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Katz MA, Harlev EB, Chazan B, Chowers M, Greenberg D, Peretz A, Tshori S, Levy J, Yacobi M, Hirsch A, Amichay D, Weinberger R, Dor AB, Taraday EK, Reznik D, Chayat CB, Sagas D, Zvi HB, Berdinstein R, Rashid G, Avni YS, Mandelboim M, Zuckerman N, Rainy N, Akriv A, Dagan N, Kepten E, Barda N, Balicer RD. Early effectiveness of BNT162b2 Covid-19 vaccine in preventing SARS-CoV-2 infection in healthcare personnel in six Israeli hospitals (CoVEHPI). Vaccine 2022; 40:512-520. [PMID: 34903372 PMCID: PMC8662353 DOI: 10.1016/j.vaccine.2021.11.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Methodologically rigorous studies on Covid-19 vaccine effectiveness (VE) in preventing SARS-CoV-2 infection are critically needed to inform national and global policy on Covid-19 vaccine use. In Israel, healthcare personnel (HCP) were initially prioritized for Covid-19 vaccination, creating an ideal setting to evaluate early real-world VE in a closely monitored population. METHODS We conducted a prospective study among HCP in 6 hospitals to estimate the effectiveness of the BNT162b2 mRNA Covid-19 vaccine in preventing SARS-CoV-2 infection. Participants filled out weekly symptom questionnaires, provided weekly nasal specimens, and three serology samples - at enrollment, 30 days and 90 days. We estimated VE against PCR-confirmed SARS-CoV-2 infection using the Cox Proportional Hazards model and against a combined PCR/serology endpoint using Fisher's exact test. RESULTS Of the 1567 HCP enrolled between December 27, 2020 and February 15, 2021, 1250 previously uninfected participants were included in the primary analysis; 998 (79.8%) were vaccinated with their first dose prior to or at enrollment, all with Pfizer BNT162b2 mRNA vaccine. There were four PCR-positive events among vaccinated participants, and nine among unvaccinated participants. Adjusted two-dose VE against any PCR-confirmed infection was 94.5% (95% CI: 82.6%-98.2%); adjusted two-dose VE against a combined endpoint of PCR and seroconversion for a 60-day follow-up period was 94.5% (95% CI: 63.0%-99.0%). Five PCR-positive samples from study participants were sequenced; all were alpha variant. CONCLUSIONS Our prospective VE study of HCP in Israel with rigorous weekly surveillance found very high VE for two doses of Pfizer BNT162b2 mRNA vaccine against SARS-CoV-2 infection in recently vaccinated HCP during a period of predominant alpha variant circulation. FUNDING Clalit Health Services.
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Affiliation(s)
- Mark A Katz
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel; School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Efrat Bron Harlev
- Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Bibiana Chazan
- Infectious Diseases and Infection Control Unit, Ha'Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michal Chowers
- Infectious Diseases, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - David Greenberg
- Pediatric Infectious Disease Unit the Pediatric Division, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Alon Peretz
- Occupational Medicine Clinic, Rabin Medical Center, Petah Tikva, Israel
| | - Sagi Tshori
- Research Authority, Kaplan Medical Center, Rehovot, Israel; The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joseph Levy
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Mili Yacobi
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Avital Hirsch
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Doron Amichay
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; Clalit Central Laboratory, Clalit Health Services, Tel Aviv, Israel
| | - Ronit Weinberger
- Clalit Central Laboratory, Clalit Health Services, Tel Aviv, Israel
| | - Anat Ben Dor
- Clalit Central Laboratory, Clalit Health Services, Tel Aviv, Israel
| | | | - Dana Reznik
- Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Chen Barazani Chayat
- Multidisciplinary Laboratory, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Dana Sagas
- Clinical Microbiology Laboratory, Ha'Emek Medical Center, Afula, Israel
| | - Haim Ben Zvi
- Microbiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Rita Berdinstein
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Microbiology Department, Kaplan Medical Center, Rehovot, Israel
| | - Gloria Rashid
- Department of Clinical Laboratories, Meir Medical Center, Kfar Saba, Israel
| | | | - Michal Mandelboim
- Central Virology Laboratory, Chaim Sheba Medical Center, Ministry of Health, Ramat Gan, Israel; Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Neta Zuckerman
- Central Virology Laboratory, Chaim Sheba Medical Center, Ministry of Health, Ramat Gan, Israel
| | - Nir Rainy
- Laboratory Division, Shamir Medical Center, Zerifin, Israel
| | - Amichay Akriv
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Noa Dagan
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel; Software and Information Systems Engineering, Ben Gurion University, Beer Sheva, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Ivan and Francesca Berkowitz Family Living Laboratory at Harvard Medical School, Boston, MA, USA
| | - Eldad Kepten
