TY - JOUR
T1 - Effectiveness of CoronaVac, ChAdOx1 nCoV-19, BNT162b2, and Ad26.COV2.S among individuals with previous SARS-CoV-2 infection in Brazil
T2 - a test-negative, case-control study
AU - Cerqueira-Silva, Thiago
AU - Andrews, Jason R.
AU - Boaventura, Viviane S.
AU - Ranzani, Otavio T.
AU - de Araújo Oliveira, Vinicius
AU - Paixão, Enny S.
AU - Júnior, Juracy Bertoldo
AU - Machado, Tales Mota
AU - Hitchings, Matt D. T.
AU - Dorion, Murilo
AU - Lind, Margaret L.
AU - Penna, Gerson O.
AU - Cummings, Derek A. T.
AU - Dean, Natalie E.
AU - Werneck, Guilherme Loureiro
AU - Pearce, Neil
AU - Barreto, Mauricio L.
AU - Ko, Albert I.
AU - Croda, Julio
AU - Barral-Netto, Manoel
N1 - Funding Information: This study was partly supported by a donation from the Fazer o Bem Faz Bem programme from JBS. GLW, MLB, JC, and MB-N are research fellows from the Brazilian National Research Council. GLW acknowledges the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (E-26/210.180/2020). JC is supported by the Oswaldo Cruz Foundation (Edital COVID-19—resposta rápida 48111668950485). OTR is funded by a Sara Borrell fellowship (CD19/00110) from the Instituto de Salud Carlos III. OTR acknowledges support from the Spanish Ministry of Science and Innovation through the Centro de Excelencia Severo Ochoa 2019–2023 programme and from the Generalitat de Catalunya through the Centres de Recerca de Catalunya programme. Funding Information: MB-N reports grants from the Fazer o Bem Faz Bem programme from JBS. AIK reports grants from Bristol Myers Squibb, Regeneron, and Serimmune; and grants and personal fees from Tata Medical Devices, outside the submitted work. VdAO, VSB, MLB, JC, and MB-N are employees of Fiocruz, a federal public institution, which manufactures Vaxzevria (ChAdOx1 nCoV-19 vaccine) in Brazil through a full technology transfer agreement with AstraZeneca. Fiocruz allocates all its manufactured products to the Ministry of Health for public health use. All other authors declare no competing interests. Funding Information: This study was partly supported by a donation from the Fazer o Bem Faz Bem programme from JBS. GLW, MLB, JC, and MB-N are research fellows from the Brazilian National Research Council. GLW acknowledges the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (E-26/210.180/2020). JC is supported by the Oswaldo Cruz Foundation (Edital COVID-19—resposta rápida 48111668950485). OTR is funded by a Sara Borrell fellowship (CD19/00110) from the Instituto de Salud Carlos III. OTR acknowledges support from the Spanish Ministry of Science and Innovation through the Centro de Excelencia Severo Ochoa 2019–2023 programme and from the Generalitat de Catalunya through the Centres de Recerca de Catalunya programme. Funding Information: Julio Croda is affiliated with Oswaldo Cruz and received support from the Oswaldo Cruz Foundation for this work. The Oswaldo Cruz Foundation and the other funders of the study did not have any further role in study design, data collection, data analysis, data interpretation, or writing of the report. Publisher Copyright: © 2022 Elsevier Ltd
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Background: COVID-19 vaccines have proven highly effective among individuals without a previous SARS-CoV-2 infection, but their effectiveness in preventing symptomatic infection and severe outcomes among individuals with previous infection is less clear. We aimed to estimate the effectiveness of four COVID-19 vaccines against symptomatic infection, hospitalisation, and death for individuals with laboratory-confirmed previous SARS-CoV-2 infection. Methods: Using national COVID-19 notification, hospitalisation, and vaccination datasets from Brazil, we did a test-negative, case-control study to assess the effectiveness of four vaccines (CoronaVac [Sinovac], ChAdOx1 nCoV-19 [AstraZeneca], Ad26.COV2.S [Janssen], and BNT162b2 [Pfizer-BioNtech]) for individuals with laboratory-confirmed previous SARS-CoV-2 infection. We matched cases with RT-PCR positive, symptomatic COVID-19 with up to ten controls with negative RT-PCR tests who presented with symptomatic illnesses, restricting both groups to tests done at least 90 days after an initial infection. We used multivariable conditional logistic regression to compare the odds of test positivity and the odds of hospitalisation or death due to COVID-19, according to vaccination status and time since first or second dose of vaccines. Findings: Between Feb 24, 2020, and Nov 11, 2021, we identified 213 457 individuals who had a subsequent, symptomatic illness with RT-PCR testing done at least 90 days after their initial SARS-CoV-2 infection and after the vaccination programme started. Among these, 