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 - 26/05/22

Doi : 10.1016/S1473-3099(22)00140-2

Thiago Cerqueira-Silva, MD ^a,^c,^{*
Contributed equally}, Jason R Andrews, MD ^e,^{*
Contributed equally}, Viviane S Boaventura, ProfMD ^a,^c, Otavio T Ranzani, PhD ^f,^g, Vinicius de Araújo Oliveira, MD ^a,^b,^c, Enny S Paixão, PhD ^h, Juracy Bertoldo Júnior, MSc ^b,^d, Tales Mota Machado, MSc ^j, Matt D T Hitchings, PhD ^k, Murilo Dorion ⁿ, Margaret L Lind, PhD ⁿ, Gerson O Penna, PhD ^o,^p, Derek A T Cummings, ProfPhD ^l,^m, Natalie E Dean, PhD ^q, Guilherme Loureiro Werneck, ProfPhD ^r, Neil Pearce, ProfPhD ⁱ, Mauricio L Barreto, ProfMD ^b,^d, Albert I Ko, ProfMD ^a,ⁿ, Julio Croda, ProfPhD ^n,^s,^t,⁎, ^{†
Contributed equally} , Manoel Barral-Netto, ProfMD ^a,^b,^c,^{†
Contributed equally}

^a Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil

^b Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, BA, Brazil

^c Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil

^d Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil

^e Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA

^f Barcelona Institute for Global Health, Barcelona, Spain

^g Pulmonary Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, São Paulo, SP, Brazil

^h Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK

ⁱ Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK

^j Diretoria de Tecnologia da Informação, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil

^k Department of Biostatistics, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA

^l Department of Biology, University of Florida, Gainesville, FL, USA

^m Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA

ⁿ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA

^o Núcleo de Medicina Tropical, Universidade de Brasília, Brasília, DF, Brazil

^p Escola Fiocruz de Governo, Fiocruz Brasília, Brasília, DF, Brazil

^q Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA

^r Departamento de Epidemiologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil

^s Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil

^t Fiocruz Mato Grosso do Sul, Fiocruz, Campo Grande, MS, Brazil

^* Correspondence to: Prof Julio Croda, Fundação Oswaldo Cruz, Mato Grosso do Sul, Campo Grande, MS, 79081-746, Brazil Fundação Oswaldo Cruz Mato Grosso do Sul Campo Grande MS 79081-746 Brazil

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Summary

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.

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Plan

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Study design, population, and data sources

Eligibility and selection of cases and controls

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Vol 22 - N° 6

P. 791-801 - juin 2022 Retour au numéro

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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 - 26/05/22

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