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Noam Barda
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel; Software and Information Systems Engineering, Ben Gurion University, Beer Sheva, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Ivan and Francesca Berkowitz Family Living Laboratory at Harvard Medical School, Boston, MA, USA
| | - Ran D Balicer
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel; School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Kustin T, Harel N, Finkel U, Perchik S, Harari S, Tahor M, Caspi I, Levy R, Leshchinsky M, Ken Dror S, Bergerzon G, Gadban H, Gadban F, Eliassian E, Shimron O, Saleh L, Ben-Zvi H, Keren Taraday E, Amichay D, Ben-Dor A, Sagas D, Strauss M, Shemer Avni Y, Huppert A, Kepten E, Balicer RD, Netzer D, Ben-Shachar S, Stern A. Evidence for increased breakthrough rates of SARS-CoV-2 variants of concern in BNT162b2-mRNA-vaccinated individuals. Nat Med 2021; 27:1379-1384. [PMID: 34127854 PMCID: PMC8363499 DOI: 10.1038/s41591-021-01413-7] [Citation(s) in RCA: 235] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/26/2021] [Indexed: 12/28/2022]
Abstract
The BNT162b2 mRNA vaccine is highly effective against SARS-CoV-2. However, apprehension exists that variants of concern (VOCs) may evade vaccine protection, due to evidence of reduced neutralization of the VOCs B.1.1.7 and B.1.351 by vaccine sera in laboratory assays. We performed a matched cohort study to examine the distribution of VOCs in infections of BNT162b2 mRNA vaccinees from Clalit Health Services (Israel) using viral genomic sequencing, and hypothesized that if vaccine effectiveness against a VOC is reduced, its proportion among breakthrough cases would be higher than in unvaccinated controls. Analyzing 813 viral genome sequences from nasopharyngeal swabs, we showed that vaccinees who tested positive at least 7 days after the second dose were disproportionally infected with B.1.351, compared with controls. Those who tested positive between 2 weeks after the first dose and 6 days after the second dose were disproportionally infected by B.1.1.7. These findings suggest reduced vaccine effectiveness against both VOCs within particular time windows. Our results emphasize the importance of rigorously tracking viral variants, and of increasing vaccination to prevent the spread of VOCs.
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Affiliation(s)
- Talia Kustin
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
- Edmond J. Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, Israel
| | - Noam Harel
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
- Edmond J. Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, Israel
| | - Uriah Finkel
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Shay Perchik
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Sheri Harari
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
- Edmond J. Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, Israel
| | - Maayan Tahor
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Itamar Caspi
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Levy
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Michael Leshchinsky
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Shifra Ken Dror
- Clalit Health Services, Central Laboratories, Haifa and Western Galilee, Nesher, Israel
| | - Galit Bergerzon
- Clalit Health Services, Central Laboratories, Haifa and Western Galilee, Nesher, Israel
| | - Hala Gadban
- Clalit Health Services, Central Laboratories, Haifa and Western Galilee, Nesher, Israel
| | - Faten Gadban
- Clalit Health Services, Central Laboratories, Haifa and Western Galilee, Nesher, Israel
| | - Eti Eliassian
- Progenin Laboratories, Jerusalem District, Clalit Health Services, Tel Aviv, Israel
| | - Orit Shimron
- Progenin Laboratories, Jerusalem District, Clalit Health Services, Tel Aviv, Israel
| | - Loulou Saleh
- Microbiology lab, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel
| | - Haim Ben-Zvi
- Microbiology lab, Rabin Medical Center, Beilinson Hospital, Petah Tiqva, Israel
| | | | - Doron Amichay
- Central Laboratory, Clalit Health Services, Tel Aviv, Israel
- Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Anat Ben-Dor
- Central Laboratory, Clalit Health Services, Tel Aviv, Israel
| | - Dana Sagas
- Microbiology Laboratory, Emek Medical Center, Afula, Israel
| | - Merav Strauss
- Microbiology Laboratory, Emek Medical Center, Afula, Israel
| | - Yonat Shemer Avni
- Laboratory of Clinical Virology, Soroka University Medical Center, Beersheba, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Amit Huppert
- The Bio-statistical and Bio-mathematical Unit, The Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eldad Kepten
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Ran D Balicer
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | | | - Shay Ben-Shachar
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel.
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Adi Stern
- The Shmunis School of Biomedicine and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel.
- Edmond J. Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv, Israel.
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