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00925njm 22002777a 4500 dc Monge, Susana author Olmedo, Carmen author Alejos, Belén author Lapeña, María Fé author Sierra, María José author Limia, Aurora author COVID-19 Registries Study Group2 author Mazagatos, Clara author Larrauri, Amparo author 2021-10 We conducted a registries-based cohort study of long-term care facility residents >65 years of age offered vaccination against severe acute respiratory syndrome coronavirus 2 before March 10, 2021, in Spain. Risk for infection in vaccinated and nonvaccinated persons was compared with risk in the same persons in a period before the vaccination campaign, adjusted by daily-varying incidence and reproduction number. We selected 299,209 persons; 99.0% had >1 dose, 92.6% had 2 doses, and 99.8% of vaccines were Pfizer/BioNTech (BNT162b2). For vaccinated persons with no previous infection, vaccine effectiveness was 81.8% (95% CI 81.0%-82.7%), and 11.6 (95% CI 11.3-11.9) cases were prevented per 10,000 vaccinated/day. In those with previous infection, effectiveness was 56.8% (95% CI 47.1%-67.7%). In nonvaccinated residents with no previous infection, risk decreased by up to 81.4% (95% CI 73.3%-90.3%). Our results confirm vaccine effectiveness in this population and suggest indirect protection in nonvaccinated persons. Emerg Infect Dis. 2021 Oct;27(10):2595-2603. 10.3201/eid2710.211184 1080-6059 Emerging infectious diseases 34314670 http://hdl.handle.net/20.500.12105/15459 COVID-19 SARS-CoV-2 Spain Coronavirus disease Elderly Indirect effects Long-term care facilities Respiratory infections Severe acute respiratory syndrome coronavirus 2 Transmissibility Vaccination Vaccine effectiveness Viruses Zoonoses Direct and Indirect Effectiveness of mRNA Vaccination against Severe Acute Respiratory Syndrome Coronavirus 2 in Long-Term Care Facilities, Spain