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Comparative effectiveness of Moderna, Pfizer-BioNTech, and Janssen (Johnson & Johnson) vaccines in preventing COVID-19 hospitalizations among adults without immunocompromising conditions — United States, March–August 2021
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September 17, 2021
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Description:What is already known about this topic? Two 2-dose mRNA COVID-19 vaccines (from Pfizer-BioNTech and Moderna) and a 1-dose viral vector vaccine (from Janssen [Johnson & Johnson]) are currently used in the United States
What is added by this report? Among U.S. adults without immunocompromising conditions, vaccine effectiveness against COVID-19 hospitalization during March 11–August 15, 2021, was higher for the Moderna vaccine (93%) than the Pfizer-BioNTech vaccine (88%) and the Janssen vaccine (71%).
What are the implications for public health practice?Although these real-world data suggest some variation in levels of protection by vaccine, all FDA-approved or authorized COVID-19 vaccines provide substantial protection against COVID-19 hospitalization.
Three COVID-19 vaccines are authorized or approved for use among adults in the United States (1,2). Two 2-dose mRNA vaccines, mRNA-1273 from Moderna and BNT162b2 from Pfizer-BioNTech, received Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) in December 2020 for persons aged ≥18 years and aged ≥16 years, respectively. A 1-dose viral vector vaccine (Ad26.COV2 from Janssen [Johnson & Johnson]) received EUA in February 2021 for persons aged ≥18 years (3). The Pfizer-BioNTech vaccine received FDA approval for persons aged ≥16 years on August 23, 2021 (4). Current guidelines from FDA and CDC recommend vaccination of eligible persons with one of these three products, without preference for any specific vaccine (4,5). To assess vaccine effectiveness (VE) of these three products in preventing COVID-19 hospitalization, CDC and collaborators conducted a case-control Analysis among 3,689 adults aged ≥18 years who were hospitalized at 21 U.S. hospitals across 18 states during March 11–August 15, 2021. An additional Analysis compared serum antibody levels (anti-spike immunoglobulin G [IgG] and anti–receptor binding domain [RBD] IgG) to SARS-CoV-2, the Virus that causes COVID-19, among 100 healthy volunteers enrolled at three hospitals 2–6 weeks after full vaccination with the Moderna, Pfizer-BioNTech, or Janssen COVID-19 vaccine. Patients with immunocompromising conditions were excluded. VE against COVID-19 hospitalizations was higher for the Moderna vaccine (93%; 95% confidence interval [CI] = 91%–95%) than for the Pfizer-BioNTech vaccine (88%; 95% CI = 85%–91%) (p = 0.011); VE for both mRNA vaccines was higher than that for the Janssen vaccine (71%; 95% CI = 56%–81%) (all p<0.001). Protection for the Pfizer-BioNTech vaccine declined 4 months after vaccination. Postvaccination anti-spike IgG and anti-RBD IgG levels were significantly lower in persons vaccinated with the Janssen vaccine than the Moderna or Pfizer-BioNTech vaccines. Although these real-world data suggest some variation in levels of protection by vaccine, all FDA-approved or authorized COVID-19 vaccines provide substantial protection against COVID-19 hospitalization.
For the VE Analysis, adults aged ≥18 years without an immunocompromising condition admitted to 21 hospitals within the Influenza and Other Viruses in the Acutely Ill (IVY) Network were prospectively recruited for a case-control Analysis (6,7). Case-patients were admitted to a hospital with COVID-19–like illness† and a positive SARS-CoV-2 reverse transcription–polymerase chain reaction (RT-PCR) or antigen test result. Control-patients were adults admitted to a hospital§ who received a negative SARS-CoV-2 RT-PCR test result.
Suggested citation for this article: Self WH, Tenforde MW, Rhoads JP, et al. Comparative Effectiveness of Moderna, Pfizer-BioNTech, and Janssen (Johnson & Johnson) Vaccines in Preventing COVID-19 Hospitalizations Among Adults Without Immunocompromising Conditions — United States, March–August 2021. MMWR Morb Mortal Wkly Rep. ePub: 17 September 2021.
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