30 910 (14·5%) had a positive RT-PCR test consistent with reinfection, and we matched 22 566 of these cases with 145 055 negative RT-PCR tests from 68 426 individuals as controls. Among individuals with previous SARS-CoV-2 infection, vaccine effectiveness against symptomatic infection 14 or more days from vaccine series completion was 39·4% (95% CI 36·1–42·6) for CoronaVac, 56·0% (51·4–60·2) for ChAdOx1 nCoV-19, 44·0% (31·5–54·2) for Ad26.COV2.S, and 64·8% (54·9–72·4) for BNT162b2. For the two-dose vaccine series (CoronaVac, ChAdOx1 nCoV-19, and BNT162b2), effectiveness against symptomatic infection was significantly greater after the second dose than after the first dose. Effectiveness against hospitalisation or death 14 or more days from vaccine series completion was 81·3% (75·3–85·8) for CoronaVac, 89·9% (83·5–93·8) for ChAdOx1 nCoV-19, 57·7% (−2·6 to 82·5) for Ad26.COV2.S, and 89·7% (54·3–97·7) for BNT162b2. Interpretation: All four vaccines conferred additional protection against symptomatic infections and severe outcomes among individuals with previous SARS-CoV-2 infection. The provision of a full vaccine series to individuals after recovery from COVID-19 might reduce morbidity and mortality. Funding: Brazilian National Research Council, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Oswaldo Cruz Foundation, JBS, Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Generalitat de Catalunya.
AB - Background: COVID-19 vaccines have proven highly effective among individuals without a previous SARS-CoV-2 infection, but their effectiveness in preventing symptomatic infection and severe outcomes among individuals with previous infection is less clear. We aimed to estimate the effectiveness of four COVID-19 vaccines against symptomatic infection, hospitalisation, and death for individuals with laboratory-confirmed previous SARS-CoV-2 infection. Methods: Using national COVID-19 notification, hospitalisation, and vaccination datasets from Brazil, we did a test-negative, case-control study to assess the effectiveness of four vaccines (CoronaVac [Sinovac], ChAdOx1 nCoV-19 [AstraZeneca], Ad26.COV2.S [Janssen], and BNT162b2 [Pfizer-BioNtech]) for individuals with laboratory-confirmed previous SARS-CoV-2 infection. We matched cases with RT-PCR positive, symptomatic COVID-19 with up to ten controls with negative RT-PCR tests who presented with symptomatic illnesses, restricting both groups to tests done at least 90 days after an initial infection. We used multivariable conditional logistic regression to compare the odds of test positivity and the odds of hospitalisation or death due to COVID-19, according to vaccination status and time since first or second dose of vaccines. Findings: Between Feb 24, 2020, and Nov 11, 2021, we identified 213 457 individuals who had a subsequent, symptomatic illness with RT-PCR testing done at least 90 days after their initial SARS-CoV-2 infection and after the vaccination programme started. Among these, 30 910 (14·5%) had a positive RT-PCR test consistent with reinfection, and we matched 22 566 of these cases with 145 055 negative RT-PCR tests from 68 426 individuals as controls. Among individuals with previous SARS-CoV-2 infection, vaccine effectiveness against symptomatic infection 14 or more days from vaccine series completion was 39·4% (95% CI 36·1–42·6) for CoronaVac, 56·0% (51·4–60·2) for ChAdOx1 nCoV-19, 44·0% (31·5–54·2) for Ad26.COV2.S, and 64·8% (54·9–72·4) for BNT162b2. For the two-dose vaccine series (CoronaVac, ChAdOx1 nCoV-19, and BNT162b2), effectiveness against symptomatic infection was significantly greater after the second dose than after the first dose. Effectiveness against hospitalisation or death 14 or more days from vaccine series completion was 81·3% (75·3–85·8) for CoronaVac, 89·9% (83·5–93·8) for ChAdOx1 nCoV-19, 57·7% (−2·6 to 82·5) for Ad26.COV2.S, and 89·7% (54·3–97·7) for BNT162b2. Interpretation: All four vaccines conferred additional protection against symptomatic infections and severe outcomes among individuals with previous SARS-CoV-2 infection. The provision of a full vaccine series to individuals after recovery from COVID-19 might reduce morbidity and mortality. Funding: Brazilian National Research Council, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Oswaldo Cruz Foundation, JBS, Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Generalitat de Catalunya.
UR - http://www.scopus.com/inward/record.url?scp=85131128898&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/S1473-3099(22)00140-2
DO - https://doi.org/10.1016/S1473-3099(22)00140-2
M3 - Article
C2 - 35366959
SN - 1473-3099
VL - 22
SP - 791
EP - 801
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 6
ER -