Lee, Man Mon, 1 Nov 2021 17:05:33 -0400 Bozio, Catherine H. (CDC/DDID/NCIRD/ID) ‘A few questions on recent early release Dr. Bozio, Tam a 4th year pharmacy student out of Campbell University in North Carolina and enjoyed reading the early release of "Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19- Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity”. [had a few questions that Thope you can help answer. [will be presenting this study to a group of hospital providers. 1) How were the adjusted odds ratios weighted” 2) Would you be able to send me a copy of the supplemental index? 3) Do you have any data on the following comorbidities diabetes, hypertension, COPD and obesity for each group? 4) Do you have an age breakdown forall the eovi jve? The ones in the study lists those that tested both positive and negative. Like illnesses that were eovid po: | thank you in advance for your time and hope to hear back soon. Thank you again. Respectilly, Man LeeTumpey, Abbigail (CDC/DDPHSS/CSELS/OD) Fri, 29 Oct 2021 14:40:58 +0000 Mahon, Barbara (CDC/DDID/NCIRD/OD); Kent, Charlotte (CDC/DDPHSS/CSELS/OD); Braden, Chris (CDC/DDID/NCEZID/OD); Branam, lan (CDC/DDPHSS/CSELS/OD); Bozio, Catherine H. (CDC/DDID/NCIRD/ID); Hall, Aron (CDC/DDID/NCIRD/DVD) Ce: CDC IMS JIC Lead -2; Turner Hoffman, Katherine (Kat) (CDC/DDPHSS/CSELS/OD} Choban, Ana (CDC/DDID/NCIRD/ID); Fisher, Angela H. (CDC/DDPHSS/CSELS/OD) Subject: Clean MMWR messaging Attachments: COVID-19 Comms Rollout - Immunity MMWR_10282021 v2.docx. Great! Here isa clean, hard copy version of the MMWR messaging. Thanks to everyone for the very helpful pivot this AM. Regards, Abbigail From: Mahon, Barbara (CDC/DDID/NCIRD/OD) Sent: Friday, October 29, 2021 10:24 AM ‘To: Tumpey, Abbigail (CDC/DDPHSS/CSELS/OD) ; Kent, Charlotte (CDC/DDPHSS/CSELS/OD) ; Braden, Chris (CDC/DDID/NCEZID/OD) ; Branam, lan (CDC/DDPHSS/CSELS/OD) ; Bozio, Catherine H. (CDC/DDID/NCIRD/ID) ; Hall, Aron (CDC/DDID/NCIRD/DVD) Cc: CDC IMS JIC Lead -2 ; Turner Hoffman, Katherine (Kat) (CDC/DDPHSS/CSELS/OD) ; Choban, Ana (CDC/DDID/NCIRD/ID) ; Fisher, Angela H. (CDC/DDPHSS/CSELS/OD) Subject: RE: Need Quick Check: MMWR messaging, That works for me. From: Tumpey, Abbigail (COC/DDPHSS/CSELS/0D) Sent: Friday, October 29, 2021 10:02 AM To: Mahon, Barbara (CDC/DDID/NCIRD/OD) ; Kent, Charlotte (CDC/DDPHSS/CSELS/OD) ; Braden, Chris (CDC/ODID/NCEZID/OD) ; Branam, lan (CDC/DDPHSS/CSELS/OD) ; Bozio, Catherine H. (CDC/DDID/NCIRD/ID) ; Hall, Aron (CDC/DDID/NCIRD/OVD) Cc: CDC IMS JIC Lead -2 ; Turner Hoffman, Katherine (Kat) (CDC/DDPHSS/CSELS/OD) ; Choban, Ana (CDC/DDID/NCIRD/ID) ; Fisher, Angela H. (CDC/DDPHSS/CSELS/0D) Subject: RE: Need Quick Check: MMWR messaging, Good catches all WE JAll good? Clean version at same linkeyo) From: Mahon, Barbara (CDC/DDID/NCIRD/OD) Sent: Friday, October 29, 2021 8:56 AM ‘To: Tumpey, Abbigail (CDC/DDPHSS/CSELS/OD) ; Kent, Charlotte (CDC/DDPHSS/CSELS/OD) ; Braden, Chris (COC/DDID/NCEZID/OD) ; Branam, lan (CDC/DDPHSS/CSELS/OD) ; Bozio, Catherine H. (CDC/DDID/NCIRD/ID) ; Hall, Aron (CDC/DDID/NCIRD/DVD) Ce: CDC IMSJIC Lead -2 ; Turner Hoffman, Katherine (Kat) (COC/DOPHSS/CSELS/OD) ; Choban, Ana (CDC/DDID/NCIRD/I0) ; Fisher, Angela H. (CDC/DDPHSS/CSELS/OD) Subject: RE: Need Quick Check: MMWR messaging Hi Abbigall, Have made some suggested edits, er © Barbara From: Tumpey, Abbigail (CDC/DDPHSS/CSELS/0D) Sent: Friday, October 29, 2022 8:25 AM To: Kent, Charlotte (CDC/DDPHSS/CSELS/OD) ; Mahon, Barbara (CDC/DDID/NCIRD/OD) ; Braden, Chris (CDC/DDID/NCEZID/OD) ; Branam, lan (CDC/DDPHSS/CSELS/OD) ; Bozio, Catherine H. (CDC/DDID/NCIRD/I0) ; Hall, Aron (CDC/DDID/NCIRD/DVD) Ce: CDC IMS JIC Lead -2 ; Turner Hoffman, Katherine (Kat) (CDC/DDPHSS/CSELS/OD) ; Choban, Ana (CDC/DDID/NCIRD/ID) ; Fisher, Angela H. (CDC/DDPHSS/CSELS/0D) Subject: Need Quick Check: MMWR messaging Colleagues,Now that the MMWR is going earlier than the Science Brief, we changed the messaging to focus just on the MMWR. Can you all double check the accuracy?? Possible to tell me by Sam?? F)covp-19 comms Rollout - immunity MMWR 10282021 v2.docx Thanks to lan for his leadership and help here. Regards, Abbigail Abbigail Tumpey, MPH CHES Acting Associate Director for Communication Centers for Disease Control and Prevention 11600 Clifton Rd. NE Atlanta, GA Phone: 404-639-1125 Cell: 404-259-7064 Email: atumpey@cdc.govpeneSteve McConnell Tue, 2 Nov 2021 17:42:09 +0000 Bozio, Catherine H. (CDC/DDID/NCIRD/ID) Subject: Comment on "Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like IlIness with Infection" Dear Dr. Bozio, head one of the teams that submits Covid-19 death forecasts into the CDC's forecast hub. tread with great interest your early release paper “Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like lliness with Infection-induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January-September 2021.” (accessed from here). ‘The graphic on the website summarizes the conclusi previous infection were 5x more likely to have a pi Here's the graphic: of the paper as: “Unvaccinated people with /e covid-19 test compared to vaccinated people.” A study of hospitalized patients with symptoms similar to COVID-19* found... Unvaccinated people with a previous infection were ° * a ™ 5x *, # more likely to have a positive COVID-19 test Get vaccinated as soon as possible bitLIy/MMWR704401 MMWR ‘This statement implies that the data in the paper applies to the population at large. But the data in the paper does not include the population at large, rather it includes only people who were hospitalized With covid-19 like illnesses, ‘My reading of the paper suggests that strongest conclusion the data supports is: “Among patients who were hospitalized with covid-like symptoms, unvaccinated patients with previous infection were Sx more likely to test positive for covid than vaccinated patients.” This s still an interesting finding, but itis not as broad as the graphic implies.‘My other question about the paper concerned Table 1, Since the paper is about patients who tested positive for covid, | thought the data in Table 1 would have been more appropriately limited to patients who tested positive, rather than describing the entire population of patients. The way that Table 1 is, currentiy presented, there is no way to see the disaggregated data for patients who tested positive. Thank you for considering these comments, and thank you for your important work in this area Best regards, Steve McConnell Chief Executive Officer Construx Software c: 206-714-8467 8: 10900 NE 8th St. Ste. 1300, Bellevue, WA 98004 w; construx.com e: stevemec@construx.comMedu, Lanre SHA Tue, 2 Nov 2021 20:18:09 +0000 Bozio, Catherine H. (CDC/DDID/NCIRD/ID) Follow-up question on your paper ‘Thank you, Dr. Bozio, for your work on the paper titled “Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Iliness with infection-induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January-September 2021” I wanted to find out if you had data about the outcomes in these two groups, ie. clinical course after the I visit, which was the basis of the analysis. Additionally, do you have an idea of the infection rates in the non-hospitalized cases, or do you expect this finding to be similar in cases that were not sufficiently ill to seek hospital care? Thanks again, and | look forward to your response. Dr. ‘Lanre Medu, Medical Health Officer, Population and Public Health Services, Saskatchewan Health Authority, 2110 Hamilton Street, Regina, SK S4P2E3, Tel-306 766 7771; Fax-306 766 7607Bozio, Catherine H. (CDC/DDID/NCIRD/ID) Sat, 30 Oct 2021 11:33:52 +0000 Choban, Ana (CDC/DDID/NCIRD/ID) Fwd: covid-19 natural immunity vs. vaccine report Best, Catherine From: Charles&Ruth Binford Sent: Saturday, October 30, 2021 12:48:31 AM To: Bozio, Catherine H. (CDC/DDID/NCIRD/ID) Subject: covid-19 natural immunity vs. vaccine report This is regarding the paper, "Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Hiness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, JanuarySeptember 2021, Early Release / October 29, 2021/70". I've see the study you mentioned from Tsrael that indicated natural immunity is as good or better then immunity from vaccination, Yet your paper indicates the opposite. I'm trying to understand why. 1 can see from the article and tables that the ratio of those testing positive for covid-19 was lower for the vaccinated group. But what I don't understand is why the raw numbers of those in the hospital with covid-like symptoms was so much higher for the vaccinated (over 6000 vaccinated vs. roughly 1000 unvaccinated). ‘The paper didn't address that issue. Does the estimated number of vaccinated people to unvaccinated-but-previously-had-covid ratio account for that difference in the raw numbers? ‘Thanks, Charles BinfordHill, Andrew (CDC/ODID/NCHHSTP/DTE) Tue, 2 Nov 2021 16:03:01 +0000 Reynolds, Sue B. (CDC/DDID/NCIRD/ID) FW: Ask a statistician \VaccinationvsNaturallmmunityaStates_ MMWR_290ct2021.pdf Hi, Sue {see you were a co-author. | haven't read the article but any quick responses to the questions below? Hope all is well. Any word on the DHOP position? Andrew From: Gurbaxani, Brian M. (COC/DDPHSS/0S/OT!) Sent: Tuesday, 2 November, 2021 11:47 To: Hill, Andrew (CDC/DDID/NCHHSTP/DTE) Ce: Glasser, John (CDC/DDID/NCIRD/DVD) Subject: Fw: Ask a statistician See my stats question below, and Betsy's tentative response. Has become even more pressing due to that this is one of the most news covered MMWR's (attached) in a while... Would appreciate some feedback. OT it OHS) Brian From: Gunnels, Betsy (CDC/DDID/NCHHSTP/DHP) Sent: Friday, October 29, 2021 2:27 PM : Gurbaxani, Brian M. (CDC/ODPHSS/0S/0TI) Sent: Friday, October 29, 2021 2:04 PM To: Gunnels, Betsy (CDC/DDID/NCHHSTP/OHP) Subject: Ask a statistician HI Betsy!Itwas great to talk to you the other day! Please keep me in mind as a resource for modeling, engineering, or anything else | can be helpful with. Anyway, | would like to ask you a hopefully quick q about stats. Attached and fascinating MMWR just came out today, and honestly (my immunologist hat is on) | am surprised at the magnitude of the results, so | looked into them. The aOR for reinfection is pretty big ~5.5, even though the crude OR ~1.8, I'm not used to adjustments making that big of a difference. So! looked at it and, well, the age profiles are quite different between groups, which could have a big impact -- many more elderly in the vaccinated group. The aOR for the 65+ group is 19.6! But the crude OR for that group is also ~1.7, so the adjustments must be making an impact somewhere else. | have no problem with the vaccine being better than natural immunity but the odds ratios look really big. | suppose I should compare them to other diseases where similar comparisons are possible. Sorry, maybe these are amateur questions but perhaps you could help me to understand. Thanks in advance! -- BrianCenters for Disease Control and Prevention Morbidity and Mortality Weekly Report Early Release / Vol. 70 October 29, 2021 Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January-September 2021 Catherine 1. Bozi, PAD; Shaun J. Grannis, MD? Alison L. Naleway, PhD; Toan C. Ong, PRDS: Kristen A. Butterfield, MPH: Malini B DeSilva, MD?; Karthik Natarsjan, PADSS. Duck-Hye Vang, PADS; Suchita Rao, MBBS Nicola ® Klein, MD, PhD, Stephanie A. Ising MHS Brian E. Dion, PAD?!; Kristin Datcomb, MD, PhD! Charlene McEvoy, MD; Juga Han; Sarah E, Rese, PHD% Ned Levis, MPH; Willan E. Fae, Pl 5, Kharbands, MDM: Pack K. Mitchell, ScD® Kristin Goddard, MPH: Kempapua Murthy MBBS: Jil Ferinands, PRD!s Anupa hia Lizo MPH(, Sue Reynolds, PAD: st, Nancy Grisel, MPP; PeeerJ-Embi, MD®™; Julie Arndorer, MPH!2; Chandni Raiyani, MPH": Palak Patel, MBRS!: Elizabeth A. Rowiey, DrPH®, Bruce Fireman, MA: \Nimish R. Vali, DiPH, MBBS2; Eric P Griggs, MPH: Matthew F. Ley, PRD® Ousseny Zerbo, PhD; Rachael M. Porer, MPH: Rebeeca J Bitch, MPH; Lenee Blawon, MPH! Sarah W. Ball, SeD® Andrea Steffens, MPH; Nazalie Olson, MPH! Jeremiah Willams, MPH Monica Dickerson, PH; Meredith MeMorrowe, MD; Stephanie |. Schrag, DPhil Jennifer. Versni, MD!