1
|
Riefolo F, Castillo-Cano B, Martín-Pérez M, Messina D, Elbers R, Brink-Kwakkel D, Villalobos F, Ingrasciotta Y, Garcia-Poza P, Swart-Polinder K, Souverein P, Saiz LC, Bissacco CA, Leache L, Tari M, Crisafulli S, Grimaldi L, Vaz T, Gini R, Klungel O, Martín-Merino E. Effectiveness of homologous/heterologous booster COVID-19 vaccination schedules against severe illness in general population and clinical subgroups in three European countries. Vaccine 2023; 41:7007-7018. [PMID: 37858451 DOI: 10.1016/j.vaccine.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
Using 4 data-sources (Spain, Italy, United Kingdom) data and a 1:1 matched cohort study, we aimed to estimate vaccine effectiveness (VE) in preventing SARS-CoV-2 infections with hospitalisations (±30 days) and death (±56 days) in general population and clinical subgroups with homologous/heterologous booster schedules (Comirnaty-BNT and Spikevax-MOD original COVID-19 vaccines) by comparison with unboosted individuals, during Delta and beginning of Omicron variants. Hazard Ratio (HR, by Cox models) and VE ([1-HR]*100) were calculated by inverse probability weights. Between December 2020-February 2022, in adults without prior SARS-CoV-2 infection, we matched 5.5 million people (>1 million with immunodeficiency, 343,727 with cancer) with a booster (3rd) dose by considering doses 1 and 2 vaccine brands and calendar time, age, sex, region, and comorbidities (immunodeficiency, cancer, severe renal disease, transplant recipient, Down Syndrome). We studied booster doses of BNT and MOD administered after doses 1 and 2 with BNT, MOD, or Oxford-AstraZeneca during a median follow-up between 9 and 16 weeks. BNT or MOD showed VE ranging from 70 to 86% across data sources as heterologous 3rd doses, whereas it was 42-88% as homologous 3rd doses. Depending on the severity and available follow-up, 3rd-dose effectiveness lasted between 1 and 5 months. In people with immunodeficiency and cancer, protection across data sources was detected with both heterologous (VE = 54-83%) and homologous (VE = 49-80%) 3rd doses. Overall, both heterologous and homologous 3rd doses with BTN or MOD showed additional protection against the severe effects of SARS-CoV-2 infections for the general population and for patients at potentially high risk of severe COVID-19 (elderly, people with immunodeficiency and cancer) in comparison with two doses schemes during Delta or early Omicron periods. The early VE after vaccination may be due to less testing among vaccinated pairs and unknown confounders, deserving cautious interpretation. The VE wane over time needs further in-depth research to properly envisage when or whether a booster of those vaccines should be administered.
Collapse
Affiliation(s)
- Fabio Riefolo
- Teamit Institute, Partnerships, Barcelona Health Hub, Barcelona, Spain; VAccine Monitoring Collaboration for Europe, Brussels, Belgium
| | | | - Mar Martín-Pérez
- Spanish Agency of Medicines and Medical Devices-AEMPS, Madrid, Spain
| | | | - Roel Elbers
- Department of Data Science and Biostatistics, University Medical Center Utrecht, the Netherlands
| | - Dorieke Brink-Kwakkel
- Department of Data Science and Biostatistics, University Medical Center Utrecht, the Netherlands
| | - Felipe Villalobos
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ylenia Ingrasciotta
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | | | - Patrick Souverein
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | - Carlo Alberto Bissacco
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, Pamplona, Spain
| | | | | | - Lamiae Grimaldi
- l'Assistance Publique-Hôpitaux de Paris (APHP), University Paris-Saclay, Paris, France
| | - Tiago Vaz
- Department of Data Science and Biostatistics, University Medical Center Utrecht, the Netherlands
| | - Rosa Gini
- VAccine Monitoring Collaboration for Europe, Brussels, Belgium; Agenzia Regionale di Sanita' Toscana, Florence, Italy
| | - Olaf Klungel
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands
| | - Elisa Martín-Merino
- VAccine Monitoring Collaboration for Europe, Brussels, Belgium; Spanish Agency of Medicines and Medical Devices-AEMPS, Madrid, Spain.
| |
Collapse
|