Report highlights 10x deaths for non-vaccinated COVID-19 cases

Sept. 14, 2021

The incidence of SARS-CoV-2 infection, hospitalization and death is higher in unvaccinated than vaccinated persons, and the incidence rate ratios are related to vaccine effectiveness.

Across 13 U.S. jurisdictions, incidence rate ratios (IRR) for hospitalization and death changed relatively little after the SARS-CoV-2 B.1.617.2 (Delta) variant reached predominance, suggesting high, continued vaccine effectiveness against severe COVID-19. Case IRRs decreased, suggesting reduced vaccine effectiveness for prevention of SARS-CoV-2 infections.

COVID-19 vaccine breakthrough infection surveillance helps monitor trends in disease incidence and severe outcomes in fully vaccinated persons, including the impact of the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19.

Reported COVID-19 cases, hospitalizations and deaths occurring among persons aged ≥18 years during April 4–July 17, 2021, were analyzed by vaccination status across 13 U.S. jurisdictions that routinely linked case surveillance and immunization registry data. Averaged weekly, age-standardized incidence rate ratios (IRRs) for cases among persons who were not fully vaccinated compared with those among fully vaccinated persons decreased from 11.1 to 4.6 between two periods when prevalence of the Delta variant was lower (<50% of sequenced isolates; April 4–June 19) and higher (≥50%; June 20–July 17), and IRRs for hospitalizations and deaths decreased between the same two periods, from 13.3 to 10.4 and from 16.6.

Findings were consistent with a potential decline in vaccine protection against confirmed SARS-CoV-2 infection and continued strong protection against COVID-19–associated hospitalization and death. Getting vaccinated protects against severe illness from COVID-19, including the Delta variant, and monitoring COVID-19 incidence by vaccination status might provide early signals of changes in vaccine-related protection that can be confirmed through well-controlled vaccine effectiveness (VE) studies.

Averaged weekly, age-standardized rates (events per 100,000 persons) were higher among persons not fully vaccinated than among fully vaccinated persons for reported cases (112.3 versus 10.1), hospitalizations (9.1 versus 0.7), and deaths (1.6 versus 0.1) during April 4–June 19, as well as during June 20–July 17 (89.1 versus 19.4; 7.0 versus 0.7; 1.1 versus 0.1, respectively). Higher hospitalization and death rates were observed in older age groups, regardless of vaccination status, resulting in a larger impact of age-standardization on overall incidence for these outcomes.

MMWR report

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