{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T21:17:09Z","timestamp":1789075029735,"version":"build-2803163510"},"reference-count":13,"publisher":"American Medical Association (AMA)","issue":"14","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2022,10,11]]},"abstract":"\n Importance<\/jats:title>\n Data about the association of COVID-19 vaccination and prior SARS-CoV-2 infection with risk of SARS-CoV-2 infection and severe COVID-19 outcomes may guide prevention strategies.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To estimate the time-varying association of primary and booster COVID-19 vaccination and prior SARS-CoV-2 infection with subsequent SARS-CoV-2 infection, hospitalization, and death.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Cohort study of 10.6 million residents in North Carolina from March 2, 2020, through June 3, 2022.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n COVID-19 primary vaccine series and boosters and prior SARS-CoV-2 infection.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Rate ratio (RR) of SARS-CoV-2 infection and hazard ratio (HR) of COVID-19\u2013related hospitalization and death.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The median age among the 10.6 million participants was 39 years; 51.3% were female, 71.5% were White, and 9.9% were Hispanic. As of June 3, 2022, 67% of participants had been vaccinated. There were 2\u202f771\u202f364 SARS-CoV-2 infections, with a hospitalization rate of 6.3% and mortality rate of 1.4%. The adjusted RR of the primary vaccine series compared with being unvaccinated against infection became 0.53 (95% CI, 0.52-0.53) for BNT162b2, 0.52 (95% CI, 0.51-0.53) for mRNA-1273, and 0.51 (95% CI, 0.50-0.53) for Ad26.COV2.S 10 months after the first dose, but the adjusted HR for hospitalization remained at 0.29 (95% CI, 0.24-0.35) for BNT162b2, 0.27 (95% CI, 0.23-0.32) for mRNA-1273, and 0.35 (95% CI, 0.29-0.42) for Ad26.COV2.S and the adjusted HR of death remained at 0.23 (95% CI, 0.17-0.29) for BNT162b2, 0.15 (95% CI, 0.11-0.20) for mRNA-1273, and 0.24 (95% CI, 0.19-0.31) for Ad26.COV2.S. For the BNT162b2 primary series, boosting in December 2021 with BNT162b2 had the adjusted RR relative to primary series of 0.39 (95% CI, 0.38-0.40) and boosting with mRNA-1273 had the adjusted RR of 0.32 (95% CI, 0.30-0.34) against infection after 1 month and boosting with BNT162b2 had the adjusted RR of 0.84 (95% CI, 0.82-0.86) and boosting with mRNA-1273 had the adjusted RR of 0.60 (95% CI, 0.57-0.62) after 3 months. Among all participants, the adjusted RR of Omicron infection compared with no prior infection was estimated at 0.23 (95% CI, 0.22-0.24) against infection, and the adjusted HRs were 0.10 (95% CI, 0.07-0.14) against hospitalization and 0.11 (95% CI, 0.08-0.15) against death after 4 months.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Receipt of primary COVID-19 vaccine series compared with being unvaccinated, receipt of boosters compared with primary vaccination, and prior infection compared with no prior infection were all significantly associated with lower risk of SARS-CoV-2 infection (including Omicron) and resulting hospitalization and death. The associated protection waned over time, especially against infection.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2022.17876","type":"journal-article","created":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T11:31:34Z","timestamp":1664191894000},"page":"1415","source":"Crossref","is-referenced-by-count":128,"title":["Association of Primary and Booster Vaccination and Prior Infection With SARS-CoV-2 Infection and Severe COVID-19 Outcomes"],"prefix":"10.1001","volume":"328","author":[{"given":"Dan-Yu","family":"Lin","sequence":"first","affiliation":[{"name":"Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Gu","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangjianchen","family":"Xu","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradford","family":"Wheeler","sequence":"additional","affiliation":[{"name":"North Carolina Department of Health and Human Services, Raleigh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley","family":"Young","sequence":"additional","affiliation":[{"name":"North Carolina Department of Health and Human Services, Raleigh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shadia Khan","family":"Sunny","sequence":"additional","affiliation":[{"name":"CDC Foundation at North Carolina Department of Health and Human Services, Raleigh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zack","family":"Moore","sequence":"additional","affiliation":[{"name":"North