High coverage COVID-19 mRNA vaccination rapidly controls SARS-CoV-2 transmission in Long-Term Care Facilities

Abstract

Residents of Long-Term Care Facilities (LTCFs) represent a major share of COVID-19 deaths worldwide. Measuring the vaccine effectiveness among the most vulnerable in these settings is essential to monitor and improve mitigation strategies. We evaluated the early effect of the administration of BNT162b2 mRNA vaccines to individuals older than 64 years residing in LTCFs in Catalonia, a region of Spain. We monitored all the SARS-CoV-2 documented infections and deaths among LTCFs residents from February 6th to March 28th, 2021, the subsequent time period after which 70% of them were fully vaccinated. We developed a modeling framework based on the relation between community and LTFCs transmission during the pre-vaccination period (July -December 2020) and compared the true observations with the counterfactual model predictions. As a measure of vaccine effectiveness, we computed the total reduction in SARS-CoV-2 documented infections and deaths among residents of LTCFs over time, as well as the reduction on the detected transmission for all the LTCFs. We estimated that once more than 70% of the LTCFs population were fully vaccinated, 74% (58%-81%, 90% CI) of COVID-19 deaths and 75% (36%-86%, 90% CI) of all expected documented infections among LTCFs residents were prevented. Further, detectable transmission among LTCFs residents was reduced up to 90% (76-93%, 90%CI) relative to that expected given transmission in the community. Our findings provide evidence that high-coverage vaccination is the most effective intervention to prevent SARS-CoV-2 transmission and death among LTCFs residents. Conditional on key factors such as vaccine roll out, escape and coverage --across age groups--, widespread vaccination could be a feasible avenue to control the COVID-19 pandemic.

Keywords: COVID-19; long-term-care facilities; time series analysis; vaccination; vaccine effectiveness.

Figure 1.

A) Comparison of the total community (grey) and LTCFs documented infections (red) trajectories in Catalonia, Spain. B) First and second dose vaccine coverage among LTCFs residents

Figure 2:

The predictions for infections (A) and deaths (B) across all of Catalonia. The solid lines show the model predictions from training July 6, 2020 through December 27, 2020, the darker shaded background shows the 50% prediction intervals (PI) and the lighter background shows the 90% PI. Vertical lines show key analysis time points: when vaccination started (solid), when 70% of residents received the first dose and when 70% of residents received the second dose. (C) The ratio between observed and predicted transmission at county level in Catalonia, represented by point estimates, grey for the training period and green for the prediction period; grey horizontal ribbon represents the 90% confidence interval. Solid green areas represent the prediction periods after vaccination starts.