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Protection Conferred by COVID-19 Vaccination, Prior SARS-CoV-2 Infection, or Hybrid Immunity Against Omicron-Associated Severe Outcomes Among Community-Dwelling Adults
Abstract Introduction We assessed protection from coronavirus disease 2019 (COVID-19) vaccines and/or prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection against Omicron-associated severe outcomes during successive sublineage-predominant periods. Methods We used a test-negat...
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| Published in: | Clinical infectious diseases 2024-05, Vol.78 (5), p.1372-1382 |
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| container_title | Clinical infectious diseases |
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| creator | Lee, Nelson Nguyen, Lena Austin, Peter C Brown, Kevin A Grewal, Ramandip Buchan, Sarah A Nasreen, Sharifa Gubbay, Jonathan Schwartz, Kevin L Tadrous, Mina Wilson, Kumanan Wilson, Sarah E Kwong, Jeffrey C |
| description | Abstract
Introduction
We assessed protection from coronavirus disease 2019 (COVID-19) vaccines and/or prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection against Omicron-associated severe outcomes during successive sublineage-predominant periods.
Methods
We used a test-negative design to estimate protection by vaccines and/or prior infection against hospitalization/death among community-dwelling, polymerase chain reaction (PCR)-tested adults aged ≥50 years in Ontario, Canada, between 2 January 2022 and 30 June 2023. Multivariable logistic regression was used to estimate the relative change in the odds of hospitalization/death with each vaccine dose (2–5) and/or prior PCR-confirmed SARS-CoV-2 infection (compared with unvaccinated, uninfected subjects) up to 15 months since the last vaccination or infection.
Results
We included 18 526 cases with Omicron-associated severe outcomes and 90 778 test-negative controls. Vaccine protection was high during BA.1/BA.2 predominance but was generally |
| doi_str_mv | 10.1093/cid/ciad716 |
| format | article |
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Introduction
We assessed protection from coronavirus disease 2019 (COVID-19) vaccines and/or prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection against Omicron-associated severe outcomes during successive sublineage-predominant periods.
Methods
We used a test-negative design to estimate protection by vaccines and/or prior infection against hospitalization/death among community-dwelling, polymerase chain reaction (PCR)-tested adults aged ≥50 years in Ontario, Canada, between 2 January 2022 and 30 June 2023. Multivariable logistic regression was used to estimate the relative change in the odds of hospitalization/death with each vaccine dose (2–5) and/or prior PCR-confirmed SARS-CoV-2 infection (compared with unvaccinated, uninfected subjects) up to 15 months since the last vaccination or infection.
Results
We included 18 526 cases with Omicron-associated severe outcomes and 90 778 test-negative controls. Vaccine protection was high during BA.1/BA.2 predominance but was generally <50% during periods of BA.4/BA.5 and BQ/XBB predominance without boosters. A third/fourth dose transiently increased protection during BA.4/BA.5 predominance (third-dose, 6-month: 68%, 95% confidence interval [CI] 63%–72%; fourth-dose, 6-month: 80%, 95% CI 77%–83%) but was lower and waned quickly during BQ/XBB predominance (third-dose, 6-month: 59%, 95% CI 48%–67%; 12-month: 49%, 95% CI 41%–56%; fourth-dose, 6-month: 62%, 95% CI 56%–68%, 12-months: 51%, 95% CI 41%–56%). Hybrid immunity conferred nearly 90% protection throughout BA.1/BA.2 and BA.4/BA.5 predominance but was reduced during BQ/XBB predominance (third-dose, 6-month: 60%, 95% CI 36%–75%; fourth-dose, 6-month: 63%, 95% CI 42%–76%). Protection was restored with a fifth dose (bivalent; 6-month: 91%, 95% CI 79%–96%). Prior infection alone did not confer lasting protection.
Conclusions
Protection from COVID-19 vaccines and/or prior SARS-CoV-2 infections against severe outcomes is reduced when immune-evasive variants/subvariants emerge and may also wane over time. Our findings support a variant-adapted booster vaccination strategy with periodic review.