> Alicis M. Ey, MD! Eduardo Aziz Baumgartner, MD!; Michelle Baron, MD?; Manjusha Caplan, MBBS!2; Mark G. Thompson, PhD; Edward Stenehjem, MD!2 Previous infection with SARS-CoV-2 (the virus that causes COVID-19) or COVID-19 vaccination can provide immu- nity and protection from subsequent SARS-CoV-2 infection, and illness. CDC used data from the VISION Network” to examine hospitalizations in adults with COVID-19-like illness, and compared the odds of receiving a positive SARS-CoV-2. test result, and thus having laboratory-confirmed COVID-19,, between unvaccinated patients with a previous SARS-CoV-2, infection occurring 90-179 days before COVID-19-like illness, hospitalization, and patients who were fully vaccinaved with an mRNA COVID-19 vaccine 90-179 days before hospitaliza- tion with no previous documented SARS-CoV-2 infection. Hospitalized adults aged 218 years with COVID-19-like illness were included if they had received testing atleast ewice: once associated with a COVID-19-like illness hospitalization, during January—September 2021 and at least once earlier (since February 1, 2020, and 214 days before that hospitalization). Among COVID-19-like illness hospitalizations in persons ‘whose previous infection or vaccination occurred 90-179 days: carer, the odds of laboratory-confirmed COVID-19 (adjusted, for sociodemographic and health characteris unvaccinated, previously infected adults were “Funded by CDG. the VISION Neework includes Columbia Universe ving “Medial Center (New York), HeathParinets (Minnesota and Wisconsin, Inuermountin Healthcare (Ua), Kaiser Permanente Northern California (California), Kaiser Permanente Noschwest (Oregon and Washington), Regent Inia ladiana), and University of Colorado (Colorado) m4 aire the odds among fully vaccinated recipients of an mRNA. COVID-19 vaccine with no previous documented infection (adjusted odds ratio [4OR] = 5.495 95% confidence interval [Cl] = 2.75-10.99). These findings suggest that among hos- pitalized adults with COVID-19-like illness whose previous infection or vaccination occurred 90-179 days earlier, vaccine- induced immunity was more protective than infectioninduced immunity against laboratory-confirmed COVID-19. All cligible persons should be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2, “To compare the early protection against COVID-19 con- ferred by SARS-CoV-2 infection and by receipt of mRNA. COVID-19 vaccines (i.e. 90-179 days after infection or vaccination), the VISION Network collected data from 187 hospitals across nine states during January~September 2021 (J). Bligible hospitalizations were defined as those among adults aged 218 years who had received SARS-CoV-2 molecular testing (from 14 days before to 72 hours after admis- sion) and had a COVID-19-like illness discharge diagnosis! ‘ Mdical evens with discharge code consistent with COVID-19-ike ils vere induded, COVID-19+like inet diagnoses incaded acute respiratory hes (eq, COVID-19,respestony ila, or pneumonia related signs oF sympeome (cough eer, dyspnes, vomiting, or arth) using diagnosis codes from he International Claaeton of Dies. Noh Revision and Iteration (Clacton of Dis, Tenth Revi, USS. Department of Health and Human Services Centers for Disease Control and PreventionEarly Release during January-September 2021. Eligible patients had also been tested at least once since February 1, 2020. To limit the analysis to patients with access to SARS-CoV-2 testing before hospitalization, patients who did not receive SARS-CoV-2 testing 214 days before hospitalization were excluded. ‘Two exposure groups were defined based on COVID-19 vaccination status and previous SARS-CoV-2 infection. ‘Vaccination status was documented in electronic health records and immunization registries. Previous infection was, ascertained based on SARS-CoV-2 testing from rapid antigen, tests or molecular assays (e.g, real-time reverse cranscription— polymerase chain reaction) performed before mRNA vaccina- tion and 214 days before admission; testing performed after February 2020 was primarily within network partners’ medical facilities. Adults were considered unvaccinated with a previous SARS-CoV-2 infection if ne COVID-19 vaccine doses were received and if the most recent positive SARS-CoV-2 test result occurred 290 days before hospitalization. Adults were considered fully vaccinated with an mRNA COVID-19 vaccine with no previous documented infection if the second dose of Pizer-BioNTech (BNT162b2) or Moderna (mRNA-1273) mRNA vaccine was received 214 days before the index test ddateS and if they had been tested since February 1, 2020, and had no positive test results 214 days before hospitaliza- tion. Patients were excluded if they had received 1 mRNA vaccine dose only, received the second dose <14 days before index test date, or received the Janssen Johnson & Johnson, [Ad26.COV2}) vaccine (because of sparse data). To reduce the chance thac the hospitalization was related co an ongoing SARS-CoV-2 infection, patients were also excluded from the previous infection group if their most recent previous positive test result occurred 14-89 days before hospitalization. ‘The outcome of laboratory-confirmed defined as COVID-19-like illness and a positive SARS-CoV-2. result from molecular testing. Among patients hospitalized with, COVID-19-like illness whose previous infection or comple tion of vaccination occurred 90-179 days earlier, the odds of Laboracory-confirmed COVID-19 were compared between pre viously infected persons and fully vaccinated mRNA COVID-19, vaccine recipients. ORs and 95% Cls were calculated using multivariable logistic regression, adjusted for age, geographic region, calendar time (days from January 1 to hospitalization), and local virus circulation, and weighted based on propensity to be in the vaccinated category (1,2). Established methods were used to calculate weights to account for differences in Tinton est date was deine athe date: of respiratory specimen collection ‘seociated with the most recent positive or negative SARS-CoV? fx elt tefore the hosptalieation or the beoptalization date i tating only cocured after admission, ‘raptor cde gfcoronavitws2019-ncoviphpinvese-criteria hem] 2 MMWR / October 29,2021 / Vo.70 sociodemographic and health characteristics berween groups (9). Separate weights were calculated for each model, aORs were stratified by mRNA vaccine product and age group. Three secondary analyses wete also conducted. First, the impact of whether and how the time interval since previous infec tion or fll vaccination was adjusted was examined, Specifically, any time since either previous infection or completion of vac- ination was considered. Then, previously infected patients were limited to those with more recent infections (i.e. 90-225 days, before hospitalization [the lowest two tertiles of number of days, since infection), and fully vaceinated patients were limited to those with the longest interval since completion of vaccination (ce. receipt of second mRNA vaccine dose 45-213 days before hospitalization [the highest two tertiles of number of days since vaccination). Thea, number of days sinee previous infection ‘or completion of vaccination, rather than calendar time, was adjusted in the model. For the next secondary analysis, ORs for hospitalizations thac occurred before and during SARS-CoV-2 B.1.617.2 (Delta) variant predominance (June-September 2021) were compared, beginning on the date the Delta vari- ant accounted for >50% of sequenced isolates in each medical facilty’s sate (2). Finally, effect modification was assessed by mRNA vaccine product or by age group: p-values <0.2 were considered indicative of a statistically significant difference in aOR by produce or age, similar to previous modeling studies of effect modification (4). All analyses were conducted using SAS (version 9.45 SAS Institute) and R (version 4.0.2; R Foundation). “This activity was reviewed by CDC and was conducted consis- tent with applicable federal law and CDC policy.** During January 1-September 2, 2021, a total of 201,269 hospitalizations for COVID-19-fike illness were identified: 139,655 (69.4%) patients were hospitalized after COVID-19 vaccines were generally available to persons in their age ‘group within their geographic region, Molecular testing for SARS-CoV-2 was performed for 94,264 (67.5%) patients with COVID-19-like illness hospitalizations. Among these patients, 7,348 (7.8%) had at least one other SARS-CoV-2 test result 214 days before hospitalization and met eriteria for cither of the two exposure categories: 1,020 hospitalizations ‘were among previously infected and unvaccinated persons, and 6,328 were among fully vaccinated and previously uninfected, patients (Table 1) Laboratory-confirmed SARS-CoV-2 infection was identi- fied among 324 (5.19) of 6,328 fully vaccinated persons and among 89 of 1,020 (8.7%) unvaccinated, previously infected persons. A higher proportion of previously infected than vac~ cinated patients were aged 18-49 years (31% versus 9%), Black, (10% versus 796), and Hispanic (19% versus 1296). S35 GER pare 46:21 GER pare 6.Early Release ‘TABLE 1. Characteristics of COVID-19-like illness hospitalizations* among unvaccinated adults with a SARS-CoV-2 infection occurring 90-179, days before the index test date’ and among adults who were fully vaccinated? 90-179 days before the index test date" without a previous documented SARS:CoV-2 infection — nine states,* nuary-September 2021 ‘Unvaccinated with previous SARS-CoV? infection Characteristic ‘No. (coun 8) Fully vaccinated without Standardized mean or previous documented infection proportion cfference™> ‘Al hospitalizations with COVID-T9-ke ness SARS-CoV. tast result associated with COVID-19-like illness hospitalization Postive Negative Sex Male Female ‘Age group. yes 18 50-64 65-74 75.84 285 Race, respective of ethnilty Woite Black Other!* Unknown Ethnicity imespective of race Hispanic Non-Hispanic Unknown Month ofindextest date! January Febrasty ares Apri May ine aly August September 71020(100) 328 100) NA 3919) x45) on 331191) 6004.85) 405 40) 2905 46) on 15 60) 342364) 31360 50009) ova 243 (20) 955 (4) 207 20) 1757 08) wry 201862) 3018) 112808), 4.35669) oz 45207) 686 (11) 834(03) 89119) 756012) 020 695 68) 445870) 136113) anna) no om) 210 a) om) macnn ray 245 28) 600) 29409) 235 (8) ‘se 18 130021) 59110) 2731083) 3113) 2.0932) 110 70) See abe footnotes on the nO PAGE Among COVID-19-like illness hospitalizations in persons whose previous infection or vaccination occurred 90-179 days calie, the odds of laboratory-confirmed COVID-19 were higher among previously infected, unvaccinated patients than among fully vaccinated patients (aOR = 5.49; 95% CI = 2.75-10.99) (Table 2). In secondary analyses, the aORs that examined the impact of whether and how time since infection or yaccina- tion was adjusted and that stratified hospitalizations before and during Delta variant predominance were all similar co the primary aOR estimate. For product- and age group-specific estimates, sparse data limited the precision of these aORs. However, an assessment of effect modification indicated the aOR of laboratory-confirmed COVID-19 was higher for previ- ously infected patients compared with patients vaccinated with ‘Moderna (aOR = 7.30) than compared with patients vaccinated, with Pfizer-BioN Tech (aOR = 5.11) during January-Seprember (p=0.02). Similarly; the interaction term for exposure group by age indicated that the aOR was higher for patients aged 265 years, (2OR = 19.57) than for those aged 18-64 years (aOR = 2.57) (interaction term, p = 0.05). Discussion In his mukistateanalyss of hospitalizations for COVID-19-lke illness among adults aged 218 years during January-September 2021 whose previous infection or vaccination occurred 90-179 days earlier, the adjusted odds of laboratory-confirmed COVID-19 "were higher among unvaccinated and previously infected patients, than among those who were fully vaccinated with 2-doses of an mRNA COVID-19 vaccine without previous documentation of SARS-CoV-2 infection, Secondary analyses that did not adjust for time since infection or vaccination or adjusted time since infection or vaccination differently as well as before and during Delta variant predominance produced similar results. These findings are consistent with evidence that neutralizing antibody tersafter receipt oF 2 doses of mRNA COVID-19 vaccine are high (5.6); however, these findings differ from those of a retrospective records-based, DMAKWR / October29,2021 / Vol. 70 3Early Release ‘TABLE 1. (Continued) Characteristics of COVID-19-likellness hosptalizations* among unvaccinated adults with a SARS-CoV--2 infection occurring 90-179 days before the index test date’ and among adults who were fully vaccinated® 90-179 days before the index test date’ without 3 previous documented SARS-CoV-2 infection — nine states, January September 2021 Tio. (cokamn ‘Unvaccinatedwith previous Fully vaccinated without Standardized mean or Characteristic SARS-CoV-Zinfection previous documented infection proportion diference”™ site Columbia University 39 23818) 073 HealthParners 20 3401) Intermountain Healthcare nan 45407) Kaiser Permanente Norther California 254 25) 3614057) Kaiser Permanente Northwest, 303) 250 (8) Regenstie institute 300138) 1145.08) University of Colorado 154105) 5336) Time since either previous SARS-CoV. infection o fullmRNA vaccination until COVID-19-Lke illness index test date days 90-119 367 36) 3325 (53) oa 120-149 35335) 210163) 150-179 30029) ‘02104) CCOVID-19 vaccination status Unvaccnated 11020 100) 0) NA Pier SiiVTech(BNT16262) oO 