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SARS-CoV-2 continues to evolve, population immunity changes, and COVID-19 vaccine formulas have been updated, necessitating ongoing COVID-19 vaccine effectiveness (VE) monitoring. To evaluate the VE of 2023-2024 COVID-19 vaccines against COVID-19-associated emergency department (ED) and urgent care (UC) encounters, hospitalizations, and critical illness, including during XBB- and JN.1-predominant periods. This test-negative design VE case-control study was conducted using data from September 21, 2023, to August 22, 2024, from EDs, UC centers, and hospitals in 6 US health care systems. Eligible adults 18 years or older with COVID-19-like illness and molecular or antigen testing for SARS-CoV-2 were studied. Case patients were those with a positive molecular or antigen test result; control patients were those with a negative molecular test result. Receipt of 2023-2024 (monovalent XBB.1.5) COVID-19 vaccination with products approved or authorized for use in the US. Main outcomes were COVID-19-associated ED and UC encounters, hospitalizations, and critical illness (admission to the intensive care unit or in-hospital death). VE was estimated comparing the odds of receipt of the 2023-2024 COVID-19 vaccine with no receipt among case and control patients. Among 345 639 eligible ED and UC encounters in immunocompetent adults 18 years or older with COVID-19-like illness and available test results (median [IQR] age, 53 [34-71] years; 209 087 [60%] female), 37 096 (11%) had a positive SARS-CoV-2 test result. VE against COVID-19-associated ED and UC encounters was 24% (95% CI, 21%-26%) during 7 to 299 days after vaccination. Among 111 931 eligible hospitalizations in immunocompetent adults 18 years or older with COVID-19-like illness and available test results (median [IQR] age, 71 [58-81] years), 10 380 (9%) had a positive SARS-CoV-2 test result. During 7 to 299 days after vaccination, VE was 29% (95% CI, 25%-33%) against COVID-19-associated hospitalization and 48% (95% CI, 40%-55%) against COVID-19-associated critical illness. VE was highest 7 to 59 days after vaccination (VE against ED and UC encounters 49%; 95% CI, 46%-52%; hospitalization, 51%; 95% CI, 46%-56%; critical illness, 68%; 95% CI, 56%-76%) and then waned (VE 180-299 days after vaccination against ED and UC encounters, -7% [95% CI, -13% to -2%]; hospitalization, -4% [95% CI, -14% to 5%]; and critical illness, 16% [95% CI, -6 to 34%]). In this case-control study of VE, 2023-2024 COVID-19 vaccines were estimated to provide additional effectiveness against medically attended COVID-19, with the highest and most sustained estimates against critical illness. These results highlight the importance of receiving recommended COVID-19 vaccination for adults 18 years or older.

During September 2023-August 2024, approximately 38,000 COVID-19-associated hospitalizations occurred among children and adolescents aged <18 years in the United States, a rate of approximately 53 per 100,000 children, ranging from 600 per 100,000 children aged <6 months to 21 per 100,000 children and adolescents aged 5-17 years. On June 27, 2024, the Advisory Committee on Immunization Practices recommended that all persons aged ≥6 months receive a 2024-2025 COVID-19 vaccine, which targeted Omicron JN.1 and JN.1-derived sublineages. Investigators used a test-negative case-control design to estimate vaccine effectiveness (VE) of 2024-2025 COVID-19 vaccines against COVID-19-associated emergency department or urgent care (ED/UC) visits during August 29, 2024-September 2, 2025, among immunocompetent children aged 9 months-4 years and children and adolescents aged 5-17 years in the CDC-funded Virtual SARS-CoV-2, Influenza, and Other respiratory viruses Network (VISION), a multisite electronic health record-based network in nine states. Among children aged 9 months-4 years, VE against COVID-19-associated ED/UC visits was estimated at 76% (95% CI = 58%-87%) during the first 7-179 days after vaccination. Among children and adolescents aged 5-17 years, VE against COVID-19-associated ED/UC visits was an estimated 56% (95% CI = 35%-70%) during the first 7-179 days after vaccination. These findings suggest that vaccination with a 2024-2025 COVID-19 vaccine dose provided children with additional protection against COVID-19-associated ED/UC encounters compared with no 2024-2025 dose.