Protection from coronavirus disease 2019 (COVID-19) vaccines, prior COVID-19 infections or hybrid immunity against severe outcomes is reduced when immune-evasive variants/subvariants emerge and may also wane over time. Our findings support a variant-adapted booster vaccination strategy with periodic review.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciad716</identifier><identifier>PMID: 38001037</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Aged ; Aged, 80 and over ; COVID-19 - immunology ; COVID-19 - prevention & control ; COVID-19 Vaccines - administration & dosage ; COVID-19 Vaccines - immunology ; Female ; Hospitalization - statistics & numerical data ; Humans ; Independent Living ; Major ; Male ; Middle Aged ; Ontario - epidemiology ; SARS-CoV-2 - immunology ; Vaccination</subject><ispartof>Clinical infectious diseases, 2024-05, Vol.78 (5), p.1372-1382</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. 2023</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c413t-7c1c6f4609b6e769ea704494853ed3bf0278ba04962805571a02fde0187b9ce73</citedby><cites>FETCH-LOGICAL-c413t-7c1c6f4609b6e769ea704494853ed3bf0278ba04962805571a02fde0187b9ce73</cites><orcidid>0000-0002-0783-6607 ; 0000-0002-7820-2046 ; 0000-0002-9793-113X ; 0000-0003-3337-233X ; 0000-0002-5286-8974</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38001037$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Nelson</creatorcontrib><creatorcontrib>Nguyen, Lena</creatorcontrib><creatorcontrib>Austin, Peter C</creatorcontrib><creatorcontrib>Brown, Kevin A</creatorcontrib><creatorcontrib>Grewal, Ramandip</creatorcontrib><creatorcontrib>Buchan, Sarah A</creatorcontrib><creatorcontrib>Nasreen, Sharifa</creatorcontrib><creatorcontrib>Gubbay, Jonathan</creatorcontrib><creatorcontrib>Schwartz, Kevin L</creatorcontrib><creatorcontrib>Tadrous, Mina</creatorcontrib><creatorcontrib>Wilson, Kumanan</creatorcontrib><creatorcontrib>Wilson, Sarah E</creatorcontrib><creatorcontrib>Kwong, Jeffrey C</creatorcontrib><title>Protection Conferred by COVID-19 Vaccination, Prior SARS-CoV-2 Infection, or Hybrid Immunity Against Omicron-Associated Severe Outcomes Among Community-Dwelling Adults</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract
Introduction
We assessed protection from coronavirus disease 2019 (COVID-19) vaccines and/or prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection against Omicron-associated severe outcomes during successive sublineage-predominant periods.
Methods
We used a test-negative design to estimate protection by vaccines and/or prior infection against hospitalization/death among community-dwelling, polymerase chain reaction (PCR)-tested adults aged ≥50 years in Ontario, Canada, between 2 January 2022 and 30 June 2023. Multivariable logistic regression was used to estimate the relative change in the odds of hospitalization/death with each vaccine dose (2–5) and/or prior PCR-confirmed SARS-CoV-2 infection (compared with unvaccinated, uninfected subjects) up to 15 months since the last vaccination or infection.
Results
We included 18 526 cases with Omicron-associated severe outcomes and 90 778 test-negative controls. Vaccine protection was high during BA.1/BA.2 predominance but was generally <50% during periods of BA.4/BA.5 and BQ/XBB predominance without boosters. A third/fourth dose transiently increased protection during BA.4/BA.5 predominance (third-dose, 6-month: 68%, 95% confidence interval [CI] 63%–72%; fourth-dose, 6-month: 80%, 95% CI 77%–83%) but was lower and waned quickly during BQ/XBB predominance (third-dose, 6-month: 59%, 95% CI 48%–67%; 12-month: 49%, 95% CI 41%–56%; fourth-dose, 6-month: 62%, 95% CI 56%–68%, 12-months: 51%, 95% CI 41%–56%). Hybrid immunity conferred nearly 90% protection throughout BA.1/BA.2 and BA.4/BA.5 predominance but was reduced during BQ/XBB predominance (third-dose, 6-month: 60%, 95% CI 36%–75%; fourth-dose, 6-month: 63%, 95% CI 42%–76%). Protection was restored with a fifth dose (bivalent; 6-month: 91%, 95% CI 79%–96%). Prior infection alone did not confer lasting protection.
Conclusions
Protection from COVID-19 vaccines and/or prior SARS-CoV-2 infections against severe outcomes is reduced when immune-evasive variants/subvariants emerge and may also wane over time. Our findings support a variant-adapted booster vaccination strategy with periodic review.
