Effectiveness of CoronaVac, ChAdOx1 nCoV-19, BNT162b2, and Ad26.COV2.S among individuals with previous SARS-CoV-2 infection in Brazil: a test-negative, case-control study

• Type of Material: Article
• Authors: Thiago Cerqueira-Silva, Instituto Gonçalo Moniz, Fiocruz; Jason R Andrews, Stanford University; Viviane S Boaventura, Instituto Gonçalo Moniz, Fiocruz; Otavio T Ranzani, Barcelona Inst Global Hlth; Vinicius de Araújo Oliveira, Instituto Gonçalo Moniz, Fiocruz; Enny S Paixao, London School of Hygiene & Tropical Medicine; Juracy Bertoldo Junior, Center for Data and Knowledge Integration for Health, Fiocruz; Tales Mota Machado, Universidade Federal de Ouro Preto; Matt DT Hitchings, University of Florida; Murilo Dorion, Yale School of Public Health; Margaret L Lind, Yale School of Public Health; Gerson O Penna, Universidade de Brasília; Derek AT Cummings, University of Florida; Natalie Dean, Emory University; Guilherme L Werneck, Universidade do Estado do Rio de Janeiro; Neil Pearce, London School of Hygiene & Tropical Medicine; Mauricio L Barreto, Center for Data and Knowledge Integration for Health, Fiocruz; Albert I Ko, Instituto Gonçalo Moniz, Fiocruz; Julio Croda, Yale School of Public Health; Manoel Barral-Netto, Fiocruz MSInstituto Gonçalo Moniz, Fiocruz
• Language: English
• Date: 2022-06-01
• Publisher: ELSEVIER SCI LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Elsevier Ltd. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/S1473-3099(22)00140-2
• Title of Journal or Parent Work: LANCET INFECTIOUS DISEASES
• Volume: 22
• Issue: 6
• Start Page: 791
• End Page: 801
• Grant/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
• Keywords: RISK; VACCINATION; Science & Technology; HOSPITAL ADMISSIONS; Life Sciences & Biomedicine; MESSENGER-RNA; COVID-19; Infectious Diseases
• Research Categories: Biology, Biostatistics; Health Sciences, Epidemiology

Abstract

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.