3736158) Moderna (mniNA-1273) om 2592141) ‘Abbreviation: NA =not applicable, * Medical events with decharge cod consstent with COVID-10-ke ines were included, COMID-19-Ike ines diagnoses included acute espatory ines (2, COVID-19,resprtory alr oF pneumonia or related signs or symptoms (cough fever dyspnea, vomiting ore) using dlegnosiscodesfrom the ntemetione) Clastieation f Diseases nth Revision and Internationa Cleeafetion of Diseases, Tenth Revision Cimisan ordered molecular assays (e. realtime reverse ‘wansciption-polymerase chain reaction for SARS-CoV'2 occurring =14 days before to <72 hous after hospital admission were included "Inde test date wae defined a the date of respiratory specimen colectionasaciated withthe most racent poave or negative SARS-CoVe? test result before the hospitalization or the hospitalization date if testing only occured after he admission. Ss Ful vaccination was defined a receipt ofthe second dose a Pier ioNTach or Madera mRNA vaccine »14 days before the index test date ‘Partners contributing hospitalizations were in Calfornia, Colorado, Indiana, Minnesota and Wisconsin, Oregon and Washington, Utah and NewYork ‘In comparing characteristics between unvaccinated aduls with 2 previous infection and full vaccinated adults without a previous documented infection, @ Standardized mean or proportion diference 0.2 was considered noteworthy, After balancing characteristics thot fered between the two compotion groups, the standardized mean or proportion differences were <0.6. “Other race includes Asian Hawallan or Othe Paci slander, American Indian or Alaskan Native, Other not sted and multiple races. cohort study in Isae,"* which did noc find higher protection for vaccinated adults compared with those with previous infection during period of Delta variant circulation, This variation s possibly relared to differences in the outcome of interest and restrictions on the timing of vaccination. The Israeli cohort study assessed any positive SARS-CoV-2 test result, whereas this study examined Inboratory-confirmed COVID-19 among hospitalized patients ‘The Israeli cohort study also only examined vaccinations that had cccurted 6 months earlier, so the benefit of more recent vaccination, ‘was not examined. This report focused on the early protection fiom infection-induced and vaccine-induced immunity, hough ic ispossble that estimates could be affected by time, Understanding Infection-induced and vaccine-induced immunity over time is important, particularly for fururescudies to consider. In this study, the benefit of vaccination compared with infec- tion without vaccination appeared to be higher for recipients of Moderna than Pfizer-BioN Tech vaccine, which is consistent with a recent study that found higher vaccine effectiveness against COVID-19 hospitalizations for Moderna vaccine recip ients than for Pfizer-BioNTech vaccine recipients (7). In this, TW inepalTowwanedoaicory/comtenc/10.1101/2021.08.24.2126241501 4 MMWR / October 29,2021 / Vo.70 study, the protective effec of vaccination also trended higher for adults aged 265 years than for those aged 18-64 years However, considering the limited data by both product type and age, additional research is needed on the relative protec- tion of vaccination versus infection without vaccination across demographic groups and vaccine products, as well as vaccina- tion in previously infected persons. “The findings in this report are subject to at east seven limita- tions, First, although this analysis was designed to compare two groups with different sources of immunity, patients might have been misclassified. IF SARS-CoV-2 testing occurred outside of network partners’ medical facilities or if vaccinated persons are les likely to seek testing, some positive SARS-CoV2 test results mighthave been missed and thus some patients classified as vaccinated and previously uninfected might also have been infected. In addition, despite the high specificity of COVID-19. ‘vaccination status from these data sources, misclassification is possible. Second, the aOR could not be further stratified by time since infection or vaccination because of sparse data and. limited ability to control for residual confounding that could, be magnified within shorter intervals, The aOR that did not adjust for time might also be subject to residual confounding,Early Release TABLE 2. Adjusted odds ratios* of laboratory-confirmed COVID-19 among hospitalizations in adults with COVID-19-tike illness comparing tunvaccinated adults with a SARS-CoV-2 infection occurring 90-179 days before the index test date and adults who were fully vaccinated 90-179 days before the Index test date without a previous documented SARS-CoV-2 infection — nine states, January-September 2021 No. row of SARS COV'2. Adjusted odés ratio outcome Totalna,_postvetetresuts (95% ‘Aad faged 218 yor) any COVID-19 RNA voccine Any mRNA vaccine Faly vacated without previous documented infection 632832415) fet Unvacinated wth a previous SARS-CoV? infection Yoo “8908 549 (275-1099) Any mRNA vaccine no restiton of time since previous infection or completion of vaccination Faly vacated without prevous documented infection we37 54200) fe {range of ie since vacation ~ 0-713 days tore hospitalization Unwacinoted wth a reviou SARS-CoV 2inecton 2005 130462) 275(190-398) {range of me since prevosinfstion - 50-94 days before hosetalation) ‘ny mRNA vaccine examining the potential influence of ime since prevousinfcton or completion of vaccination Fully vaccinated” without previous documented nection limited to those wih ongestpeiog 12231 458(3.7 ref Sincevacination ange of tnesince vocation = 45-213 dys belorehosptalation Unvacnated witha previous SARS-CoV2 infection imied to those with marerecent infections 1388107 7.71 396(249-635) {range of ime since prevousinfection - 50-225 days before osptalaton) ‘Any mRNA vaccine adjusting fr time since previous infection or completion of vaccination n model Fall vochated witout pes documented infection 6028 324651) fet Unvacenated wth a previous SARS-COV"? infection Yoo 89087) 322(168-620) 8 time relative to SARS-CoV-28.1.6172 (Det) varant predominance Before Dela predominance January-June 2021) Fal vaccinated without previous documented infection as 808) te Unvacnated wth a prewous SARS-CoV fection on 70184) an 28-1316 During Det predominance UuneSeptember 2021)" Falyvaccsted’ witout pevous documented infection 5230655) fe Unvaceated wth a previous SARS-CoV? infection 1 191100) 755 045-1652 By mRNA vacine product? Piizer BioN Tech (BNT16262) Fully vaccinated! without previous documented nection 373815658) fet Unvacinated wth a previous SARS-Co¥? infection yoo “89087) 511 283-1029) Moderna mRNA-1275) Ful vacated without prevous documented infection 252109442) ff Unvaccnated witha previous SARS-CoV? infection 100 85087) 7.30(640-1560) By age group, yst rest Ful vaccinated? without previous documented infection 125 7150) fe Unvecinated wth a previous SARS-CoV? infection 5649488) 27014-4165) 365 Fully vacated” without previous documented infection aos 253152) fe Unvaccnated witha preous SARS-CoV? fection as 0186) 1957 (634-4591 ‘Abbreviations: CI= confidence interval ref = referent group, * Odds flios were adjusted forage, geographic region, calendar tine (days since January 1, 2027), and lca vts culation (percentage of SARS-CoV2 postive results rom testing within the counties surrounding the fcity on the date ofthe hospitalization) and balanced using mverse weights on characteristics thet Gere between the we groups (calculated separately or each odds ato mode! using faclity characteristics, sociodemographic characterises and underying ‘medical conditions. Cardiovascular dlgease was also adjusted n the main model and in the model for PizerBioNTech. Any Ikelyimmunesuppression was also Included inthe model for Modema, Neuromuscular and rsptatory conitons were ako adjusted inthe model for adults aged 265 years Number of days since previous infection or completion of vaccination instead of clend time, was adjusted in the model within the stated secondary analysis {Full vaccination was defined as receipt of the second dose of Pfr SioNTech or Madera mfINA vaccine =14 days before the index test date {3 Pwaluefrom assessment of effect modiiation by mRNA product was 402, {1Pwaluefor interaction term for exposure group by age group was 005. = SARS-CaV.2B 1617 2 (Delta variant predominance began on the date the Delt variant accounted for >50%of sequenced isolates in each meta fait’ state ttpsfdoLorg/10.1888Smmvitmmn7037e2 particularly related co waning of both types of immunity. Third, selection bias might be possible if vaccination status influences likelihood of testing and if previous infection influences the likelihood of vaccination, Previous work from the VISION net- work did not identify systematic bias in testing by vaccination, status, based on data through May 2021 (1), Fourth, residual confounding might exist because the study did not measure ‘or adjust for behavioral differences berween the comparison ‘groups that could modify the risk of che outcome. Fifth, these results might not be generalizable co nonhospitalized patients, who have different access to medical care or different health ‘eare-secking behaviors, particularly outside of the nine states DMAKWR / October29,2021 / Vol. 70 5Early Release covered, Sixth, the statistical model incorporated the use of a weighted propensity score method which is subject to biases, in estimates or standard errors if the propensity score model, is misspecified. Numerous techniques were used to reduce potential suboptimal specification of the model, including buc not limited to including a large set of covariates for machine learning estimation of propensity scores, including covariates in both regression and propensity models, ensuring large sample sizesand checking stability of weights, and conducting second- ary analyses to assess robustness of results. Finally, the study assessed COVID-19 mRNA vaccines onlys findings should not be generalized to the Janssen vaccine. In this U.S.-based epidemiologic analysis of patients hospi- talized with COVID-19-like illness whose previous infection, or vaccination occurred 90-179 days earlier, vaceine-induced immunity was more protective than infection-induced immunity against laboratory-confirmed COVID-19, inchiding during a petiod of Delta variant predominance. All eligible persons should, be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2. ‘Acknowledgments Jeffenon Jones, Claire Midgley, Ruth Link-Glks, Sharon Saydab, Jerome Tos, Adi Gundlapall, Natalie Thornburg Aga Shefr, John Kool, Erin Tromble, Meissa Caer, Cory Kokko, Stephanie Weaver, Kushali Muthumalaippan, Bio-Ping Zhu, Roumiana Boneva, CDC. ‘Coneapondng author: Caterne H, Bono, 7@ede pu TEDE COVID-I9 Response Team: Center for Biomedical Informatics Regenatit Insitute Indianapolis, Indiana; diana University School of “Maticns, Indianapolis, India, "Center for Eleth Reseach, Kater Petmanente ‘Nanhses, Portland, Oxgon Deparment of Medicine, Univesity of Colorado, ‘Anachate Medical Campus, Aurora, Colorado “West, Rockville, Marland: "earners faite, Minneapolis Mins Depurtmenc of Brome Iaformatics, Columbia Universi, New Yor, New Yorks °New York Prbyteian Hospital, New Vrk ity, New York Kaiser ermanente Verne Stn Center, Keser Permanente Northern Caloris, Oakland, California: Finks Schoo ‘of Public Health, Indiana University Indianapolis, Indiana; ?Divsion of Infectious Dace and Clinical Epidemiology Iermoantin Healthcare, Salt Lake iy Uh, Baylor Scot 8 White Health, Teas ASM University College ‘of Medicine. Temple. Teas; Childress Minasoa, Minneapolis, Minnesota "Regen Ines, Indnspalis Indian All authors have completed and submitted the International Commixtee of Medical Journal Editors form for disclosure of potential conflicts of interest. Stephanie A. Irving reports support from Westat to Kaiser Permanente Northwest Center for Health Research. Nicola P. Klein reports support from Pfizer to Kaiser Permanente, Northern California for COVID-19 vaccine clinical trials, and institutional support from Merck, GlaxoSmithKline, and Sanofi Pasteur outside the current study. Charlene McEvoy reports, support fiom AstraZeneca o HealthPartnes Institue for COVID-19 vaccine tras. Alison L. Naleway reports Pfizer Research funding to ‘summary ‘What i aleady known about this topic? Previous infection with SARS-CoV-2 or COVID-19 vaccination ‘can provide immunity and protection against subsequent ‘SARS,CoV’2 infection and illness. ‘Whatis added by this report? Among COVID-19-tke illness hospitalizations among adults ‘aged =18 years whose previous infection or vaccination. ‘occured 90-179 days earlier, the adjusted odds of laboratory- ‘confirmed COVID-19 among unvaccinated adults with previous ‘SARS-CoV'2 infection were 5.49-fld