Background: Certain populations are disproportionately affected by COVID-19; identifying patterns in SARS-CoV-2 infectivity rates can inform public health decisions and the need for prevention efforts in these communities.
Objectives: Describe demographic and clinical characteristics of SARS-CoV-2 test positivity rates in US individuals based on receipt of mRNA-1273 or no COVID-19 vaccination.
Methods: SARS-CoV-2 test (RT-PCR or antigen) outcomes within the US CVS Health retail pharmacy network test population were collected between 25 April 2021 and 29 January 2022; self-reported demographic, health, and COVID-19 vaccination information were also collected. Test data were analyzed based on vaccination status (≥14 d after 2-dose mRNA-1273 or no COVID-19 vaccine; vaccination with other COVID-19 vaccines were excluded).
Results: Overall, 23,010,347 SARS-CoV-2 tests were performed (unvaccinated, n=9,415,865 [40.9%]; mRNA-1273, n=4,132,953 [18.0%]). During the overall study period and the week of 23-29 January 2022 (omicron period), the highest SARS-CoV-2 test positivity rates were among American Indian or Alaska Native, White, and Hispanic populations (overall: unvaccinated, 15.0%-16.5%; mRNA-1273, 8.0%-9.7%; omicron: unvaccinated, 29.8%-32.6%; mRNA-1273, 22.8%-26.3%). By age, SARS-CoV-2 test positivity was highest among adults aged 18–29 y (overall: unvaccinated, 16.1%; mRNA-1273, 8.8%; omicron: unvaccinated, 29.9%; mRNA-1273, 21.9%). Among children < 18 y (self-reported off-label mRNA-1273 use), overall SARS-CoV-2 test positivity ranged between 10.5%-15.3% (unvaccinated) and 6.9%-9.6% (mRNA-1273); during the omicron period, SARS-CoV-2 test positivity ranged between 26.9%-32.4% (unvaccinated) and 21.5%-28.0% (mRNA-1273). High rates in self-reported comorbidities were associated with the off-label use of mRNA-1273. SARS-CoV-2 test positivity was greater among symptomatic cases (overall: unvaccinated, 24.7%; mRNA-1273, 15.2%; omicron: unvaccinated, 45.2%; mRNA-1273, 35.8%) vs asymptomatic cases (overall: unvaccinated, 6.1%; mRNA-1273, 2.8%; omicron: unvaccinated, 12.3%; mRNA-1273, 7.3%). Heart disease (unvaccinated, 16.3%; mRNA-1273, 10.3%) was the most commonly reported comorbidity overall; during omicron, heart disease (unvaccinated, 28.2%) and cirrhosis (mRNA-1273, 26.2%) were most commonly reported.
Conclusions: SARS-CoV-2 test positivity rates were higher during omicron vs the overall study period; mRNA-1273-vaccinated individuals had a lower rate of SARS-CoV-2 test positivity compared with unvaccinated individuals. Patterns in race/ethnicity, age, and comorbidity distribution were identified, which can inform targeted interventions in these populations.
