study.

setting21 hospitals across the United States.

participants11 690 adults (≥18 years) admitted to hospital: 5728 with covid-19 (cases) and 5962 without covid-19 (controls). Patients were classified into SARS-CoV-2 variant groups based on viral whole genome sequencing, and, if sequencing did not reveal a lineage, by the predominant circulating variant at the time of hospital admission: alpha (11 March to 3 July 2021), delta (4 July to 25 December 2021), and omicron (26 December 2021 to 14 January 2022).

main outcome measuresVaccine effectiveness calculated using a test negative design for mRNA vaccines to prevent covid-19 related hospital admissions by each variant (alpha, delta, omicron). Among patients admitted to hospital with covid-19, disease severity on the World Health Organization's clinical progression scale was compared among variants using proportional odds regression.

resultsEffectiveness of the mRNA vaccines to prevent covid-19 associated hospital admissions was 85% (95% confidence interval 82% to 88%) for two vaccine doses against the alpha variant, 85% (83% to 87%) for two doses against the delta variant, 94% (92% to 95%) for three doses against the delta variant, 65% (51% to 75%) for two doses against the omicron variant; and 86% (77% to 91%) for three doses against the omicron variant. In-hospital mortality was 7.6% (81/1060) for alpha, 12.2% (461/3788) for delta, and 7.1% (40/565) for omicron. Among unvaccinated patients with covid-19 admitted to hospital, severity on the WHO clinical progression scale was higher for the delta versus alpha variant (adjusted proportional odds ratio 1.28, 95% confidence interval 1.11 to 1.46), and lower for the omicron versus delta variant (0.61, 0.49 to 0.77). Compared with unvaccinated patients, severity was lower for vaccinated patients for each variant, including alpha (adjusted proportional odds ratio 0.33, 0.23 to 0.49), delta (0.44, 0.37 to 0.51), and omicron (0.61, 0.44 to 0.85).

conclusionsmRNA vaccines were found to be highly effective in preventing covid-19 associated hospital admissions related to the alpha, delta, and omicron variants, but three vaccine doses were required to achieve protection against omicron similar to the protection that two doses provided against the delta and alpha variants. Among adults admitted to hospital with covid-19, the omicron variant was associated with less severe disease than the delta variant but still resulted in substantial morbidity and mortality. Vaccinated patients admitted to hospital with covid-19 had significantly lower disease severity than unvaccinated patients for all the variants.

Indexed as

COVID-19 VaccinesSARS-CoV-2Case-Control StudiesCOVID-19HospitalizationHumansImmunization ScheduleProspective StudiesSeverity of Illness IndexUnited StatesCOVID-19 Vaccines

Identifiers

PMID35264324
PMCPMC8905308
OpenAlexW4220907252

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.