higher than the odds, ‘among fully vaccinated recipients ofan mRNA COVID-19 ‘vaccine who had no previous documented infection (95% ‘confidence interval= 2.75-10.99). What are the implications for public heath practice? Alleligible persons should be vaccinated against COVID-19 as ‘soon 25 possible, including unvaccinated persons previously infected with SARS-CoV-2, Kaiser Permanente Northwes for unrelated study of meningococcal B vaccine safety during pregnancy. Suchitra Rao reports grants from GlaxoSmithKline and Biofire Diagnostics. No other potential conflicts of interest were disclosed. References 1. ThompsonMMG, Senchjam E, Grams eal Eevee of Covi 19 vaccines in ambulatory and inpatient cae serting: N Engl J Med 2021:385:1355-71 PRID'34496194 pds on 10.1056) NEJMes21 10362 annis SJ, Rowley EA, Ong TC, etal: VISION Nerwork. Ines ‘estimates of COVID-19 vaccine effectiveness against COVID-19- associated emergency department or urgent care clinical encounters and hospitalizations among adults during SARS-CoV.2 B.L.617.2 (Del) variant predomninance—-nine states, June-August 2021. MMWR Mor Moreal Wly Rep 2021:70:1291-3. PMID:34529642 hurpst/doi ‘ong/10.15585 ramon 7037e2 3. Mansion R, Joe MM, Sun W, Hennesy S. On the estimation and use of propensity scores in catecoattol and eac-cohore sie. Am J Epidemiol 2047 :166'382-9, PMID:17504780 haps. op, 1093/69 Maraall SW. Power for tests of iteration: effet of taxing the Type 1 ‘error rate. Epidemiol Perspect Innov 2007%4r4, PMID:17578572 hep) ddoj.ory/10-1186)1742-5573-4-4 5, Bdars VV, Hudson WH, Xie X, Ahmed Ry Suthar MS, Neutrlising antibodies against SARS-CaV2 variants after infection and vaccination, JAMA 20213325:1896-8, PMID:33739374 hepefd.org10 1001) jama.2021.4388 6 dara WV, Pinsky BA, Suchar MS, etal, fection and vaesine induced rewraliing-antibody responses to the SARS-CaV’2 B.1.617 variants N Engl } Med 2021;385:664-6, PMID:34233096 heeps! do, ‘rg/10.1056/NEJMc2107799 7. Self WH, Tenforde MW, Rhoads J ca; IVY Neework. Comparative celfeciveness of Moderna, Pizer BioN Tec, and Janssen Johnson 8 Johnson) vaccines in preventing COVID- 19 hospitalizations among adults {without immunocompromining conditions-—United States, March~ ‘August 2021. MMWR Morb Moctal Wkly Rep 2021,70:1337—43. PMUD:34555004 hueps:/doiog/10.15385/mmwemun7038el Readers who have difficulty accessing this PDF file may access the HTML file at hurps/#www.cdegov/mmv/volumes/70¢vwr/mm7044e1 hhum’s_cidemm7044el_v. Address all inquiries about the MMWR Series, including material to be considered for publication, to Editor, ‘MMUWR Series, Mailstop V25~ 6 MMWR / October 29,2021 / Vo.70 CDG, 1600 Glifon Rd, N.E. Atlanta, GA 30329-4027 or co mmwrrq@edc.gov.From: Dunworth, Soumya (CDC/DDPHSS/CSELS/OD) Sent: Fri, 29 Oct 2022 14:51:41 +0000 To: Bozio, Catherine H. (CDC/DDID/NCIRD/ID) Subject: FW: MMWR Embargoed eBooks for 10/29 Early Release Attachments: MMWR ER - October 29, 2021 - Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-1S-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January-September 2021.pdf From: MMWR Communications (CDC) Sent: Friday, October 29, 2021 10:51 AM ‘To: MMWR Communications (CDC) ; CDC MMWR ER Ebook Subject: MMWR Embargoed eBooks for 10/29 Early Release MMWR fac Morbidity and Mortality Weekly Report The MMWR is embargoed until 1 PM ET Friday, October 29, 2021 Please find the eBooks for today’s MMWR Early Release attached. Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Iliness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January-September 2021 Link when live https: //www.cdc.gov/mmwr/volumes/70/wr/mm7044e1.htm?s_cid=mm7044e1_wA study of hospitalized patients with symptoms similar to COVID-19* found... Unvaccinated people with a previous infection were * * * 5x * more likely to have a positive COVID-19 test compared to vaccinated peoplet “ome enaeene mame cen enn Get vaccinated as soon as possible bietnmnwnoeser MWR The Advisory Committee on Immunization Practices’ Interim Recommendations for Additional Primary and Booster Doses of COVID-19 Vaccines — United States, 2021 Link when live: https: //www.cde.gov/mmwr/ volumes /70/wr/mm7044e2.htm?s_cid=mm7044e2_w Best, lan fan Branam, MA Health Communication Specialist Center for Surveillance, Epidemiology, and Laboratory Services Centers for Disease Control and Prevention 0: 404-639-9316 | M: 404-275-3133 | E: ibranam@cdc.govCenters for Disease Control and Prevention Morbidity and Mortality Weekly Report Early Release / Vol. 70 October 29, 2021 Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January-September 2021 Catherine 1. Bozi, PAD; Shaun J. Grannis, MD? Alison L. Naleway, PhD; Toan C. Ong, PRDS: Kristen A. Butterfield, MPH: Malini B DeSilva, MD?; Karthik Natarsjan, PADSS. Duck-Hye Vang, PADS; Suchita Rao, MBBS Nicola ® Klein, MD, PhD, Stephanie A. Ising MHS Brian E. Dion, PAD?!; Kristin Datcomb, MD, PhD! Charlene McEvoy, MD; Juga Han; Sarah E, Rese, PHD% Ned Levis, MPH; Willan E. Fae, Pl 5, Kharbands, MDM: Pack K. Mitchell, ScD® Kristin Goddard, MPH: Kempapua Murthy MBBS: Jil Ferinands, PRD!s Anupa hia Lizo MPH(, Sue Reynolds, PAD: st, Nancy Grisel, MPP; PeeerJ-Embi, MD®™; Julie Arndorer, MPH!2; Chandni Raiyani, MPH": Palak Patel, MBRS!: Elizabeth A. Rowiey, DrPH®, Bruce Fireman, MA: \Nimish R. Vali, DiPH, MBBS2; Eric P Griggs, MPH: Matthew F. Ley, PRD® Ousseny Zerbo, PhD; Rachael M. Porer, MPH: Rebeeca J Bitch, MPH; Lenee Blawon, MPH! Sarah W. Ball, SeD® Andrea Steffens, MPH; Nazalie Olson, MPH! Jeremiah Willams, MPH Monica Dickerson, PH; Meredith MeMorrowe, MD; Stephanie |. Schrag, DPhil Jennifer. Versni, MD!> Alicis M. Ey, MD! Eduardo Aziz Baumgartner, MD!; Michelle Baron, MD?; Manjusha Caplan, MBBS!2; Mark G. Thompson, PhD; Edward Stenehjem, MD!2 Previous infection with SARS-CoV-2 (the virus that causes COVID-19) or COVID-19 vaccination can provide immu- nity and protection from subsequent SARS-CoV-2 infection, and illness. CDC used data from the VISION Network” to examine hospitalizations in adults with COVID-19-like illness, and compared the odds of receiving a positive SARS-CoV-2. test result, and thus having laboratory-confirmed COVID-19,, between unvaccinated patients with a previous SARS-CoV-2, infection occurring 90-179 days before COVID-19-like illness, hospitalization, and patients who were fully vaccinaved with an mRNA COVID-19 vaccine 90-179 days before hospitaliza- tion with no previous documented SARS-CoV-2 infection. Hospitalized adults aged 218 years with COVID-19-like illness were included if they had received testing atleast ewice: once associated with a COVID-19-like illness hospitalization, during January—September 2021 and at least once earlier (since February 1, 2020, and 214 days before that hospitalization). Among COVID-19-like illness hospitalizations in persons ‘whose previous infection or vaccination occurred 90-179 days: carer, the odds of laboratory-confirmed COVID-19 (adjusted, for sociodemographic and health characteris unvaccinated, previously infected adults were “Funded by CDG. the VISION Neework includes Columbia Universe ving “Medial Center (New York), HeathParinets (Minnesota and Wisconsin, Inuermountin Healthcare (Ua), Kaiser Permanente Northern California (California), Kaiser Permanente Noschwest (Oregon and Washington), Regent Inia ladiana), and University of Colorado (Colorado) m4 aire the odds among fully vaccinated recipients of an mRNA. COVID-19 vaccine with no previous documented infection (adjusted odds ratio [4OR] = 5.495 95% confidence interval [Cl] = 2.75-10.99). These findings suggest that among hos- pitalized adults with COVID-19-like illness whose previous infection or vaccination occurred 90-179 days earlier, vaccine- induced immunity was more protective than infectioninduced immunity against laboratory-confirmed COVID-19. All cligible persons should be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2, “To compare the early protection against COVID-19 con- ferred by SARS-CoV-2 infection and by receipt of mRNA. COVID-19 vaccines (i.e. 90-179 days after infection or vaccination), the VISION Network collected data from 187 hospitals across nine states during January~September 2021 (J). Bligible hospitalizations were defined as those among adults aged 218 years who had received SARS-CoV-2 molecular testing (from 14 days before to 72 hours after admis- sion) and had a COVID-19-like illness discharge diagnosis! ‘ Mdical evens with discharge code consistent with COVID-19-ike ils vere induded, COVID-19+like inet diagnoses incaded acute respiratory hes (eq, COVID-19,respestony ila, or pneumonia related signs oF sympeome (cough eer, dyspnes, vomiting, or arth) using diagnosis codes from he International Claaeton of Dies. Noh Revision and Iteration (Clacton of Dis, Tenth Revi, USS. Department of Health and Human Services Centers for Disease Control and PreventionEarly Release during January-September 2021. Eligible patients had also been tested at least once since February 1, 2020. To limit the analysis to patients with access to SARS-CoV-2 testing before hospitalization, patients who did not receive SARS-CoV-2 testing 214 days before hospitalization were excluded. ‘Two exposure groups were defined based on COVID-19 vaccination status and previous SARS-CoV-2 infection. ‘Vaccination status was documented in electronic health records and immunization registries. Previous infection was, ascertained based on SARS-CoV-2 testing from rapid antigen, tests or molecular assays (e.g, real-time reverse cranscription— polymerase chain reaction) performed before mRNA vaccina- tion and 214 days before admission; testing performed after February 2020 was primarily within network partners’ medical facilities. Adults were considered unvaccinated with a previous SARS-CoV-2 infection if ne COVID-19 vaccine doses were received and if the most recent positive SARS-CoV-2 test result occurred 290 days before hospitalization. Adults were considered fully vaccinated with an mRNA COVID-19 vaccine with no previous documented infection if the second dose of Pizer-BioNTech (BNT162b2) or Moderna (mRNA-1273) mRNA vaccine was received 214 days before the index test ddateS and if they had been tested since February 1, 2020, and had no positive test results 214 days before hospitaliza- tion. Patients were excluded if they had received 1 mRNA vaccine dose only, received the second dose <14 days before index test date, or received the Janssen Johnson & Johnson, [Ad26.COV2}) vaccine (because of sparse data). To reduce the chance thac the hospitalization was related co an ongoing SARS-CoV-2 infection, patients were also excluded from the previous infection group if their most recent previous positive test result occurred 14-89 days before hospitalization. ‘The outcome of laboratory-confirmed defined as COVID-19-like illness and a positive SARS-CoV-2. result from molecular testing. Among patients hospitalized with, COVID-19-like illness whose previous infection or comple tion of vaccination occurred 90-179 days earlier, the odds of Laboracory-confirmed COVID-19 were compared between pre viously infected persons and fully vaccinated mRNA COVID-19, vaccine recipients. ORs and 95% Cls were calculated using multivariable logistic regression, adjusted for age, geographic region, calendar time (days from January 1 to hospitalization), and local virus circulation, and weighted based on propensity to be in the vaccinated category (1,2). Established methods were used to calculate weights to account for differences in Tinton est date was deine athe date: of respiratory specimen collection ‘seociated with the most recent positive or negative SARS-CoV? fx elt tefore the hosptalieation or the beoptalization date i tating only cocured after admission, ‘raptor cde gfcoronavitws2019-ncoviphpinvese-criteria hem] 2 MMWR / October 29,2021 / Vo.70 sociodemographic and health characteristics berween groups (9). Separate weights were calculated for each model, aORs were stratified by mRNA vaccine product and age group. Three secondary analyses wete also conducted. First, the impact of whether and how the time interval since previous infec tion or fll vaccination was adjusted was examined, Specifically, any time since either previous infection or completion of vac- ination was considered. Then, previously infected patients were limited to those with more recent infections (i.e. 90-225 days, before hospitalization [the lowest two tertiles of number of days, since infection), and fully vaceinated patients were limited to those with the longest interval since completion of vaccination (ce. receipt of second mRNA vaccine dose 45-213 days before hospitalization [the highest two tertiles of number of days since vaccination). Thea, number of days sinee previous infection ‘or completion of vaccination, rather than calendar time, was adjusted in the model. For the next secondary analysis, ORs for hospitalizations thac occurred before and during SARS-CoV-2 B.1.617.2 (Delta) variant predominance (June-September 2021) were compared, beginning on the date the Delta vari- ant accounted for >50% of sequenced isolates in each medical facilty’s sate (2). Finally, effect modification was assessed by mRNA vaccine product or by age group: p-values <0.2 were considered indicative of a statistically significant difference in aOR by produce or age, similar to previous modeling studies of effect modification (4). All analyses were conducted using SAS (version 9.45 SAS Institute) and R (version 4.0.2; R Foundation). “This activity was reviewed by CDC and was conducted consis- tent with applicable federal law and CDC policy.