It is important to understand real-world BNT162b2 COVID-19 vaccine effectiveness (VE), especially among racial and ethnic minority groups. We performed a test-negative case-control study to measure BNT162b2 COVID-19 VE in the prevention of COVID-19-associated acute respiratory illness (ARI) hospitalizations at two Atlanta hospitals from May 2021–January 2023 and adjusted for potential confounders by multivariate analysis. Among 5139 eligible adults with ARI, 2763 (53.8%) were enrolled, and 1571 (64.5%) were included in the BNT162b2 analysis. The median age was 58 years (IQR, 44–68), 889 (56.6%) were female, 1034 (65.8%) were African American, 359 (22.9%) were White, 56 (3.6%) were Hispanic ethnicity, 645 (41.1%) were SARS-CoV-2-positive, 412 (26.2%) were vaccinated with a primary series, and 273 (17.4%) had received ≥1 booster of BNT162b2. The overall adjusted VE of the BNT162b2 primary series was 58.5% (95% CI 46.0, 68.1), while the adjusted VE of ≥1 booster was 78.9% (95% CI 70.0, 85.1). The adjusted overall VE of primary series for African American/Black individuals was 64.0% (95% CI 49.9, 74.1) and 82.7% (95% CI 71.9, 89.4) in those who received ≥1 booster. When analysis was limited to the period of Omicron predominance, overall VE of the primary series decreased with widened confidence intervals (24.5%, 95% CI −4.5, 45.4%), while VE of ≥1 booster was maintained at 60.9% (95% CI 42.0, 73.6). BNT162b2 primary series and booster vaccination provided protection against COVID-19-associated ARI hospitalization among a predominantly African American population.

Background: Automated hand hygiene monitoring systems (AHHMSs) can monitor a large number of hand hygiene opportunities, and some provide real-time feedback; however, the impact of these systems is unclear. We sought to better understand how one of these systems improves hand hygiene adherence. Methods: The AHHMS was installed in seven units of an urban teaching hospital, and healthcare workers, primarily nurses and nurse technicians, were enrolled. We used a prospective observational cohort design with multiple interventions, including providing individual adherence rates and real-time voice reminders, to understand how these interventions improve hand hygiene adherence. Results: Over the 40-week study period, 744,769 hand hygiene observations were observed among the 346 participants. The overall hand hygiene adherence rate increased from 37.0% (95% CI: 34.3% to 39.9%) at the start of the study to 55.5% (95% CI: 51.6% to 59.6%). This increase of 18.5% was statistically significant. However, adherence varied widely among different units and between individual participants. Voice reminders (58.7% (95% CI: 55.9% to 61.6%)) led to a significantly higher hand hygiene adherence rate than weekly individual feedback (46.4% (95%: 42.2% to 51.0%)) after adjusting for work shift and the seven individual participating clinical units. With the combination of interventions, improved adjusted adherence rates were sustained until the end of the study period. Conclusions: After the introduction of the AHHMS, real-time voice reminders improved short-term hand hygiene adherence more than feedback of individual adherence rates. Multiple interventions and cultural changes are required to sustain improved adherence.

Background/Objectives: COVID-19 mRNA vaccines protect against hospitalization, but less is known about real-world vaccine effectiveness (VE) against other severe outcomes. Methods: We enrolled adults hospitalized with acute respiratory illness at two hospitals in Atlanta, Georgia, USA from May 2021 to January 2023. Participants were eligible if they had standard-of-care COVID-19 testing or provided an upper respiratory swab for analysis. Vaccination status was confirmed through the state registry. mRNA COVID-19 VE among those with severe outcomes was determined using a test-negative case–control design with stepwise logistic regression adjusting for confounding variables. Results: Of 1973 participants eligible for analysis, 886 (44.9%) were unvaccinated, 641 (32.5%) received a primary series, and 446 (22.6%) received a primary series plus ≥ 1 booster. A total of 734 (37.2%) were positive for COVID-19. During the pre-Delta/Delta (2 May 2021–19 December 2021) vs. Omicron (20 December 2021–31 January 2023) eras, adjusted COVID-19 mRNA VE of a primary series compared to no vaccination was 85.5% (95% CI: 77.0%, 90.8%) vs. 38.2% (95% CI: 11.5%, 56.8%) overall, 90.0% (95% CI: 82.6%, 94.2%) vs. 54.4% (95% CI: 9.0%, 77.1%) among those with radiographic pneumonia, and 94.4% (95% CI: 80.5%, 98.4%) vs. 62.5% (95% CI: 19.0%, 82.7%) among those admitted to the ICU. VE against severe outcomes was highest within the 6 months following vaccination and during the pre-Delta/Delta era. A booster dose partially restored VE against Omicron-associated hospitalization and pneumonia. Conclusions: COVID-19 mRNA vaccines were effective at preventing hospitalization and other severe outcomes in adults during periods of pre-Delta/Delta and Omicron variant circulation.