Protection from coronavirus disease 2019 (COVID-19) vaccines, prior COVID-19 infections or hybrid immunity against severe outcomes is reduced when immune-evasive variants/subvariants emerge and may also wane over time. Our findings support a variant-adapted booster vaccination strategy with periodic review.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>COVID-19 - immunology</subject><subject>COVID-19 - prevention & control</subject><subject>COVID-19 Vaccines - administration & dosage</subject><subject>COVID-19 Vaccines - immunology</subject><subject>Female</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Independent Living</subject><subject>Major</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Ontario - epidemiology</subject><subject>SARS-CoV-2 - immunology</subject><subject>Vaccination</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><recordid>eNp9kcFu1DAQhiMEoqVw4o58QkhgsOMktk8oSildqdJWLOzVcpzJYrSxF9sp2ifiNevVLhVcOFgeeb75Zzx_Ubyk5D0lkn0wdshHD5w2j4pzWjOOm1rSxzkmtcCVYOKseBbjD0IoFaR-WpwxkWPC-Hnx-zb4BCZZ71Dn3QghwID6PeqW68UlphKttTHW6QPxDt0G6wNatV9WuPNrXKJFLjHHXE5c7_tgB7SYptnZtEftRlsXE1pO1gTvcBujz6Om3GIFdxAALedk_AQRtZN3mzzCqRRf_oLt1uandpi3KT4vnox6G-HF6b4ovl19-tpd45vl50XX3mBTUZYwN9Q0Y9UQ2TfAGwmak6qSlagZDKwfSclFr0klmzJvouZUk3IcgFDBe2mAs4vi41F3N_cTDAZcCnqrdsFOOuyV11b9m3H2u9r4O0UPXjSCZoU3J4Xgf84Qk5psNPkz2oGfoyqFZKKqCZMZfXtE83JiDDA-9KFEHfRU9ladvM30q79He2D_mJmB10fAz7v_Kt0DX1WvRA</recordid><startdate>20240515</startdate><enddate>20240515</enddate><creator>Lee, Nelson</creator><creator>Nguyen, Lena</creator><creator>Austin, Peter C</creator><creator>Brown, Kevin A</creator><creator>Grewal, Ramandip</creator><creator>Buchan, Sarah A</creator><creator>Nasreen, Sharifa</creator><creator>Gubbay, Jonathan</creator><creator>Schwartz, Kevin L</creator><creator>Tadrous, Mina</creator><creator>Wilson, Kumanan</creator><creator>Wilson, Sarah E</creator><creator>Kwong, Jeffrey C</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-0783-6607</orcidid><orcidid>https://orcid.org/0000-0002-7820-2046</orcidid><orcidid>https://orcid.org/0000-0002-9793-113X</orcidid><orcidid>https://orcid.org/0000-0003-3337-233X</orcidid><orcidid>https://orcid.org/0000-0002-5286-8974</orcidid></search><sort><creationdate>20240515</creationdate><title>Protection Conferred by COVID-19 Vaccination, Prior SARS-CoV-2 Infection, or Hybrid Immunity Against Omicron-Associated Severe Outcomes Among Community-Dwelling Adults</title><author>Lee, Nelson ; Nguyen, Lena ; Austin, Peter C ; Brown, Kevin A ; Grewal, Ramandip ; Buchan, Sarah A ; Nasreen, Sharifa ; Gubbay, Jonathan ; Schwartz, Kevin L ; Tadrous, Mina ; Wilson, Kumanan ; Wilson, Sarah E ; Kwong, Jeffrey C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c413t-7c1c6f4609b6e769ea704494853ed3bf0278ba04962805571a02fde0187b9ce73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>COVID-19 - immunology</topic><topic>COVID-19 - prevention & control</topic><topic>COVID-19 Vaccines - administration & dosage</topic><topic>COVID-19 Vaccines - immunology</topic><topic>Female</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Independent Living</topic><topic>Major</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Ontario - epidemiology</topic><topic>SARS-CoV-2 - immunology</topic><topic>Vaccination</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Nelson</creatorcontrib><creatorcontrib>Nguyen, Lena</creatorcontrib><creatorcontrib>Austin, Peter C</creatorcontrib><creatorcontrib>Brown, Kevin A</creatorcontrib><creatorcontrib>Grewal, Ramandip</creatorcontrib><creatorcontrib>Buchan, Sarah A</creatorcontrib><creatorcontrib>Nasreen, Sharifa</creatorcontrib><creatorcontrib>Gubbay, Jonathan</creatorcontrib><creatorcontrib>Schwartz, Kevin L</creatorcontrib><creatorcontrib>Tadrous, Mina</creatorcontrib><creatorcontrib>Wilson, Kumanan</creatorcontrib><creatorcontrib>Wilson, Sarah E</creatorcontrib><creatorcontrib>Kwong, Jeffrey C</creatorcontrib><collection>Oxford University Press Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Nelson</au><au>Nguyen, Lena</au><au>Austin, Peter C</au><au>Brown, Kevin A</au><au>Grewal, Ramandip</au><au>Buchan, Sarah A</au><au>Nasreen, Sharifa</au><au>Gubbay, Jonathan</au><au>Schwartz, Kevin L</au><au>Tadrous, Mina</au><au>Wilson, Kumanan</au><au>Wilson, Sarah E</au><au>Kwong, Jeffrey C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Protection Conferred by COVID-19 Vaccination, Prior SARS-CoV-2 Infection, or Hybrid Immunity Against Omicron-Associated Severe Outcomes Among Community-Dwelling Adults</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2024-05-15</date><risdate>2024</risdate><volume>78</volume><issue>5</issue><spage>1372</spage><epage>1382</epage><pages>1372-1382</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Abstract
Introduction
We assessed protection from coronavirus disease 2019 (COVID-19) vaccines and/or prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection against Omicron-associated severe outcomes during successive sublineage-predominant periods.