** During January 1-September 2, 2021, a total of 201,269 hospitalizations for COVID-19-fike illness were identified: 139,655 (69.4%) patients were hospitalized after COVID-19 vaccines were generally available to persons in their age ‘group within their geographic region, Molecular testing for SARS-CoV-2 was performed for 94,264 (67.5%) patients with COVID-19-like illness hospitalizations. Among these patients, 7,348 (7.8%) had at least one other SARS-CoV-2 test result 214 days before hospitalization and met eriteria for cither of the two exposure categories: 1,020 hospitalizations ‘were among previously infected and unvaccinated persons, and 6,328 were among fully vaccinated and previously uninfected, patients (Table 1) Laboratory-confirmed SARS-CoV-2 infection was identi- fied among 324 (5.19) of 6,328 fully vaccinated persons and among 89 of 1,020 (8.7%) unvaccinated, previously infected persons. A higher proportion of previously infected than vac~ cinated patients were aged 18-49 years (31% versus 9%), Black, (10% versus 796), and Hispanic (19% versus 1296). S35 GER pare 46:21 GER pare 6.Early Release ‘TABLE 1. Characteristics of COVID-19-like illness hospitalizations* among unvaccinated adults with a SARS-CoV-2 infection occurring 90-179, days before the index test date’ and among adults who were fully vaccinated? 90-179 days before the index test date" without a previous documented SARS:CoV-2 infection — nine states,* nuary-September 2021 ‘Unvaccinated with previous SARS-CoV? infection Characteristic ‘No. (coun 8) Fully vaccinated without Standardized mean or previous documented infection proportion cfference™> ‘Al hospitalizations with COVID-T9-ke ness SARS-CoV. tast result associated with COVID-19-like illness hospitalization Postive Negative Sex Male Female ‘Age group. yes 18 50-64 65-74 75.84 285 Race, respective of ethnilty Woite Black Other!* Unknown Ethnicity imespective of race Hispanic Non-Hispanic Unknown Month ofindextest date! January Febrasty ares Apri May ine aly August September 71020(100) 328 100) NA 3919) x45) on 331191) 6004.85) 405 40) 2905 46) on 15 60) 342364) 31360 50009) ova 243 (20) 955 (4) 207 20) 1757 08) wry 201862) 3018) 112808), 4.35669) oz 45207) 686 (11) 834(03) 89119) 756012) 020 695 68) 445870) 136113) anna) no om) 210 a) om) macnn ray 245 28) 600) 29409) 235 (8) ‘se 18 130021) 59110) 2731083) 3113) 2.0932) 110 70) See abe footnotes on the nO PAGE Among COVID-19-like illness hospitalizations in persons whose previous infection or vaccination occurred 90-179 days calie, the odds of laboratory-confirmed COVID-19 were higher among previously infected, unvaccinated patients than among fully vaccinated patients (aOR = 5.49; 95% CI = 2.75-10.99) (Table 2). In secondary analyses, the aORs that examined the impact of whether and how time since infection or yaccina- tion was adjusted and that stratified hospitalizations before and during Delta variant predominance were all similar co the primary aOR estimate. For product- and age group-specific estimates, sparse data limited the precision of these aORs. However, an assessment of effect modification indicated the aOR of laboratory-confirmed COVID-19 was higher for previ- ously infected patients compared with patients vaccinated with ‘Moderna (aOR = 7.30) than compared with patients vaccinated, with Pfizer-BioN Tech (aOR = 5.11) during January-Seprember (p=0.02). Similarly; the interaction term for exposure group by age indicated that the aOR was higher for patients aged 265 years, (2OR = 19.57) than for those aged 18-64 years (aOR = 2.57) (interaction term, p = 0.05). Discussion In his mukistateanalyss of hospitalizations for COVID-19-lke illness among adults aged 218 years during January-September 2021 whose previous infection or vaccination occurred 90-179 days earlier, the adjusted odds of laboratory-confirmed COVID-19 "were higher among unvaccinated and previously infected patients, than among those who were fully vaccinated with 2-doses of an mRNA COVID-19 vaccine without previous documentation of SARS-CoV-2 infection, Secondary analyses that did not adjust for time since infection or vaccination or adjusted time since infection or vaccination differently as well as before and during Delta variant predominance produced similar results. These findings are consistent with evidence that neutralizing antibody tersafter receipt oF 2 doses of mRNA COVID-19 vaccine are high (5.6); however, these findings differ from those of a retrospective records-based, DMAKWR / October29,2021 / Vol. 70 3Early Release ‘TABLE 1. (Continued) Characteristics of COVID-19-likellness hosptalizations* among unvaccinated adults with a SARS-CoV--2 infection occurring 90-179 days before the index test date’ and among adults who were fully vaccinated® 90-179 days before the index test date’ without 3 previous documented SARS-CoV-2 infection — nine states, January September 2021 Tio. (cokamn ‘Unvaccinatedwith previous Fully vaccinated without Standardized mean or Characteristic SARS-CoV-Zinfection previous documented infection proportion diference”™ site Columbia University 39 23818) 073 HealthParners 20 3401) Intermountain Healthcare nan 45407) Kaiser Permanente Norther California 254 25) 3614057) Kaiser Permanente Northwest, 303) 250 (8) Regenstie institute 300138) 1145.08) University of Colorado 154105) 5336) Time since either previous SARS-CoV. infection o fullmRNA vaccination until COVID-19-Lke illness index test date days 90-119 367 36) 3325 (53) oa 120-149 35335) 210163) 150-179 30029) ‘02104) CCOVID-19 vaccination status Unvaccnated 11020 100) 0) NA Pier SiiVTech(BNT16262) oO 3736158) Moderna (mniNA-1273) om 2592141) ‘Abbreviation: NA =not applicable, * Medical events with decharge cod consstent with COVID-10-ke ines were included, COMID-19-Ike ines diagnoses included acute espatory ines (2, COVID-19,resprtory alr oF pneumonia or related signs or symptoms (cough fever dyspnea, vomiting ore) using dlegnosiscodesfrom the ntemetione) Clastieation f Diseases nth Revision and Internationa Cleeafetion of Diseases, Tenth Revision Cimisan ordered molecular assays (e. realtime reverse ‘wansciption-polymerase chain reaction for SARS-CoV'2 occurring =14 days before to <72 hous after hospital admission were included "Inde test date wae defined a the date of respiratory specimen colectionasaciated withthe most racent poave or negative SARS-CoVe? test result before the hospitalization or the hospitalization date if testing only occured after he admission. Ss Ful vaccination was defined a receipt ofthe second dose a Pier ioNTach or Madera mRNA vaccine »14 days before the index test date ‘Partners contributing hospitalizations were in Calfornia, Colorado, Indiana, Minnesota and Wisconsin, Oregon and Washington, Utah and NewYork ‘In comparing characteristics between unvaccinated aduls with 2 previous infection and full vaccinated adults without a previous documented infection, @ Standardized mean or proportion diference 0.2 was considered noteworthy, After balancing characteristics thot fered between the two compotion groups, the standardized mean or proportion differences were <0.6. “Other race includes Asian Hawallan or Othe Paci slander, American Indian or Alaskan Native, Other not sted and multiple races. cohort study in Isae,"* which did noc find higher protection for vaccinated adults compared with those with previous infection during period of Delta variant circulation, This variation s possibly relared to differences in the outcome of interest and restrictions on the timing of vaccination. The Israeli cohort study assessed any positive SARS-CoV-2 test result, whereas this study examined Inboratory-confirmed COVID-19 among hospitalized patients ‘The Israeli cohort study also only examined vaccinations that had cccurted 6 months earlier, so the benefit of more recent vaccination, ‘was not examined. This report focused on the early protection fiom infection-induced and vaccine-induced immunity, hough ic ispossble that estimates could be affected by time, Understanding Infection-induced and vaccine-induced immunity over time is important, particularly for fururescudies to consider. In this study, the benefit of vaccination compared with infec- tion without vaccination appeared to be higher for recipients of Moderna than Pfizer-BioN Tech vaccine, which is consistent with a recent study that found higher vaccine effectiveness against COVID-19 hospitalizations for Moderna vaccine recip ients than for Pfizer-BioNTech vaccine recipients (7). In this, TW inepalTowwanedoaicory/comtenc/10.1101/2021.08.24.2126241501 4 MMWR / October 29,2021 / Vo.70 study, the protective effec of vaccination also trended higher for adults aged 265 years than for those aged 18-64 years However, considering the limited data by both product type and age, additional research is needed on the relative protec- tion of vaccination versus infection without vaccination across demographic groups and vaccine products, as well as vaccina- tion in previously infected persons. “The findings in this report are subject to at east seven limita- tions, First, although this analysis was designed to compare two groups with different sources of immunity, patients might have been misclassified. IF SARS-CoV-2 testing occurred outside of network partners’ medical facilities or if vaccinated persons are les likely to seek testing, some positive SARS-CoV2 test results mighthave been missed and thus some patients classified as vaccinated and previously uninfected might also have been infected. In addition, despite the high specificity of COVID-19. ‘vaccination status from these data sources, misclassification is possible. Second, the aOR could not be further stratified by time since infection or vaccination because of sparse data and. limited ability to control for residual confounding that could, be magnified within shorter intervals, The aOR that did not adjust for time might also be subject to residual confounding,Early Release TABLE 2. Adjusted odds ratios* of laboratory-confirmed COVID-19 among hospitalizations in adults with COVID-19-tike illness comparing tunvaccinated adults with a SARS-CoV-2 infection occurring 90-179 days before the index test date and adults who were fully vaccinated 90-179 days before the Index test date without a previous documented SARS-CoV-2 infection — nine states, January-September 2021 No. row of SARS COV'2. Adjusted odés ratio outcome Totalna,_postvetetresuts (95% ‘Aad faged 218 yor) any COVID-19 RNA voccine Any mRNA vaccine Faly vacated without previous documented infection 632832415) fet Unvacinated wth a previous SARS-CoV? infection Yoo “8908 549 (275-1099) Any mRNA vaccine no restiton of time since previous infection or completion of vaccination Faly vacated without prevous documented infection we37 54200) fe {range of ie since vacation ~ 0-713 days tore hospitalization Unwacinoted wth a reviou SARS-CoV 2inecton 2005 130462) 275(190-398) {range of me since prevosinfstion - 50-94 days before hosetalation) ‘ny mRNA vaccine examining the potential influence of ime since prevousinfcton or completion of vaccination Fully vaccinated” without previous documented nection limited to those wih ongestpeiog 12231 458(3.7 ref Sincevacination ange of tnesince vocation = 45-213 dys belorehosptalation Unvacnated witha previous SARS-CoV2 infection imied to those with marerecent infections 1388107 7.71 396(249-635) {range of ime since prevousinfection - 50-225 days before osptalaton) ‘Any mRNA vaccine adjusting fr time since previous infection or completion of vaccination n model Fall vochated witout pes documented infection 6028 324651) fet Unvacenated wth a previous SARS-COV"? infection Yoo 89087) 322(168-620) 8 time relative to SARS-CoV-28.1.6172 (Det) varant predominance Before Dela predominance January-June 2021) Fal vaccinated without previous documented infection as 808) te Unvacnated wth a prewous SARS-CoV fection on 70184) an 28-1316 During Det predominance UuneSeptember 2021)" Falyvaccsted’ witout pevous documented infection 5230655) fe Unvaceated wth a previous SARS-CoV? infection 1 191100) 755 045-1652 By mRNA vacine