Key points: Question: Among infants eligible to receive protection from maternal vaccination or infant long-acting monoclonal antibodies, what is the effectiveness RSV preventive strategies when accounting for real-world delays in administration? Findings: In this target trial emulation study of 120,586 mother-infant pairs from U.S. claims data, long-acting monoclonal antibody effectiveness was sensitive to implementation delays, rendering preventive strategies that protected infants at or close to birth more effective at preventing respiratory disease than a monoclonal antibody strategy that reflected real-world implementation. Meaning: Strategies, such as maternal vaccination or monoclonal antibodies provided within the first week of life, that protect infants at birth or close to birth are especially valuable in settings where delayed long-acting monoclonal antibody receipt is likely. Importance: Maternal vaccination and long-acting monoclonal antibodies are now available in the U.S. to prevent RSV. Long-acting monoclonal antibody administration in the U.S. commonly occurs after hospital discharge in outpatient settings, leaving some infants unprotected early in life when severe RSV risk is highest. Comparative effectiveness between the two interventions and whether delays affect effectiveness estimates have not been quantified. Objective: To evaluate the effectiveness of infant long-acting monoclonal antibody strategies and a maternal vaccination strategy, each compared to no intervention, and the comparative effectiveness of intervention strategies when accounting for real-world delays in monoclonal antibody receipt. Design: Cohort study using target trial emulation to compare four strategies for prevention of RSV-related outcomes. Setting: The U.S. between 2023 and 2025 using a nationwide database of employer-sponsored commercial insurance claims. Participants: 120,586 commercially insured mother-infants, whose infants were born in the U.S. during the 2023-2024 or 2024-2025 RSV season. Infants who could not be paired with their mother’s record, did not enroll in commercial insurance within 75 days from birth, received palivizumab, and had an implausible birth date were excluded. Interventions: Comparison of four RSV prevention strategies: (i) maternal RSVpreF; (ii) long-acting monoclonal antibody given within the first week of life (mAb as intended); (iii) long-acting monoclonal antibody given within a six-month grace period from birth (mAb within grace period); and (iv) a control. Main outcomes and measures: Effectiveness against first RSV-associated hospitalization and medically-attended RSV illness was summarized using adjusted hazard ratios (aHR) and estimated using an inverse propensity weighting approach, with weights accounting for maternal age, maternal comorbidities affecting pregnancy, obstetric and newborn complications, season, region, and birth timing relative to October 1. A weighted Kaplan Meier estimator was used to estimate strategy-specific cumulative incidence of RSV outcomes over time. Results: In the first five weeks of life, the mAb within grace period strategy doubled the hazard of RSV hospitalization (aHR: 2.0 [95% CI: 1.0-4.9]) and increased the hazard of medically-attended RSV (aHR: 1.6 [95% CI: 1.0-2.7]) compared to the maternal RSVpreF strategy. The hazard for RSV hospitalization was similar for the mAb as intended strategy compared to the maternal RSVpreF strategy (aHR = 0.9 [95% CI: 0.3-1.9]). Conclusions and relevance: RSVpreF and monoclonal antibodies were similarly effective when monoclonal antibodies were administered close to birth, but when accounting for real-world delays in monoclonal antibody receipt, the maternal RSVpreF strategy was more effective than the mAb within grace period strategy.