Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status — 13 U.S. Jurisdictions, April 4–July 17, 2021

Scobie, Heather M.; Johnson, Amelia G.; Suthar, Amitabh B.; Severson, Rachel; Alden, Nisha B.; Balter, Sharon; Bertolino, Daniel; Blythe, David; Brady, Shane; Cadwell, Betsy; Cheng, Iris; Davidson, Sherri; Delgadillo, Janelle; Devinney, Katelynn; Duchin, Jeff; Duwell, Monique; Fisher, Rebecca; Fleischauer, Aaron; Grant, Ashley; Griffin, Jennifer; Haddix, Meredith; Hand, Julie; Hanson, Matt; Hawkins, Eric; Herlihy, Rachel K.; Hicks, Liam; Holtzman, Corinne; Hoskins, Mikhail; Hyun, Judie; Kaur, Ramandeep; Kay, Meagan; Kidrowski, Holly; Kim, Curi; Komatsu, Kenneth; Kugeler, Kiersten; Lewis, Melissa; Lyons, B. Casey; Lyons, Shelby; Lynfield, Ruth; McCaffrey, Keegan; McMullen, Chelsea; Milroy, Lauren; Meyer, Stephanie; Nolen, Leisha; Patel, Monita R.; Pogosjans, Sargis; Reese, Heather E.; Saupe, Amy; Sell, Jessica; Sokol, Theresa; Sosin, Daniel; Stanislawski, Emma; Stevens, Kelly; Vest, Hailey; White, Kelly; Wilson, Erica; MacNeil, Adam; Ritchey, Matthew D.; Silk, Benjamin J.

COVID-19 vaccine breakthrough infection surveillance helps monitor trends in disease incidence and severe outcomes in fully vaccinated persons, including the impact of the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19. Reported COVID-19 cases, hospitalizations, and deaths occurring among persons aged ≥18 years during April 4-July 17, 2021, were analyzed by vaccination status across 13 U.S. jurisdictions that routinely linked case surveillance and immunization registry data. Averaged weekly, age-standardized incidence rate ratios (IRRs) for cases among persons who were not fully vaccinated compared with those among fully vaccinated persons decreased from 11.1 (95% confidence interval [CI] = 7.8-15.8) to 4.6 (95% CI = 2.5-8.5) between two periods when prevalence of the Delta variant was lower (<50% of sequenced isolates; April 4-June 19) and higher (≥50%; June 20-July 17), and IRRs for hospitalizations and deaths decreased between the same two periods, from 13.3 (95% CI = 11.3-15.6) to 10.4 (95% CI = 8.1-13.3) and from 16.6 (95% CI = 13.5-20.4) to 11.3 (95% CI = 9.1-13.9). Findings were consistent with a potential decline in vaccine protection against confirmed SARS-CoV-2 infection and continued strong protection against COVID-19-associated hospitalization and death. Getting vaccinated protects against severe illness from COVID-19, including the Delta variant, and monitoring COVID-19 incidence by vaccination status might provide early signals of changes in vaccine-related protection that can be confirmed through well-controlled vaccine effectiveness (VE) studies.