product? Piizer BioN Tech (BNT16262) Fully vaccinated! without previous documented nection 373815658) fet Unvacinated wth a previous SARS-Co¥? infection yoo “89087) 511 283-1029) Moderna mRNA-1275) Ful vacated without prevous documented infection 252109442) ff Unvaccnated witha previous SARS-CoV? infection 100 85087) 7.30(640-1560) By age group, yst rest Ful vaccinated? without previous documented infection 125 7150) fe Unvecinated wth a previous SARS-CoV? infection 5649488) 27014-4165) 365 Fully vacated” without previous documented infection aos 253152) fe Unvaccnated witha preous SARS-CoV? fection as 0186) 1957 (634-4591 ‘Abbreviations: CI= confidence interval ref = referent group, * Odds flios were adjusted forage, geographic region, calendar tine (days since January 1, 2027), and lca vts culation (percentage of SARS-CoV2 postive results rom testing within the counties surrounding the fcity on the date ofthe hospitalization) and balanced using mverse weights on characteristics thet Gere between the we groups (calculated separately or each odds ato mode! using faclity characteristics, sociodemographic characterises and underying ‘medical conditions. Cardiovascular dlgease was also adjusted n the main model and in the model for PizerBioNTech. Any Ikelyimmunesuppression was also Included inthe model for Modema, Neuromuscular and rsptatory conitons were ako adjusted inthe model for adults aged 265 years Number of days since previous infection or completion of vaccination instead of clend time, was adjusted in the model within the stated secondary analysis {Full vaccination was defined as receipt of the second dose of Pfr SioNTech or Madera mfINA vaccine =14 days before the index test date {3 Pwaluefrom assessment of effect modiiation by mRNA product was 402, {1Pwaluefor interaction term for exposure group by age group was 005. = SARS-CaV.2B 1617 2 (Delta variant predominance began on the date the Delt variant accounted for >50%of sequenced isolates in each meta fait’ state ttpsfdoLorg/10.1888Smmvitmmn7037e2 particularly related co waning of both types of immunity. Third, selection bias might be possible if vaccination status influences likelihood of testing and if previous infection influences the likelihood of vaccination, Previous work from the VISION net- work did not identify systematic bias in testing by vaccination, status, based on data through May 2021 (1), Fourth, residual confounding might exist because the study did not measure ‘or adjust for behavioral differences berween the comparison ‘groups that could modify the risk of che outcome. Fifth, these results might not be generalizable co nonhospitalized patients, who have different access to medical care or different health ‘eare-secking behaviors, particularly outside of the nine states DMAKWR / October29,2021 / Vol. 70 5Early Release covered, Sixth, the statistical model incorporated the use of a weighted propensity score method which is subject to biases, in estimates or standard errors if the propensity score model, is misspecified. Numerous techniques were used to reduce potential suboptimal specification of the model, including buc not limited to including a large set of covariates for machine learning estimation of propensity scores, including covariates in both regression and propensity models, ensuring large sample sizesand checking stability of weights, and conducting second- ary analyses to assess robustness of results. Finally, the study assessed COVID-19 mRNA vaccines onlys findings should not be generalized to the Janssen vaccine. In this U.S.-based epidemiologic analysis of patients hospi- talized with COVID-19-like illness whose previous infection, or vaccination occurred 90-179 days earlier, vaceine-induced immunity was more protective than infection-induced immunity against laboratory-confirmed COVID-19, inchiding during a petiod of Delta variant predominance. All eligible persons should, be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2. ‘Acknowledgments Jeffenon Jones, Claire Midgley, Ruth Link-Glks, Sharon Saydab, Jerome Tos, Adi Gundlapall, Natalie Thornburg Aga Shefr, John Kool, Erin Tromble, Meissa Caer, Cory Kokko, Stephanie Weaver, Kushali Muthumalaippan, Bio-Ping Zhu, Roumiana Boneva, CDC. ‘Coneapondng author: Caterne H, Bono, 7@ede pu TEDE COVID-I9 Response Team: Center for Biomedical Informatics Regenatit Insitute Indianapolis, Indiana; diana University School of “Maticns, Indianapolis, India, "Center for Eleth Reseach, Kater Petmanente ‘Nanhses, Portland, Oxgon Deparment of Medicine, Univesity of Colorado, ‘Anachate Medical Campus, Aurora, Colorado “West, Rockville, Marland: "earners faite, Minneapolis Mins Depurtmenc of Brome Iaformatics, Columbia Universi, New Yor, New Yorks °New York Prbyteian Hospital, New Vrk ity, New York Kaiser ermanente Verne Stn Center, Keser Permanente Northern Caloris, Oakland, California: Finks Schoo ‘of Public Health, Indiana University Indianapolis, Indiana; ?Divsion of Infectious Dace and Clinical Epidemiology Iermoantin Healthcare, Salt Lake iy Uh, Baylor Scot 8 White Health, Teas ASM University College ‘of Medicine. Temple. Teas; Childress Minasoa, Minneapolis, Minnesota "Regen Ines, Indnspalis Indian All authors have completed and submitted the International Commixtee of Medical Journal Editors form for disclosure of potential conflicts of interest. Stephanie A. Irving reports support from Westat to Kaiser Permanente Northwest Center for Health Research. Nicola P. Klein reports support from Pfizer to Kaiser Permanente, Northern California for COVID-19 vaccine clinical trials, and institutional support from Merck, GlaxoSmithKline, and Sanofi Pasteur outside the current study. Charlene McEvoy reports, support fiom AstraZeneca o HealthPartnes Institue for COVID-19 vaccine tras. Alison L. Naleway reports Pfizer Research funding to ‘summary ‘What i aleady known about this topic? Previous infection with SARS-CoV-2 or COVID-19 vaccination ‘can provide immunity and protection against subsequent ‘SARS,CoV’2 infection and illness. ‘Whatis added by this report? Among COVID-19-tke illness hospitalizations among adults ‘aged =18 years whose previous infection or vaccination. ‘occured 90-179 days earlier, the adjusted odds of laboratory- ‘confirmed COVID-19 among unvaccinated adults with previous ‘SARS-CoV'2 infection were 5.49-fld higher than the odds, ‘among fully vaccinated recipients ofan mRNA COVID-19 ‘vaccine who had no previous documented infection (95% ‘confidence interval= 2.75-10.99). What are the implications for public heath practice? Alleligible persons should be vaccinated against COVID-19 as ‘soon 25 possible, including unvaccinated persons previously infected with SARS-CoV-2, Kaiser Permanente Northwes for unrelated study of meningococcal B vaccine safety during pregnancy. Suchitra Rao reports grants from GlaxoSmithKline and Biofire Diagnostics. No other potential conflicts of interest were disclosed. References 1. ThompsonMMG, Senchjam E, Grams eal Eevee of Covi 19 vaccines in ambulatory and inpatient cae serting: N Engl J Med 2021:385:1355-71 PRID'34496194 pds on 10.1056) NEJMes21 10362 annis SJ, Rowley EA, Ong TC, etal: VISION Nerwork. Ines ‘estimates of COVID-19 vaccine effectiveness against COVID-19- associated emergency department or urgent care clinical encounters and hospitalizations among adults during SARS-CoV.2 B.L.617.2 (Del) variant predomninance—-nine states, June-August 2021. MMWR Mor Moreal Wly Rep 2021:70:1291-3. PMID:34529642 hurpst/doi ‘ong/10.15585 ramon 7037e2 3. Mansion R, Joe MM, Sun W, Hennesy S. On the estimation and use of propensity scores in catecoattol and eac-cohore sie. Am J Epidemiol 2047 :166'382-9, PMID:17504780 haps. op, 1093/69 Maraall SW. Power for tests of iteration: effet of taxing the Type 1 ‘error rate. Epidemiol Perspect Innov 2007%4r4, PMID:17578572 hep) ddoj.ory/10-1186)1742-5573-4-4 5, Bdars VV, Hudson WH, Xie X, Ahmed Ry Suthar MS, Neutrlising antibodies against SARS-CaV2 variants after infection and vaccination, JAMA 20213325:1896-8, PMID:33739374 hepefd.org10 1001) jama.2021.4388 6 dara WV, Pinsky BA, Suchar MS, etal, fection and vaesine induced rewraliing-antibody responses to the SARS-CaV’2 B.1.617 variants N Engl } Med 2021;385:664-6, PMID:34233096 heeps! do, ‘rg/10.1056/NEJMc2107799 7. Self WH, Tenforde MW, Rhoads J ca; IVY Neework. Comparative celfeciveness of Moderna, Pizer BioN Tec, and Janssen Johnson 8 Johnson) vaccines in preventing COVID- 19 hospitalizations among adults {without immunocompromining conditions-—United States, March~ ‘August 2021. MMWR Morb Moctal Wkly Rep 2021,70:1337—43. PMUD:34555004 hueps:/doiog/10.15385/mmwemun7038el Readers who have difficulty accessing this PDF file may access the HTML file at hurps/#www.cdegov/mmv/volumes/70¢vwr/mm7044e1 hhum’s_cidemm7044el_v. Address all inquiries about the MMWR Series, including material to be considered for publication, to Editor, ‘MMUWR Series, Mailstop V25~ 6 MMWR / October 29,2021 / Vo.70 CDG, 1600 Glifon Rd, N.E. Atlanta, GA 30329-4027 or co mmwrrq@edc.gov.Christopher Funk (CENSUS/NPC FED) Fri, § Nov 2021 14:12:41 +0000 Bozio, Catherine H. (CDC/DDID/NCIRD/ID) Subject: Fw: New CDC Study: Vaccination Offers Higher Protection than Previous Infection Hello, Ihave been directed to ask you questions regarding a study the CDC is using to promote the covid vaccine. The study appears to contradict several other studies that have been completed this year, Question: The study in question states that 7.348 patients met the criteria for either exposure category. Of the 7,348 patients, 1,020 were previously infected and unvaccinated, and 6,328 were fully vaccinated. One would reason that this study indicates that individuals who are fully vaccinated are 6 times more likely to be hospitalized from Covid-19 like illness than those who were previously infected and unvaccinated. ‘Would someone like to comment on this? One other point, Laboratory confirmed Covid-19 infection was identified among 324 fully ated patients, and 89 unvaccinated previously infected patients. This would also indicate that fully vaccinated patients are being hospitalized from laboratory confirmed Covid-19 at a rate that's 4 times greater than those who were previously infected and unvaccinated, Would someone like to comment on this? Chris Funk Supervisor, Facilities Management Support Services Branch US. Census Bureau Office: 812-218-3440 Christopher.funk@census.gov Census.gov From: MM\WR Questions (CDC) Sent: Friday, November 5, 2021 10:01 AM To: Christopher Funk (CENSUS/NPC FED) Subject: New CDC Study: Vaccination Offers Higher Protection than Previous Infection Thank you for contacting MMWR, Please contact the corresponding author Catherine H. Bozio, ise7@cdc.gov. , for your concerns Best, MMWR New CDC Study: Vaccination Offers Higher Protection than Previous COVID-19 Infection CDC Online Newsroom | CDCLaboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January-September 2021 | MMWR (cde.gov) Question: The study in question states that 7,348 patients met the criteria for either exposure category, Of the 7,348 patients, 1,020 were previously infected and unvaccinated, and 6,328 were fully vaccinated. One would reason that this study indicates that individuals who are fully vaccinated are 6 times more likely to be hospitalized from Covid-19 like illness than those who were previously infected and unvaccinated. Would someone like to comment on this? One other point. Laboratory confirmed Covid-19 infection was identified among 324 fully vaccinated patients, and 89 unvaccinated previously infected patients. This would also indicate that fully vaccinated patients are nearly 4 times as likely to have a hospitalization from laboratory confirmed Covid-19 than those who were previously infected and unvaccinated, ‘Would someone like to comment on this? Chris Funk Supervisor, Facilities Management Support Services Branch U.S. Census Bureau Office: 812-218-3440 Christopher.funk@census.gov Census. gov From: CDCInfo Sent: Wednesday, November 3, 2021 10:58 AM To: Christopher Funk (CENSUS/NPC FED) Subject: CDC-INFO; Topic New CDC Study: Vaccination Offers Higher Protection than Previous Infection; [CDC-2148313-H3Y 1C7] CRM:09155124‘Thank you for your inquiry to CDC-INFO. So CDC can verify the most current information and best respond to your inquiry, would you please more specifically cite what new CDC study you were referring to, perhaps the title, and where you saw it (document, Web link, ete.) This information will help us respond to your inquiry, CDC-INFO is a service of the Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR). This service is provided by the Verizon and MAXIMUS contract with CDC and ATSDR Original Message Se From: General Public Subject: New CDC Study: Vaccination Offers Higher Protection than Previous Infection 11/3/2021 Email Address: