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Hall VJ, Insalata F, Foulkes S, Kirwan P, Sparkes D, Atti A, Cole M, de Lacy E, Price L, Corrigan D, Brown CS, Islam J, Charlett A, Hopkins S. Effectiveness of BNT162b2 mRNA vaccine third doses and previous infection in protecting against SARS-CoV-2 infections during the Delta and Omicron variant waves; the UK SIREN cohort study September 2021 to February 2022. J Infect 2024; 88:30-40. [PMID: 37926119 DOI: 10.1016/j.jinf.2023.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Third doses of COVID-19 vaccines were widely deployed following the primary vaccine course waning and the emergence of the Omicron-variant. We investigated protection from third-dose vaccines and previous infection against SARS-CoV-2 infection during Delta-variant and Omicron-variant (BA.1 & BA.2) waves in our frequently PCR-tested cohort of healthcare-workers. Relative effectiveness of BNT162b2 third doses and infection-acquired immunity was assessed by comparing the time to PCR-confirmed infection in boosted participants with those with waned dose-2 protection (≥254 days after dose-2), by primary series vaccination type. Follow-up time was divided by dominant circulating variant: Delta 07 September 2021 to 30 November 2021, Omicron 13 December 2021t o 28 February 2022. We used a Cox regression model with adjustment/stratification for demographic characteristics and staff-type. We explored protection associated with vaccination, infection and both. We included 19,614 participants, 29% previously infected. There were 278 primary infections (4 per 10,000 person-days of follow-up) and 85 reinfections (0.8/10,000 person-days) during the Delta period and 2467 primary infections (43/10,000 person-days) and 881 reinfections (33/10,000) during the Omicron period. Relative Vaccine Effectiveness (VE) 0-2 months post-3rd dose (3rd dose) (3-doses BNT162b2) in the previously uninfected cohort against Delta infections was 63% (95% Confidence Interval (CI) 40%-77%) and was lower (35%) against Omicron infection (95% CI 21%-47%). The relative VE of 3rd dose (heterologous BNT162b2) was greater for primary course ChAdOX1 recipients, with VE 0-2 months post-3rd dose over ≥68% higher for both variants. Third-dose protection waned rapidly against Omicron, with no significant difference between two and three BNT162b2 doses observed after 4-months. Previous infection continued to provide additional protection against Omicron (67% (CI 56%-75%) 3-6 months post-infection), but this waned to about 25% after 9-months, approximately three times lower than against Delta. Infection rates surged with Omicron emergence. Third doses of BNT162b2 vaccine provided short-term protection, with rapid waning against Omicron infections. Protection associated with infections incurred before Omicron was markedly diminished against the Omicron wave. Our findings demonstrate the complexity of an evolving pandemic with the potential emergence of immune-escape variants and the importance of continued monitoring.
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Affiliation(s)
- Victoria J Hall
- UK Health Security Agency, 10 South Colonnade, London E14 4PU, United Kingdom.
| | - Ferdinando Insalata
- UK Health Security Agency, 10 South Colonnade, London E14 4PU, United Kingdom; Department of Mathematics, Imperial College London, London, SW7 2AZ, United Kingdom.
| | - Sarah Foulkes
- UK Health Security Agency, 10 South Colonnade, London E14 4PU, United Kingdom.
| | - Peter Kirwan
- UK Health Security Agency, 10 South Colonnade, London E14 4PU, United Kingdom; MRC Biostatistics Unit, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, United Kingdom.
| | - Dominic Sparkes
- UK Health Security Agency, 10 South Colonnade, London E14 4PU, United Kingdom.
| | - Ana Atti
- UK Health Security Agency, 10 South Colonnade, London E14 4PU, United Kingdom.
| | - Michelle Cole
- UK Health Security Agency, 10 South Colonnade, London E14 4PU, United Kingdom.
| | - Elen de Lacy
- Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, United Kingdom.
| | - Lesley Price
- Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, United Kingdom; Public Health Scotland, Gyle Square 1 South Gyle Crescent, Edinburgh EH12 9EB, United Kingdom.
| | - Diane Corrigan
- Public Health Agency Northern Ireland, Unit 12-22 Linenhall Street, Belfast BT2 8BS, United Kingdom.
| | - Colin S Brown
- UK Health Security Agency, 10 South Colonnade, London E14 4PU, United Kingdom.
| | - Jasmin Islam
- UK Health Security Agency, 10 South Colonnade, London E14 4PU, United Kingdom.
| | - Andre Charlett
- UK Health Security Agency, UK Health Security Agency, Nobel House, 17 Smith Square, London, SW1P 3JR.
| | - Susan Hopkins
- UK Health Security Agency, UK Health Security Agency, Nobel House, 17 Smith Square, London, SW1P 3JR.
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Humoral immunity induced by mRNA COVID-19 vaccines in Nursing Home Residents previously infected with SARS-CoV-2. Aging Clin Exp Res 2022; 34:2577-2584. [PMID: 36127623 PMCID: PMC9489481 DOI: 10.1007/s40520-022-02239-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/25/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Nursing home (NH) residents suffered the greatest impact of the COVID-19 pandemic. Limited data are available on vaccine-induced immunity and on the protection ensured by a prior infection in this population. AIMS The present study aims to monitor antibody levels and their persistence over a 6-month period in NH residents according to the history of prior SARS-CoV-2 infection. METHODS We measured anti-trimeric Spike IgG antibody levels in a sample of 395 residents from 25 NHs in 6 Italian Regions at study enrolment (prior to the first dose of vaccine, T0) and then after 2 (T1) and 6 months (T2) following the first vaccine dose. All participants received mRNA vaccines (BNT162b2 or mRNA-1273). Analyses were performed using log-transformed values of antibody concentrations and geometric means (GM) were calculated. RESULTS Superior humoral immunity was induced in NH residents with previous SARS-CoV-2 infection. (T0: GM 186.6 vs. 6.1 BAU/ml, p < 0.001; T1: GM 5264.1 vs. 944.4 BAU/ml, p < 0.001; T2: GM 1473.6 vs. 128.7 BAU/ml, p < 0.001). Residents with prior SARS-CoV-2 infection receiving two vaccine doses presented significantly higher antibody concentration at T1 and T2. A longer interval between previous infection and vaccination was associated with a better antibody response over time. DISCUSSION In a frail sample of NH residents, prior SARS-CoV-2 infection was associated with a higher humoral response to vaccination. Number of vaccine doses and the interval between infection and vaccination are relevant parameters in determining humoral immunity. CONCLUSIONS These findings provide important information to plan future immunization policies and disease prevention strategies in a highly vulnerable population.
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