Full Vaccination Most Beneficial for Older Veterans With COVID-19 Despite Frailty Status

Despite frailty status, study authors concluded that infected older veterans who were fully vaccinated against COVID-19 were more protected from hospitalization.

With little evidence existing on whether frailty is associated with altered vaccine effectiveness against hospitalization among individuals with COVID-19, researchers sought to assess protection against hospitalization in this population.

Administrative data was extracted from the Veterans Affairs (VA) Greater Los Angeles Health Care System for all Veterans aged 50 years or older with a positive COVID-19 PCR or antigen test from December 1, 2021, to January 31, 2022, which covered the Omicron variant wave.

Fully vaccinated individuals were determined by having completed a COVID-19 vaccine series and either had received or were not yet eligible for a booster. Researchers utilized the VA Frailty Index to determine frailty status among veterans, which was classified as nonfrail, frail, or severely frail (FI < 0.2, 0.2-0.4, and >0.4 respectively).

Of the 1091 veterans who tested positive for COVID-19, 155 were admitted to the hospital and 1026 (94%) were male with a median age of 67 years.
Vaccination status among veterans showed 519 (48%) were fully vaccinated, 271 (25%) were partially vaccinated, and 301 (28%) were unvaccinated. Frailty classification showed 662 (61%) individuals were nonfrail, 335 (31%) were frail, and 94 (9%) were severely frail.

Researchers reported that veterans with greater degrees of frailty were more likely to be admitted to the hospital for each vaccination status.

“Crude relative risk (95% CI) of admission for fully vaccinated vs unvaccinated are similar: 0.28 (0.15-0.54) for nonfrail, 0.42 (0.26-0.67) for frail, and 0.33 (0.18-0.57) for severely frail,” wrote researchers. “Absolute risk differences (95% CI) for fully vaccinated vs unvaccinated increase with greater frailty: 11% (5-17) for nonfrail, 19% (8-30) for frail, and 45% (22-68) for severely frail.”

Regardless of frailty status, study findings showed up-to-date vaccination against COVID-19 is beneficial and less protection was offered for individuals with partial vaccination status.

“As preventive measures such as mask requirements are discontinued, clinicians should realize that frail patients remain at higher risk,” concluded researchers. “Frailty may help with prioritizing antiviral therapy when resources are limited and may be an indication for future COVID-19 boosters. Further work should consider vaccine effectiveness against additional outcomes across levels of frailty to inform how well vaccination protects those most vulnerable.”

Reference:
Seligman B, Ikuta K, Orshansky G, Bidwell Goetz M. Frailty, vaccination, and hospitalization following COVID-19 positivity in older veterans. J Am Geriatr Soc. Published online May 31, 2022. doi:10.1111/jgs.17919