christopher.funk@census.gov Question: The study in question states that 7,348 patients met the criteria for either exposure category. Of the 7,348 patients, 1,020 were previously infected and unvaccinated, and 6,328 were fully vaccinated. One would reason this study indicates that individuals who are fully vaccinated are 6 times more likely to be hospitalized ftom Covid-19 like illness than those who were previously infected and unvaccinated. Would someone like to comment on this? One other point. Laboratory confirmed Covid-19 infection was identified among 324 fully vaccinated patients, and 89 unvaccinated previously infected patients. This would also indicate that fully vaccinated patients are nearly 4 times as likely to have a hospitalization from laboratory confirmed Covid-19 than those who were previously infected and unvaccinated. Would someone like to comment on this? Thank you, Chris Funk Optional Information Name: Chris Funk Title: Facilities Organization: Census Bureau Phone: 8122183440 Other Email: christopher.funk@census.gov Address: PI Extraction:Bozio, Catherine H. (CDC/DDID/NCIRD/ID) Sat, 30 Oct 2021 00:51:38 +0000 Choban, Ana (CDC/DDID/NCIRD/ID) Subject: FW: Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID- 19-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January-September 2021 Best, Catherine Original Messay From: GERALD A SANTULLI mer Sent: Friday, October 29, 2021 8:45 PMT To: Bozio, Catherine H. (CDC/DDIDINCIRDIID) Subject: Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Ilness with Infection-Induced or mRNA Vactine-Induced SARS-CoV-2 Immunity — Nine States, January-September 2021 Good evening Dr. Bozio, ve read with interest the article you co-authored and released today. Thave a couple of questions that woutd help clarify your study and it’s conclusions for me, 1. “The outcome of laboratory-confirmed COVID-19 was defined as COVID-19-like illness and a positive SARS- CoV-2 result from molecular testing. Could you provide additional information on the PCR tests for both the natural immunity group and the vaccinated group? Were the same CT eycles used for both the natural immunity and vaccinated groups and what were the CT eycles used in your study’? 2. Would it be possible to show your calculations for the adjusted odds ratio [aOR] and how you derived $.49? Itis rot explained in the article, ‘Thanks very much, Gerald Santulli, DMDMali Ross Thu, 4 Nov 2022 15:59:00 +0000 Bozio, Catherine H. (CDC/DDID/NCIRD/ID) Help w/Calculation Good Morning Ms. Bozio, | read your study on the CDC website that concluded that unvaccinated people with a previous infection were 5x more likely to have a positive COVID-19 test, Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January~September 2021 | MMWR (cde.gov) When | scrolled down to the numbers used for the study, I could not figure out how you came up with that figure of 5x more likely. I'm sure you are very busy, but is there any way you could have someone walk me through this? Much appreciated, Amalia RossEPIX Update (CDC) Fri, 29 Oct 2022 13:36:40 -0400 Bozlo, Catherine H. (CDC/DDID/NCIRD/ID) Subject: Important: MMWR Early Release: Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like illness with Infection-Induced or mRNA Vaccine-Induced SARS- CoV-2 Immunity — Nine States, Jan-Sep 2021 The Epidemic Information Exchange Check Epi-X for an Important Report MMWR Early Release: Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Ilness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, Jan-Sep 2021 Alleligible persons should be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2. This MMWR is available through this posting or here. hitpsi//epix2, cdc.goviv2/Reports/Display.aspx?id=411994 HOW TO CONTACT Epi-x For technical issues, contact the Help Desk: iXHel (877) 438-3749 For help with preparing or posting a report, contact the Editor on Call; EpixEditor@cde.gov (877) 862-2392 (toll free within the United States) HOW TO MANAGE Epi-X NOTIFICATIONS ‘Manage your notifications ABOUT THIS E-MAIL You have received this message because you are an authorized Epi-X user. Information In this message must be used only In accordance With the Epi-X User Agreement.CDC IMS 2019 NCOV Response STLT Partner Engagement Thu, 28 Oct 2022 19:39:55 +0000 CDC IMS 2019 NCOV Response STLT Partner Engagement; Briggs-Hagen, Melissa (COC/ODID/NCIRD/DVD); Taylor, Christopher A. (CDC/DDID/NCIRD/DVD); Bozio, Catherine H (CDC/DDID/NCIRO/ID); Neatherlin, John C. (CDC/DDPHSIS/CGH/DGHP); Budzyn, Samantha (CDC/ODPHSS/CSELS/OHIS) (CTR); Routh, Janell A. (CDC/ODID/NCIRD/DVD); Wojno, Abbey (COC/ODID/NCEZID/OGMAQ); Galloway, Summer (CDC/DDID/NCIRO/ID}; Noelte, Kate (COC/DDPHSIS/CPR/DStR); Limbago, Brandi (CDC/DDID/NCIRD/OD); Laufer Halpin, Alison S. (CDC/DDID/NCEZID/DHAP); Haller, Elizabeth (CDC/DDID/NCHHSTP/DASH); Hall, Aron (CDC/DDID/NCIRD/DVD); Burton, Deron (CDC/DDID/NCHHSTP/OD); Brooks, John T. (COC/DDID/NCHHSTP/OHP); Hicks, Lauri (COC/ODID/NCEZID/DHAP); Mahon, Barbara (CDC/DDID/NCIRO/OD) ce: Honein, Margaret (Peggy) (CDC/ODID/NCEZID/OPEI); Weakland, Aliki P (CDC/DDID/NCEZID/DPE!); Walker, Desiree (CDC/DDPHSIS/CPR/DSLR) (CTR); Montero, Jose (COC/DDPHSIS/CSTLTS/OD); CDC IMS Response Coordinator -2; CDC IMS AV/Communications; CDC IMS 2019 NCOV Response Deputy Incident Manager; Johnson, Shyonna (CDC/DDNID/NCBDDD/DBDID) (CTR); Daskalakis, Demetre (CDC/DDID/NCHHSTP/OHP); Dowell, Deborah (Debbie) (CDC/DDNID/NCIPC/DOP); CDC IMS 2018 NCOV Response IM-PDIM Special Assts; Anderson, Mark (CDC/DDPHSIS/CGH/OGHP);, Kingsbury, Keighlee (COC/DDNID/NCBDDD/DBDID) (CTR); Harris Sharpe, Bria (CDC/DDNID/NCBDDD/DBDID); Auerbach, John (CDC/OD); Bautista, Lucia (CDC/DDID/NCIRD/OD) (CTR); Kirby, Emily (CDC/NIOSH/OD); Fell, Tiffany K. (COC/DDNID/NCCOPHP/DHDSP); Fox, Kimberley (CDC/ODID/NCIRD/DBO); Layden, Jennifer (COC/DOPHSS/0S/00); Barrios, Lisa C. (COC/DDID/NCHHSTP/DASH); Thomas, Craig W. 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Brooks zudd@cdegov Debbie Dowell dov@edegov ‘aur Hick wus @cdcnov os)Pragna Patel pips@edegov Greta Masset u6@cdc.nov ‘Jose Montero Zan3@cdegov Keighlee Kingsbury (Executive ans@edegov Assistant for STLT TF leadership) John Auerbach jxad@cdc gov Chris Braden erbS@cdegov ‘Amy Mowbray himB@cdexov Kate Noalte wis@edegov ‘Surbhi Modi DkU@adcigov x)Desi Alexander (IT support IM) DiyS@cdenov Rolled Off ‘Celeste Philip Wav@edcgov William Carson PyeT@cdc gov ‘Cassie Sager Vied@cdegov Emily Maz Pyo9@ede.gov Jordan Moody Pyp2@ede.govInternal Agenda CDC COVID-19 Al State, Tribal, Local, and Territorial (STLT) Update Call Monday, November 1st, 2021 - 2:00 PM ~ 2:45 PM ET @*Speakers please join at 1:45 PM for sound check NOTE: The line will open to attendees at 1:55PM Panelists received an email from STLT TF with their task force link ‘Please do not share your panelist link Welcome and introductions: Kate Noelte, Senior-Advisor, STLT Support Task Force, CDC Thank you for joining us today and welcome to those who are joining us for the first time. The purpose of the call is to provide regular updates to state, local, Tribal and territorial preparedness directors, epidemiologists and health officials; public health laboratory directors; big city health coalitions; immunization services professionals; and nongovernmental partners ‘Asa reminder, this call s not for the media. If you are with the media, please disconnect now. For those new to the call the call flow is as follows: CDC experts will share information on several topics and there will be time for Q&A during the last portion of the call © At any time during our call, we encourage you to put any questions you may have in the Q&A box at the center bottom of the webinar window. ‘We want to remind you that the link you used to access today’s call is unique to you and is valid for the duration of this call series ~so there is no need to re-register weekly. Simply save the link and log in for the call each week. Run of show for November 1": MMWR: Severity of Disease Among Adults Hospitalized with Laboratory-Confirmed COVID-19 Before and During the Period of SARS-CoV-2 B.1.617.2 (Delta) Predominance — COVID-NET, 14 States, January-August 2021: Chris Taylor, COC MMWR: Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January-September 2021: Catherine Bozio, COC Updates to CDC Guidance for Institutions for Higher Education (IHE): John Neatherlin, CDC Community of Practice: Kate Noelte, COC Additional SMEs on for questions: © $3: John Neatherlin, Elizabeth Haller © Epi: Aron Hall and Deron Burton © GMTF: Abbey Wojno © Labs: Summer Galloway, Brandi Limbago, Allison Laufer Haplin, Melissa Carter © VIF: Janell Routh © CMO: Lauri Hicks © Senior Science Advisor: John Brooks (© Science Brief: SARS-CoV-2 Infection-induced and Vaccine-induced Immunity: John Brooks, Melissa Briggs-Hagen PPHP will place in chat at end of call: © After the call additional questions can be directed to: eocevent424@cdc.gov. © Upcoming All STLT Update Call: Monday, November 8 oxo)Internal Agenda CDC COVID-19 All State, Tribal, Local, and Territorial (STLT) Update Call Monday, November 1st, 2021 - 2:00 PM ~ 2:45 PM ET ©) EPI Update: As of Monday, November 1" Ene ‘Cumulative Total Daily 7-Day Dally Change from Prior 7- Cumulative 7-Day Average DayPeriod Rate per 100K ‘cases? 53515386786 69.197 33% 1459 Hospital Admissions? 33239,473 4677 5137 104% 108 Deaths! 743,410 um 1108 28% 23 ‘Test Volume! 622,802,391 1,398,516 21% 20928 ‘Test Positivity! 75% 53% 55% Response Update (NEM!) xreo: HAS Protect. Additional information available on COU D Data T¥a or and in the DC COVID-19Internal Agenda CDC COVID-19 All State, Tribal, Local, and Territorial (STLT) Update Call Monday, November 1st, 2021 - 2:00 PM ~ 2:45 PM ET (Over 221.5 milin people or 66.7% of the population have received atleast 1 dose “ee Grove Received at Least 1 Dose Fully Vaccinated USOveral (6.2% (N = 221,520,153) '58.0% (N= 192,453,500) 12:17 Years of ge 59.0% (N= 13,430,186) 49.8% (N= 13,347,232) 212 Yeas of Age 780% (N=221,286 846) 67.8% (N= 192,317,895) 218 Years of Age 799% (N= 205,383,978) 69.6% (N= 179,729:970) 265 Years of Age 97.2% (N= 53,185,430) 85.3% (N= 46,665,304) Dally(Hof Doses Current 7-Day Prior 7-Day Change rom Prior Cumulative Total administred)* Dally Average Dally Average 7-Day Petiod Doses Administered 22070088 ——«1A12416—NA)—+1:208517 768,503, 156.6% First Doset 192453500 298686 (21.1%) 166,991 220,805 240% Fully Vaccinated 221520353 208,573 (148%) 267,828 205,317 304% Additional Doses 18,607,505 884,472(626%) 817,080 346,708, 11357% uta of Oe 31, 2021, 060067 Seurces: ata Motoring and Reporting Seton, Vaccine Tsk Force COC COWD Tracker ie Paved an 3, 290~ Oct 9,201 canted an pebble cae and eth Mumba recnaepering Sof 6. Agta od ath a ‘be nsnes in ~sat The tle he ae es 2 bers an ay eee ote toca eae ered ence here ‘unas we gen gre! oe npeoprte ne Of 130.84 strc enes eet retenne37 wee epareen he ne rece emer ‘dee L368 ne covet wel on 2608 mt pone 10.78 itr dered tent, weep en tbe mest eer ‘ee 2181 cen wed LIT te por we Aref tbe 2520, CO ogres copra COVE 9 cot ede et ea et fevvsetng aay, sostnn 9 anode sag cette He Te ped Aa 01, 2920-08221 "tne pra Mar OL, 220~Oe 2221: Tne peed tt ome 7 aeagead pent age Ot 2021 ~Oet 26,2021 “noe sto US ae OU eres, etre eta espace eta a abe" beh) “unto incon tang on acer bf Sonn any cent ors hha fe preragey nae 10% ‘on e220 st reve ed parting estat n arth nd pts ata pry niente ED om no ened deca of 8783 Deployment Update ‘+ As of October 31, 2021, CDC has 17 field and remote teams deployed, including 66 deployers, aiding states as they manage their response to the COVID-19 outbreak. * CDC continues to deploy teams, as requested by states, to support epidemiology, data management, case investigation and contact tracing, community mitigation, infection prevention and control, health education and laboratory needs. + Teams also provide technical assistance for outbreaks in high-risk settings such as long-term care and correctional facilities, as well as among at-risk populations. Jurisdiction/Location | Team Deployment Start Deployment Mission Date Guam 10/29/2021 To investigate risk factors for COVID-19 transmission and severe ase in Guam (despite high vaccination rates) to inform strategies for testing, control and prevention of SARS-CoV-2 infection and guide the expansion of screening and laboratory testing capacity in response the recent local surge in COVID-19 cases.Internal Agenda CDC COVID-19 All State, Tribal, Local, and Territorial (STLT) Update Call Monday, November 1st, 2021 - 2:00 PM - 2:45 PM ET 10/25/2021 Evaluate the impact of modified quarantine strategies on secondary transmission of SARS-Cov-2 among students, teachers, and staff In the K-12 school setting in one Illinois ‘county: St. Clair County (east of St. Louls, MO). Specifically, one field deployment team to travel to East St. Louis, IL from October 25 through November 22, 2021. Kentucky 10/25/2021 The mission of this deployment is to evaluate the impact of modified quarantine strategies on secondary transmission of SARS-Cov-2 among students, teachers, and staff in the K-12, school setting in Lexington (Fayette County), Kentucky. New Jersey New Mexico 10/24/2021 10/25/2021 "The mission of this cruise ship inspections are to conduct on-site inspections of passenger operating cruise ships to assess ‘compliance with CDC COVID-19 Operations Manual. Inspections will ensure ships are properly mitigating risks of COVID-19 transmission amongst on board passengers and crew. On board inspectional coverage will take place while the vessel is at the port and/or while the vessel is underway. 