Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression - 20/04/23

Doi : 10.1016/S1473-3099(22)00801-5

Niklas Bobrovitz, DPhil ^a,^c,^d,⁎ , Harriet Ware, MSc ^d, Xiaomeng Ma, MSc ^b, Zihan Li, BASc ^d,^e, Reza Hosseini, MD ^d,^f, Christian Cao ^a,^d, Anabel Selemon ^d, Mairead Whelan, MSc ^d, Zahra Premji, PhD ^g, Hanane Issa, MSc ^h, Brianna Cheng, MSc ^a, Laith J Abu Raddad, ProfPhD ⁱ, David L Buckeridge, ProfPhD ^j, Maria D Van Kerkhove, PhD ^k, Vanessa Piechotta, PhD ^l, Melissa M Higdon, MPH ^m, Annelies Wilder-Smith, ProfMD ^n,^o, Isabel Bergeri, PharmD ^k, Daniel R Feikin, MD ⁿ, Rahul K Arora, BHSc ^d,^p,^{^{†
Contributed equally}}, Minal K Patel, MD ^n,^{^{†
Contributed equally}}, Lorenzo Subissi, PhD ^k,^{^{†
Contributed equally}}

^a Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

^b Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada

^c Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada

^d Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

^e Department of Bioengineering, University of California, Berkeley, CA, USA

^f School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

^g Libraries, University of Victoria, Victoria, BC, Canada

^h Institute of Health Informatics, University College London, London, UK

ⁱ Infectious Disease Epidemiology Group, Weill Cornell Medicine–Qatar, Cornell University, Doha, Qatar

^j Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montreal, QC, Canada

^k Health Emergencies Programme, World Health Organization, Geneva, Switzerland

^l Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany

^m International Vaccine Access Center, Department of International Health, John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

ⁿ Department of Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland

^o Heidelberg Institute of Global Health, University of Heidelberg, Germany

^p Institute of Biomedical Engineering, University of Oxford, Oxford, UK

^* Correspondence to: Dr Niklas Bobrovitz, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada Temerty Faculty of Medicine University of Toronto Toronto ON M5S 1A8 Canada

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Summary

Background

The global surge in the omicron (B.1.1.529) variant has resulted in many individuals with hybrid immunity (immunity developed through a combination of SARS-CoV-2 infection and vaccination). We aimed to systematically review the magnitude and duration of the protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against infection and severe disease caused by the omicron variant.

Methods

For this systematic review and meta-regression, we searched for cohort, cross-sectional, and case–control studies in MEDLINE, Embase, Web of Science, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, the WHO COVID-19 database, and Europe PubMed Central from Jan 1, 2020, to June 1, 2022, using keywords related to SARS-CoV-2, reinfection, protective effectiveness, previous infection, presence of antibodies, and hybrid immunity. The main outcomes were the protective effectiveness against reinfection and against hospital admission or severe disease of hybrid immunity, hybrid immunity relative to previous infection alone, hybrid immunity relative to previous vaccination alone, and hybrid immunity relative to hybrid immunity with fewer vaccine doses. Risk of bias was assessed with the Risk of Bias In Non-Randomized Studies of Interventions Tool. We used log-odds random-effects meta-regression to estimate the magnitude of protection at 1-month intervals. This study was registered with PROSPERO (CRD42022318605).

Findings

11 studies reporting the protective effectiveness of previous SARS-CoV-2 infection and 15 studies reporting the protective effectiveness of hybrid immunity were included. For previous infection, there were 97 estimates (27 with a moderate risk of bias and 70 with a serious risk of bias). The effectiveness of previous infection against hospital admission or severe disease was 74·6% (95% CI 63·1–83·5) at 12 months. The effectiveness of previous infection against reinfection waned to 24·7% (95% CI 16·4–35·5) at 12 months. For hybrid immunity, there were 153 estimates (78 with a moderate risk of bias and 75 with a serious risk of bias). The effectiveness of hybrid immunity against hospital admission or severe disease was 97·4% (95% CI 91·4–99·2) at 12 months with primary series vaccination and 95·3% (81·9–98·9) at 6 months with the first booster vaccination after the most recent infection or vaccination. Against reinfection, the effectiveness of hybrid immunity following primary series vaccination waned to 41·8% (95% CI 31·5–52·8) at 12 months, while the effectiveness of hybrid immunity following first booster vaccination waned to 46·5% (36·0–57·3) at 6 months.

Interpretation

All estimates of protection waned within months against reinfection but remained high and sustained for hospital admission or severe disease. Individuals with hybrid immunity had the highest magnitude and durability of protection, and as a result might be able to extend the period before booster vaccinations are needed compared to individuals who have never been infected.

Funding

WHO COVID-19 Solidarity Response Fund and the Coalition for Epidemic Preparedness Innovations.

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Vol 23 - N° 5

P. 556-567 - mai 2023 Retour au numéro

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Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression - 20/04/23

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