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Asymptomatic and Symptomatic SARS-CoV-2 Infections After BNT162b2 Vaccination in a Routinely Screened Workforce

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

A 2-dose regimen of the BNT162b2 vaccine (Pfizer-BioNTech) against SARS-CoV-2 was authorized in December 2020 based on reported 94.8% efficacy.1 Although an association between vaccination and a reduction in symptomatic disease has been well described, an association with asymptomatic infection remains unclear.2,3

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Article Information

Corresponding Author: Li Tang, PhD, Department of Biostatistics, St Jude Children’s Research Hospital, 262 Danny Thomas Pl, Mail Stop 768, Memphis, TN 38105 (li.tang@stjude.org).

Accepted for Publication: April 12, 2021.

Published Online: May 6, 2021. doi:10.1001/jama.2021.6564

Author Contributions: Dr Tang had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Tang and Hijano are co–first authors. Drs Hoffman and Hayden are co–senior authors.

Concept and design: Tang, Hijano, Gaur, Geiger, Hoffman, Hayden.

Acquisition, analysis, or interpretation of data: Tang, Hijano, Gaur, Neufeld, Hoffman, Hayden.

Drafting of the manuscript: Tang, Hijano, Gaur, Hoffman.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Tang.

Administrative, technical, or material support: Geiger, Hoffman, Hayden.

Supervision: Hijano, Gaur, Geiger, Neufeld, Hoffman.

Conflict of Interest Disclosures: Dr Neufeld reports serving as a consultant to Pfizer outside the submitted work. Dr Hayden reports serving on advisory boards for Roche Molecular, Quidel Corporation, and Inflammatix outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported in part by the American Lebanese Syrian Associated Charities (ALSAC).

Role of the Funder/Sponsor: The funder had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We acknowledge the following members from St Jude Children’s Research Hospital for their contributions to this work: data aggregation and analysis efforts of Yilun Sun, MS, Biostatistics, and Sandra Dennis, BS, Human Resources; the insight and guidance of Richard Webby, PhD, Infectious Diseases, Greg Armstrong, MD, Epidemiology and Cancer Control, and Motomi Mori, PhD, Biostatistics; and the commitment and support of Hana Hakim, MD, Infectious Diseases, Kari Lahmon, BSN, Nursing Administration, and Sri Suganda, MT, MB (ASCP), Pathology. No one received financial compensation for their contributions.

References
1.
Polack  FP , Thomas  SJ , Kitchin  N ,  et al; C4591001 Clinical Trial Group.  Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine.   N Engl J Med. 2020;383(27):2603-2615. doi:10.1056/NEJMoa2034577PubMedGoogle ScholarCrossref
2.
Amit  S , Regev-Yochay  G , Afek  A , Kreiss  Y , Leshem  E .  Early rate reductions of SARS-CoV-2 infection and COVID-19 in BNT162b2 vaccine recipients.   Lancet. 2021;397(10277):875-877. doi:10.1016/S0140-6736(21)00448-7PubMedGoogle ScholarCrossref
3.
Dagan  N , Barda  N , Kepten  E ,  et al.  BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting.   N Engl J Med. 2021;384(15):1412-1423. doi:10.1056/NEJMoa2101765PubMedGoogle ScholarCrossref
4.
State of Tennessee Health Department. COVID-19 vaccination plan. Posted March 8, 2021. Accessed March 21, 2021. https://www.tn.gov/content/dam/tn/health/documents/cedep/novel-coronavirus/COVID-19_Vaccination_Plan.pdf
5.
Hightower  AW , Orenstein  WA , Martin  SM .  Recommendations for the use of Taylor series confidence intervals for estimates of vaccine efficacy.   Bull World Health Organ. 1988;66(1):99-105.PubMedGoogle Scholar
6.
Centers for Disease Control and Prevention. What healthcare personnel need to know about COVID-19 vaccines. Updated April 30, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/hcp.html
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