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Effectiveness of primary series and booster vaccination against SARS-CoV-2 infection and hospitalisation among adolescents aged 12–17 years in Singapore: a national cohort study - 26/01/23

Doi : 10.1016/S1473-3099(22)00573-4 
Calvin J Chiew, MPH a, , M Premikha, MBBS b, Chia Yin Chong, MBBS d, e, g, h, Wycliffe E Wei, MPH a, Benjamin Ong, ProfMBBS c, e, David Chien Lye, ProfMBBS e, g, i, j, Derrick Heng, ProfMPhil a, f, Vernon J Lee, ProfPhD a, f, Kelvin Bryan Tan, PhD b, f
a Public Health Group, Ministry of Health, Singapore 
b Crisis Strategy and Operations Group, Ministry of Health, Singapore 
c DMS Office, Ministry of Health, Singapore 
d Department of Infectious Diseases, KK Women’s and Children’s Hospital, Singapore 
e Yong Loo Lin School of Medicine, National University of Singapore, Singapore 
f Saw Swee Hock School of Public Health, National University of Singapore, Singapore 
g Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 
h Duke-NUS Medical School, Singapore 
i National Centre for Infectious Diseases, Singapore 
j Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 

* Correspondence to: Dr Calvin J Chiew, Communicable Diseases Division, Ministry of Health, Singapore 169852 Communicable Diseases Division Ministry of Health 169852 Singapore

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Summary

Background

Singapore offered the BNT162b2 vaccine (tozinameran; Pfizer-BioNTech) to adolescents aged 12–17 years in May 18, 2021, and extended booster vaccines to this group in Jan 21, 2022. Literature on the effectiveness of primary series and booster vaccination among adolescents is scarce outside of Europe and North America. We aimed to determine primary series and booster vaccine effectiveness against SARS-CoV-2 infection and hospitalisation among adolescents in Singapore.

Methods

For this national cohort study, we assessed the incidence of confirmed SARS-CoV-2 infection and hospitalisation among adolescents aged 12–17 years vaccinated with BNT162b2 in Singapore from Sept 1 to Dec 15, 2021, during the delta (B.1.617.2) variant wave, and from Jan 21 to April 28, 2022, during the omicron (B.1.1.529) variant wave. Data were collected from official databases maintained by the Ministry of Health of Singapore. Individuals were classified as partly vaccinated (those who had received one dose and those who had received the second dose no more than 7 days previously), fully vaccinated (8 days after receiving a second dose), or boosted (8 days after receiving a third dose) and compared with unvaccinated individuals.

Findings

249 763 individuals aged 12–17 years were included in the study, contributing over 56·2 million person-days of observation. Compared with unvaccinated individuals, two vaccine doses achieved vaccine effectiveness of 66% (95% CI 63–69) against infection with the delta variant and 25% (21–29) against infection with the omicron variant, and 83% (74–89) against delta variant-associated hospitalisation and 75% (56–86) against omicron variant-associated hospitalisation. Booster vaccination with a third dose achieved vaccine effectiveness of 56% (53–58) against infection with the omicron variant and 94% (86–97) against omicron-associated hospitalisation, compared with unvaccinated adolescents. Vaccine effectiveness against infection for both variants after two doses waned over time, whereas vaccine effectiveness against hospitalisation for both variants remained stable; both were increased after three doses.

Interpretation

Among adolescents aged 12–17 years, vaccine effectiveness against confirmed SARS-CoV-2 infection after two doses of BNT162b2 decreased over time and increased after a third dose. Boosted adolescents were also the most protected from hospitalisation compared with fully vaccinated, partly vaccinated, and unvaccinated adolescents. Therefore, the booster dose of BNT162b2 can help to reduce the burden on the health-care system and individual morbidity during an omicron wave.

Funding

None.

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Vol 23 - N° 2

P. 177-182 - février 2023 Retour au numéro
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