Methods
We used a test-negative design to estimate protection by vaccines and/or prior infection against hospitalization/death among community-dwelling, polymerase chain reaction (PCR)-tested adults aged ≥50 years in Ontario, Canada, between 2 January 2022 and 30 June 2023. Multivariable logistic regression was used to estimate the relative change in the odds of hospitalization/death with each vaccine dose (2–5) and/or prior PCR-confirmed SARS-CoV-2 infection (compared with unvaccinated, uninfected subjects) up to 15 months since the last vaccination or infection.
Results
We included 18 526 cases with Omicron-associated severe outcomes and 90 778 test-negative controls. Vaccine protection was high during BA.1/BA.2 predominance but was generally <50% during periods of BA.4/BA.5 and BQ/XBB predominance without boosters. A third/fourth dose transiently increased protection during BA.4/BA.5 predominance (third-dose, 6-month: 68%, 95% confidence interval [CI] 63%–72%; fourth-dose, 6-month: 80%, 95% CI 77%–83%) but was lower and waned quickly during BQ/XBB predominance (third-dose, 6-month: 59%, 95% CI 48%–67%; 12-month: 49%, 95% CI 41%–56%; fourth-dose, 6-month: 62%, 95% CI 56%–68%, 12-months: 51%, 95% CI 41%–56%). Hybrid immunity conferred nearly 90% protection throughout BA.1/BA.2 and BA.4/BA.5 predominance but was reduced during BQ/XBB predominance (third-dose, 6-month: 60%, 95% CI 36%–75%; fourth-dose, 6-month: 63%, 95% CI 42%–76%). Protection was restored with a fifth dose (bivalent; 6-month: 91%, 95% CI 79%–96%). Prior infection alone did not confer lasting protection.
Conclusions
Protection from COVID-19 vaccines and/or prior SARS-CoV-2 infections against severe outcomes is reduced when immune-evasive variants/subvariants emerge and may also wane over time. Our findings support a variant-adapted booster vaccination strategy with periodic review.
Protection from coronavirus disease 2019 (COVID-19) vaccines, prior COVID-19 infections or hybrid immunity against severe outcomes is reduced when immune-evasive variants/subvariants emerge and may also wane over time. Our findings support a variant-adapted booster vaccination strategy with periodic review.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>38001037</pmid><doi>10.1093/cid/ciad716</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-0783-6607</orcidid><orcidid>https://orcid.org/0000-0002-7820-2046</orcidid><orcidid>https://orcid.org/0000-0002-9793-113X</orcidid><orcidid>https://orcid.org/0000-0003-3337-233X</orcidid><orcidid>https://orcid.org/0000-0002-5286-8974</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Oxford Journals Online |
| subjects | Aged Aged, 80 and over COVID-19 - immunology COVID-19 - prevention & control COVID-19 Vaccines - administration & dosage COVID-19 Vaccines - immunology Female Hospitalization - statistics & numerical data Humans Independent Living Major Male Middle Aged Ontario - epidemiology SARS-CoV-2 - immunology Vaccination |
| title | Protection Conferred by COVID-19 Vaccination, Prior SARS-CoV-2 Infection, or Hybrid Immunity Against Omicron-Associated Severe Outcomes Among Community-Dwelling Adults |
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