• Amanda B Payne, Janet A Watts, Patrick K Mitchell, Kristin Dascomb, Stephanie A Irving, Nicola P Klein, Shaun J Grannis, Toan C Ong, Sarah W Ball, Malini B DeSilva, Karthik Natarajan, Tamara Sheffield, Daniel Bride, Julie Arndorfer, Allison L Naleway, Padma Koppolu, Bruce Fireman, Ousseny Zerbo, Julius Timbol, Kristin Goddard, Brian E Dixon, William F Fadel, Colin Rogerson, Katie S Allen, Suchitra Rao, David Mayer, Michelle Barron, Sarah E Reese, Elizabeth A K Rowley, Morgan Najdowski, Allison Avrich Ciesla, Josephine Mak, Emily L Reeves, Omobosola O Akinsete, Charlene E McEvoy, Inih J Essien, Mark W Tenforde, Katherine E Fleming-Dutra, and Ruth Link-Gelles.
• National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: bvx2@cdc.gov.
• Lancet. 2024 Oct 19; 404 (10462): 154715591547-1559.

BackgroundRespiratory syncytial virus vaccines first recommended for use during 2023 were efficacious against lower respiratory tract disease in clinical trials. Limited real-world data regarding respiratory syncytial virus vaccine effectiveness are available. To inform vaccine policy and address gaps in evidence from the clinical trials, we aimed to assess the effectiveness against respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years.MethodsWe conducted a test-negative design analysis in an electronic health records-based network in eight states in the USA, including hospitalisations and emergency department encounters with respiratory syncytial virus-like illness among adults aged at least 60 years who underwent respiratory syncytial virus testing from Oct 1, 2023, to March 31, 2024. Respiratory syncytial virus vaccination status at the time of the encounter was derived from electronic health record documentation, state and city immunisation registries, and, for some sites, medical claims. Vaccine effectiveness was estimated by immunocompromise status, comparing the odds of vaccination among respiratory syncytial virus-positive case patients and respiratory syncytial virus-negative control patients, and adjusting for age, race and ethnicity, sex, calendar day, social vulnerability index, number of underlying non-respiratory medical conditions, presence of respiratory underlying medical conditions, and geographical region.FindingsAmong 28 271 hospitalisations for respiratory syncytial virus-like illness among adults aged at least 60 years without immunocompromising conditions, vaccine effectiveness was 80% (95% CI 71-85) against respiratory syncytial virus-associated hospitalisations, and vaccine effectiveness was 81% (52-92) against respiratory syncytial virus-associated critical illness (ICU admission or death, or both). Among 8435 hospitalisations for respiratory syncytial virus-like illness among adults with immunocompromising conditions, vaccine effectiveness was 73% (48-85) against associated hospitalisation. Among 36 521 emergency department encounters for respiratory syncytial virus-like illness among adults aged at least 60 years without an immunocompromising condition, vaccine effectiveness was 77% (70-83) against respiratory syncytial virus-associated emergency department encounters. Vaccine effectiveness estimates were similar by age group and product type.InterpretationRespiratory syncytial virus vaccination was effective in preventing respiratory syncytial virus-associated hospitalisations and emergency department encounters among adults aged at least 60 years in the USA during the 2023-24 respiratory syncytial virus season, which was the first season after respiratory syncytial virus vaccine was approved.FundingThe Centers for Disease Control and Prevention.Copyright © 2024 Published by Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.

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