2-5 inspectors will participate in each inspection; port inspection will take ~8. hours; underway inspections will last the duration of the sailing voyage, typically between 2 and 3 days. Evaluate the impact of modified quarantine (test-to-stay) strategies on secondary transmission of SARS-Cov-2 among students, teachers, and staffin the K-12 school setting in ‘Alamogordo, NM. }Internal Agenda CDC COVID-19 Al State, Tribal, Local, and Territorial (STLT) Update Call Monday, November 1st, 2021 - 2:00 PM ~ 2:45 PM ET xs) IV. Questions and answersInternal Agenda CDC COVID-19 All State, Tribal, Local, and Territorial (STLT) Update Call Monday, November 1st, 2021 - 2:00 PM ~ 2:45 PM ET $3: Elizabeth Haller © Epi: Aron Hall and Deron Burton © GMTF: Abbey Wojno * Lab: Summer Galloway, Brandi Limbago, Allison Laufer Haplin Melissa Carter © VIF: Janell Routh © CMO: Lauri Hicks * Senior Science Advisor: John Brooks * Science Brief: SARS-CoV-2 Infection-induced and Vaccine-induced Immunity: John Brooks, Melissa Briggs-Hagen V. Speaker Panelist Links [agenda Topic Breaker A IMIMWR: Severity of Disease [chris Taylor JAmong Adults Hospitalized ith Laboratory-Confirmed (OVID-19 Before and During he Period of SARS-CoV-2 b.1.617.2 (Delta) Predominance — COVID-NET, ha States, January-August 021 IMIMWR: Laboratory-Confirmedkatherine Bozio OVID-19 Among Adults Hospitalized with COVID-19- Like tlness with infection- Iinduced or mRNA Vaccine- Induced SARS-CoV-2 Immunity - Nine States, January= September 2021 [Updates to COC Guidance for ohn Neatherlin Institutions for Higher Education (HE) oe) Vi. Standing Panelist Links Standing Panelist Emai Zoom information Barbara Mahon ‘Bdm3@ede nov (x6)Internal Agenda CDC COVID-19 All State, Tribal, Local, and Territorial (STLT) Update Call Monday, November 1st, 2021 - 2:00 PM ~ 2:45 PM ET ‘Mark Anderson Mea6@cdegov John T. Brooks wudi@edegou Debbie Dowell ‘edo7@cdegov {aur Hick auas@cdegou Pragna Patel ‘pps @cdcgov Greta Massetti aheG@ede gov (x6) ‘Jose Montero znn3@ede now Keighlee Kingsbury ‘ons@edegov (Executive Assistant for STLTTF leadership) John Auerbach pad@cdegov Chris Braden ‘qb5@cdcgovInternal Agenda CDC COVID-19 All State, Tribal, Local, and Territorial (STLT) Update Call Monday, November 1st, 2021 - 2:00 PM ~ 2:45 PM ET ‘Amy Mowbray him3@cdenov Kate Noelte wiiB@edegov ‘Surbhi Modi bk@ede gov sia? Desi Alexander (TT DhyS@cdegov support IM) Vil, Task Force Links Team Email Zoom Information, STLT Support | Eoceventé?4@cdc gov Task Force ChiefHealth | Eoceventéaa@cde.gov Equity Officer (CHEO) Community Focevent357@cde gov Interventions Critical Populations {CICP) Task Force Data, Analytics, | Eocevent463@cde gov oe) and Visualizations (av) Epidemiology | Eocevent422@cdegov and Surveillance Task Force Global Migration | Eocevent2i3@cdegov Task Force (MTF)Internal Agenda CDC COVID-19 All State, Tribal, Local, and Territorial (STLT) Update Call Monday, November 1st, 2021 - 2:00 PM ~ 2:45 PM ET Health Systems | Eocevent2i8@cdeov and Worker Safety (HSWS) International | Cocevent223@cde gov Task Force Toit eocliclead@ede now Information Center (IC) laboratory and | Eocevent521@cdegov Testing Task Force Partnerships and | eocevent337@cde gov Risk ‘Management (PRM) ‘Vaccine Task | Eoceventdi7@cdc gov (x6) Force Incident Foceventsag@ede gov Manager Deputy Incident | eocevent259@ede.gov Manager Chief Medical | Eocevent270@cde gov Officer COCPanelist | Eocevent382@cdagov (Non-covio Response Update)Mahanna Gabrielli, Elizabeth Tue, 2 Nov 2021 12:17:59 +0000 Bozio, Catherine H. (CDC/DDID/NCIRD/ID) Subject: Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19- Like lliness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January-September 2021 Dear Dr. Bozio, First, | thank you for undertaking this study and releasing the results. | have many patients who have had prior infection and who are hesitant to take the vaccine. And we have a real paucity of data comparing infection-induced immunity vs vaccine-induced immunity vs no prior immunity. And it makes it very difficult to convince well educated and knowledable patients that the vaccine will give them a meaninful reduction in the risk of severe covi However for your study, | do wonder how clinically significant the findings are? | am an intensivist who takes care of COVID patients and nonCOVID patients alike. For me, the chance of being positive for COVID in both groups was clinically quite low: 5.1 vs 8.7 in vaccinated vs prior-infection induced immunity. While clearly there is an increased risk for the subjects that had prior infection-induced immunity, this doesn't mean much to me unless compared with the group with no known immunity (neither infection-induced nor vaccine-induced). Since you have this data, are you able to compare to this third group? If the infection-induced immunity group does not have a statistically reduced risk of having a positive COVID test while the vaccine-induced group does have a statistically reduced chance of having a positive COVID test, now that is clinically significant. I don't know if you can use the same database, but the other very clinically significant question | have is, In patients with a current positive COVID-19 PCR results, do subjects with prior vaccine- induced immunity have a clinically significant reduced risk of severe covid as compared to subjects with prior infection-induced immunity? Thank you for performing this very important research! Warm regards, Elizabeth Elizabeth Mahanna Gabrielli, MD Assistant Clinical Professor of Anesthesiology, Perioperative Medicine and Pain Management Division chief, Geriatric Anesthesiology Division of Geriatric anesthesiology, Neuroanesthesiology, and Critical Care Medicine 31611 NW 12th Ave; C307 Miami, FL 33336 Celt & I: exm1044@med.miami.eduyLynchJames WJR Mon, 1 Nov 2021 19:23:51 +0000 Bozio, Catherine H. (CDC/DDID/NCIRD/ID) MMWR article Catherine H. Bozio, PhD Dear Dr. Bozio | read with interest your lead author publication entitled “Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19-Like lines with Infection-Induced or mRNA Vaccine-induced SARS-CoV-2 Immunity — Nine States, January-September 202 As a medical oncologist who cares for patients with lymphoproliferative disorders, | follow this area very closely as the mortality in my patients approaches 30% when diagnosed with Covid. | had several questions that | hope you may help me with. 1, Do you have any data about the severity of the illnesses in the patients who were either vaccinated or previously infected compared to those who presented with a covid-like illness and tested positive without previous infection or vaccination. Intuitively | would guess these patients would fair less well that those with previous exposure. 2. Do you have any data about the mortality among the 2 groups studied? | ask because the raw percentages between those with previous infection versus vaccination were 8.7 and 5.1 respectively. While I realize that the aOR with your statistical corrections was 5.5, this does suffer from the caveats you mention, that such analyses are always Potentially confounded by innocent biases and modeling errors. | there were any major difference in mortality of the hospitalization, this would seem important and compelling Thanks for taking the time to perform this important work. | hope you will be able to offer some insight as we all think through these important topics. Sincerely Jw! James W. Lynch Jr, MD Professor of Hematology/Oncology Assistant Dean for Admissions University of Florida Academic Health CenterBozio, Catherine H. (CDC/DDID/NCIRD/ID) Fri, 29 Oct 2022 12:01:36 +0000 Briggs-Hagen, Melissa (CDC/DDID/NCIRD/OVD); Thompson, Mark (CDC/DDID/NCIRD/ID) Subject: RE: Articles on infection and vaccine induced immunity. Here's the citation (with correct title); Bozio CH, Grannis SJ, Naleway AL et al. Laboratory-confirmed COVID-19 among adults hospitalized with COVID-19-like illness with infection-induced or mRNA vaccine-induced SARS-CoV-2 immunity—nine states, January-September 2021. MMWR Morb Mortal Wkly Rep 2021;70. Epub October 29, 2021 MMUR is trying to see if the DO! URL at the end of the citation, Best, Catherine From: Briggs-Hagen, Melissa (CDC/DDID/NCIRD/DVD) Sent: Thursday, October 28, 2021 6:46 PM To: Bozio, Catherine H. (CDC/DDID/NCIRD/ID) ; Thompson, Mark (CDC/DDID/NCIRD/ID) Subject: RE: Articles on infection and vaccine induced immunity. Thanks for the heads’ up. The science brief also received feedback, now requiring additional last-minute edits. Happy to correct your citation whenever you have an updated one to send my way. | guess we'll just have to see how tomorrow goes! Would appreciate not having this level of stress in any future projects... Best, Melissa From: Bozio, Catherine H. (CDC/DDID/NCIRD/ID) Sent: Thursday, October 28, 2021 3:47 PM To: Briggs-Hagen, Melissa (CDC/DDID/NCIRD/DVD) ; Thompson, Mark (COC/DDID/NCIRO/ID) Subject: RE: Articles on infection and vaccine induced immunity. Hi Melissa, I wanted to give you a heads-up that the MMWR title is getting slightly modified. \’m hoping to get it finalized by tonight and will share with you once it is finalized. Would that give you enough time to modify the citation in the brief? Sorry for the down-to-the-wire changes! Best, CatherineFrom: Briggs-Hagen, Melissa (CDC/DDID/NCIRD/DVD) Sent: Wednesday, October 27, 2021 2:39 AM To: Bozio, Catherine H. (CDC/DDID/NCIRD/I0) ; Thompson, Mark (CDC/DDID/NCIRD/ID) Subject: Re: Articles on infection and vaccine induced immunity. Great, thanks! Will add it before posting. Melissa Get Outlook for 105 From: Bozio, Catherine H. (CDC/DDID/NCIRD/ID) Sent: Tuesday, October 26, 2021 10:02:35 PM To: Briggs-Hagen, Melissa (CDC/DDID/NCIRD/OVD) ; Thompson, Mark (CDC/ODID/NCIRD/ID) Subject: RE: Articles on infection and vaccine induced immunity. Hi Melissa, I wanted to share the tentative MMWR citation, in case it's helpful: Bozio CH, Grannis SJ, Naleway AL, et al. Laboratory-confirmed COVID-19 among adults with infection-induced and vaccine-induced SARS-CoV-2 immunity hospitalized with COVID-19-like illness — nine states, January-September 2021. MMWR Morb Mortal Wkly Rep 2021;70:xx—xx. Best, Catherine From: Hall, Aron (CDC/DDID/NCIRD/DVD) Sent: Tuesday, October 26, 2021 10:40 AM To: Briggs-Hagen, Melissa (CDC/DDID/NCIRD/DVD) ; Bozio, Catherine H (CDC/DDID/NCIRD/ID) ; Thompson, Mark (CDC/DDID/NCIRD/ID) Subject: RE: Articles on infection and vaccine induced immunity. Thanks, Melissa. Looks good to me. From: Briggs-Hagen, Melissa (CDC/DDID/NCIRD/DVD) Sent: Tuesday, October 26, 2021 10:36 AM To: Hall, Aron (COC/DDID/NCIRD/DVD) ; Borio, Catherine H. (CDC/DDID/NCIRD/ID) ; Thompson, Mark (CDC/DDID/NCIRD/ID) Subject: RE: Articles on infection and vaccine induced immunity. Thanks allPlease see revised statement below. Catherin: DE OH) wer Please advise if any further concerns, Thanks! Best, Melissa ons) From: Hall, Aron (CDC/DDID/NCIRD/DVD) Sent: Tuesday, October 26, 2021 10:03 AM To: Briggs-Hagen, Melissa (CDC/DDID/NCIRD/DVD) ; Bozio, Catherine H, (CDC/DDID/NCIRD/ID) ; Thompson, Mark (CDC/DDID/NCIRD/ID) Cc: Mahon, Barbara (CDC/DDID/NCIRD/OD) Subject: RE: Articles on infection and vaccine induced immunity. 'm not suggesting any greater depth or additional comparisons in the brief, but that we just state the (xs) From the results of the MMWR: Among COVID-19-like illness hospitalizations whose prior infection or vaccination occurred 90-179 days beforehand, the odds of laboratory-confirmed COVID-19 were higher among previously infected patients than among fully vaccinated patients (aOR = 5.49; 95% Cl = 2.75 10.99) (Table 2). In secondary analyses, the aORs that examined the impact of whether and how timing of infection or vaccination exposure was adjusted and aORs that stratified hospitalizations before and during Delta variant predominance were all similar to the primary aOR estimate. OC) Aron From: Briggs-Hagen, Melissa (CDC/DDID/NCIRD/DVD) Sent: Tuesday, October 26, 2021 9:54 AM all, Aron (CDC/DDID/NCIRD/DVD) ; Bozio, Catherine H. (CDC/DDID/NCIRD/ID) «ise7?@cdc.gov>; Thompson, Mark (CDC/DDID/NCIRD/ID)