Carolina Department of Health and Human Services, Raleigh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donglin","family":"Zeng","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"10","key":"joi220106r1","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1056\/NEJMoa2117128","article-title":"Effectiveness of Covid-19 vaccines over a 9-month period in North Carolina.","volume":"386","author":"Lin","year":"2022","journal-title":"N Engl J Med"},{"issue":"4","key":"joi220106r3","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1214\/aos\/1176345976","article-title":"Cox\u2019s regression model for counting processes: a large sample study.","volume":"10","author":"Andersen","year":"1982","journal-title":"Ann Stat"},{"issue":"2","key":"joi220106r4","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.2517-6161.1972.tb00899.x","article-title":"Regression models and life-tables.","volume":"34","author":"Cox","year":"1972","journal-title":"J R Stat Soc B"},{"issue":"27","key":"joi220106r5","doi-asserted-by":"publisher","first-page":"5983","DOI":"10.1002\/sim.v40.27","article-title":"Assessing vaccine durability in randomized trials following placebo crossover.","volume":"40","author":"Fintzi","year":"2021","journal-title":"Stat Med"},{"issue":"16","key":"joi220106r6","doi-asserted-by":"publisher","first-page":"1532","DOI":"10.1056\/NEJMoa2119451","article-title":"Covid-19 vaccine effectiveness against the omicron (B.1.1.529) variant.","volume":"386","author":"Andrews","year":"2022","journal-title":"N Engl J Med"},{"issue":"19","key":"joi220106r7","doi-asserted-by":"publisher","first-page":"1804","DOI":"10.1056\/NEJMoa2200797","article-title":"Effect of mRNA vaccine boosters against SARS-CoV-2 omicron infection in Qatar.","volume":"386","author":"Abu-Raddad","year":"2022","journal-title":"N Engl J Med"},{"issue":"14","key":"joi220106r8","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.1056\/NEJMc2200415","article-title":"Effectiveness of homologous or heterologous Covid-19 boosters in veterans.","volume":"386","author":"Mayr","year":"2022","journal-title":"N Engl J Med"},{"issue":"7","key":"joi220106r9","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1001\/jama.2022.0470","article-title":"Association between 3 doses of mRNA COVID-19 vaccine and symptomatic infection caused by the SARS-CoV-2 Omicron and Delta variants.","volume":"327","author":"Accorsi","year":"2022","journal-title":"JAMA"},{"issue":"23","key":"joi220106r10","doi-asserted-by":"publisher","first-page":"2201","DOI":"10.1056\/NEJMoa2118946","article-title":"Protection and waning of natural and hybrid immunity to SARS-CoV-2.","volume":"386","author":"Goldberg","year":"2022","journal-title":"N Engl J Med"},{"issue":"13","key":"joi220106r11","doi-asserted-by":"publisher","first-page":"1207","DOI":"10.1056\/NEJMoa2118691","article-title":"Protection against SARS-CoV-2 after Covid-19 vaccination and previous infection.","volume":"386","author":"Hall","year":"2022","journal-title":"N Engl J Med"},{"issue":"13","key":"joi220106r12","doi-asserted-by":"publisher","first-page":"1288","DOI":"10.1056\/NEJMc2200133","article-title":"Protection against the omicron variant from previous SARS-CoV-2 infection.","volume":"386","author":"Altarawneh","year":"2022","journal-title":"N Engl J Med"},{"issue":"1","key":"joi220106r13","doi-asserted-by":"publisher","first-page":"4675","DOI":"10.1038\/s41467-022-32363-4","article-title":"Protection of omicron sub-lineage infection against reinfection with another Omicron sub-lineage.","volume":"13","author":"Chemaitelly","year":"2022","journal-title":"Nat Commun"},{"key":"joi220106r2","unstructured":"US Dept of Health and Human Services. COVID-19 Pandemic Response, Laboratory Data Reporting: CARES Act Section 18115. Updated January 8, 2021. Accessed January 11, 2022. https:\/\/www.hhs.gov\/sites\/default\/files\/covid-19-laboratory-data-reporting-guidance.pdf"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2796893\/jama_lin_2022_oi_220106_1664819892.63433.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,4]],"date-time":"2024-10-04T14:06:15Z","timestamp":1728050775000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2796893"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,11]]},"references-count":13,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2022,10,11]]}},"URL":"https:\/\/doi.org\/10.1001\/jama.2022.17876","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.742339262.793597824","asserted-by":"object"}]},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2022,10,11]]}}}