Comparative mRNA booster effectiveness against death or hospitalization with COVID-19 pneumonia across at-risk US Veteran populations

J. Daniel Kelly (), Samuel Leonard, W. John Boscardin, Katherine J. Hoggatt, Emily N. Lum, Charles C. Austin, Amy Byers, Phyllis C. Tien, Peter C. Austin, Dawn M. Bravata and Salomeh Keyhani
Additional contact information
J. Daniel Kelly: San Francisco VA Medical Center
Samuel Leonard: San Francisco VA Medical Center
W. John Boscardin: UCSF
Katherine J. Hoggatt: San Francisco VA Medical Center
Emily N. Lum: San Francisco VA Medical Center
Charles C. Austin: Richard L. Roudebush VA Medical Center
Amy Byers: San Francisco VA Medical Center
Phyllis C. Tien: San Francisco VA Medical Center
Peter C. Austin: Institute for Clinical Evaluative Sciences
Dawn M. Bravata: Richard L. Roudebush VA Medical Center
Salomeh Keyhani: San Francisco VA Medical Center

Nature Communications, 2023, vol. 14, issue 1, 1-10

Abstract: Abstract Studies of comparative mRNA booster effectiveness among high-risk populations can inform mRNA booster-specific guidelines. The study emulated a target trial of COVID-19 vaccinated U.S. Veterans who received three doses of either mRNA-1273 or BNT162b2 vaccines. Participants were followed for up to 32 weeks between July 1, 2021 to May 30, 2022. Non-overlapping populations were average and high risk; high-risk sub-groups were age ≥65 years, high-risk co-morbid conditions, and immunocompromising conditions. Of 1,703,189 participants, 10.9 per 10,000 persons died or were hospitalized with COVID-19 pneumonia over 32 weeks (95% CI: 10.2, 11.8). Although relative risks of death or hospitalization with COVID-19 pneumonia were similar across at-risk groups, absolute risk varied when comparing three doses of BNT162b2 with mRNA-1273 (BNT162b2 minus mRNA-1273) between average-risk and high-risk populations, confirmed by the presence of additive interaction. The risk difference of death or hospitalization with COVID-19 pneumonia for high-risk populations was 2.2 (0.9, 3.6). Effects were not modified by predominant viral variant. In this work, the risk of death or hospitalization with COVID-19 pneumonia over 32 weeks was lower among high-risk populations who received three doses of mRNA-1273 vaccine instead of BNT162b2 vaccine; no difference was found among the average-risk population and age >65 sub-group.

Date: 2023
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DOI: 10.1038/s41467-023-38503-8

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