A new report from the Centers for Disease Control and Prevention (CDC) analyzed how two doses of mRNA vaccines were 74.7% effective against infection among nursing home residents early in the vaccination program. During June–July 2021, when B.1.617.2 (Delta) variant circulation predominated, effectiveness declined significantly to 53.1%.
This study could not differentiate the independent impact of the Delta variant from other factors, such as potential waning of vaccine-induced immunity. Further research on the possible impact of both factors on vaccine effectiveness (VE) among nursing home residents is warranted.
Because nursing home residents might remain at some risk for SARS-CoV-2 infection despite vaccination, multipronged COVID-19 prevention strategies, including infection control, testing and vaccination of nursing home staff members, residents and visitors are critical.
These results (pre-Delta 74.7%; Delta 53.1%) fall within the range of findings from other studies of COVID-19 mRNA VE in nursing home residents conducted before the Delta variant was prevalent, with estimates against infection ranging from 53% to 92%. Variability in VE estimates across studies can result from differences in underlying populations, SARS-CoV-2 testing practices and diagnostics, prevalence of previous infections, analytic methods and virus variant strains in circulation.
Nursing home residents, who are often elderly and frail, might have a less robust response to vaccines, and are at higher risk for infection with SARS-CoV-2 and for severe COVID-19. In addition, nursing home residents were among the earliest groups vaccinated in the United States; thus, if vaccine-induced immunity does wane over time, this decrease in VE might first be observed among nursing home residents. Because increased U.S. circulation of the Delta variant coincided with a period ≥6 months after vaccine introduction, the extent to which reduced vaccine protection against Delta and potential waning immunity contributed to the lower VE in the Delta period could not be determined by this study.
Nursing homes were aggressive in case ascertainment because of guidelines recommending weekly point prevalence surveys if a single SARS-CoV-2 infection in a staff member or resident was identified.
This analysis assessed VE against any infection, without being able to distinguish between asymptomatic and symptomatic infections. Additional evaluations are needed to understand protection against severe disease in nursing home residents over time.
Both Pfizer-BioNTech and Moderna mRNA vaccines were highly effective in preventing SARS-CoV-2 infection in nursing home residents early after vaccine introduction. However, the effectiveness among this population in recent months has been significantly lower. To prevent transmission of SARS-CoV-2 in nursing homes, these findings highlight the critical importance of COVID-19 vaccination of staff members, residents, and visitors and adherence to rigorous COVID-19 prevention strategies. An additional dose of COVID-19 vaccine might be considered for nursing home and long-term care facility residents to optimize a protective immune response.