Assessing COVID-19 vaccine effectiveness against Omicron subvariants: Report from a meeting of the World Health Organization

Feikin, Daniel R.; Andrews, Nick; Collie, Shirley; Knoll, Maria Deloria; Kwong, Jeffrey C.; Link‐Gelles, Ruth; Pilishvili, Tamara; Patel, Minal

doi:10.1016/j.vaccine.2023.02.020

Cited by 27 publications

(27 citation statements)

References 38 publications

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“…It is also highly consistent with reports from the United States, Canada, South Africa and Europe 6–8,24 on lower VE against severe form of the disease during the Omicron subvariants predominance, in particular BA.2 and BA.4/BA.5. Rapid waning of first booster VE against hospitalisation during Omicron predominant period has also been reported in the literature (VE of 29%–58% 3–6 months after uptake) 6,8 . This decline in VE motivated the recommendation for an additional booster dose in vulnerable population subgroups, but also the development of adapted vaccines to closely match circulating variants.…”

Section: Discussionsupporting

confidence: 90%

“…While the first booster initially restored immunity to similar levels to the ones observed at the beginning of the vaccination programme (≥95% by the end of 2021), its VE also during Omicron predominant period has also been reported in the literature (VE of 29%-58% 3-6 months after uptake). 6,8 This decline in VE motivated the recommendation for an additional booster dose in vulnerable population subgroups, but also the development of adapted vaccines to closely match circulating variants.…”

Section: Discussionmentioning

confidence: 99%

“…Following the rollout of mass COVID‐19 vaccination programmes, real‐world VE monitoring started to estimate the level and duration of protection, the VE in specific populations not covered by clinical trials and VE against new emerging genetic variants of SARS‐CoV‐2 2,3,6–8 . Rapid availability of this information has been of great value in guiding public health decision‐makers to adapt vaccination programmes according to public health needs.…”

Section: Introductionmentioning

confidence: 99%

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Monitoring COVID‐19 vaccine effectiveness against COVID‐19 hospitalisation and death using electronic health registries in ≥65 years old population in six European countries, October 2021 to November 2022

Kislaya,

Sentís,

Starrfelt

et al. 2023

Influenza Resp Viruses

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BackgroundWithin the ECDC‐VEBIS project, we prospectively monitored vaccine effectiveness (VE) against COVID‐19 hospitalisation and COVID‐19‐related death using electronic health registries (EHR), between October 2021 and November 2022, in community‐dwelling residents aged 65–79 and ≥80 years in six European countries.MethodsEHR linkage was used to construct population cohorts in Belgium, Denmark, Luxembourg, Navarre (Spain), Norway and Portugal. Using a common protocol, for each outcome, VE was estimated monthly over 8‐week follow‐up periods, allowing 1 month‐lag for data consolidation. Cox proportional‐hazards models were used to estimate adjusted hazard ratios (aHR) and VE = (1 − aHR) × 100%. Site‐specific estimates were pooled using random‐effects meta‐analysis.ResultsFor ≥80 years, considering unvaccinated as the reference, VE against COVID‐19 hospitalisation decreased from 66.9% (95% CI: 60.1; 72.6) to 36.1% (95% CI: −27.3; 67.9) for the primary vaccination and from 95.6% (95% CI: 88.0; 98.4) to 67.7% (95% CI: 45.9; 80.8) for the first booster. Similar trends were observed for 65–79 years. The second booster VE against hospitalisation ranged between 82.0% (95% CI: 75.9; 87.0) and 83.9% (95% CI: 77.7; 88.4) for the ≥80 years and between 39.3% (95% CI: −3.9; 64.5) and 80.6% (95% CI: 67.2; 88.5) for 65–79 years. The first booster VE against COVID‐19‐related death declined over time for both age groups, while the second booster VE against death remained above 80% for the ≥80 years.ConclusionsSuccessive vaccine boosters played a relevant role in maintaining protection against COVID‐19 hospitalisation and death, in the context of decreasing VE over time. Multicountry data from EHR facilitate robust near‐real‐time VE monitoring in the EU/EEA and support public health decision‐making.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Monitoring COVID‐19 vaccine effectiveness against COVID‐19 hospitalisation and death using electronic health registries in ≥65 years old population in six European countries, October 2021 to November 2022

Kislaya,

Sentís,

Starrfelt

et al. 2023

Influenza Resp Viruses

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“…[5] Several studies of the Omicron (B.1.1.529) subvariants reported heightened capacity for immune evasion, [6] and reduced vaccine effectiveness for first-generation monovalent COVID-19 vaccines. [7] Other reports suggest that additional doses of the monovalent mRNA vaccines, [8,9] heterologous boosting, [10,11] and the bivalent mRNA vaccines provide additional immune protection to SARS-CoV-2 B.1.1.529 infection and severe COVID-19 illness. [12] For patients with cancer, evidence suggests that primer vaccinations elicit lower antibody titers compared to healthy individuals, albeit dependent on disease state, co-morbidities, and anticancer treatment status.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low booster uptake in cancer patients despite health benefits

Figueiredo,

Levy,

Choi

et al. 2023

Preprint

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Patients with cancer are at increased risk of death from COVID-19 and have reduced immune responses to SARS-CoV2 vaccines, necessitating regular boosters. We performed comprehensive chart reviews, surveys of patients attitudes, serology for SARS-CoV-2 antibodies and T-cell receptor (TCR) &#946, sequencing for cellular responses on a cohort of 982 cancer patients receiving active cancer therapy accrued between November-3-2020 and Mar-31-2023. We found that 92.3% of patients received the primer vaccine, 70.8% received one monovalent booster, but only 30.1% received a bivalent booster. Booster uptake was lower under age 50, and among African American or Hispanic patients. Nearly all patients seroconverted after 2+ booster vaccinations (>99%) and improved cellular responses, demonstrating that repeated boosters could overcome poor response to vaccination. Receipt of booster vaccinations was associated with a lower risk of all-cause mortality (HR=0.61, P=0.024). Booster uptake in high-risk cancer patients remains low and strategies to encourage booster uptake are needed.

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Immunogenicity, clinical efficacy and safety of additional second COVID‐19 booster vaccines against Omicron and its subvariants: A systematic review

Chenchula,

Chandra,

Adusumilli

et al. 2024

Reviews in Medical Virology

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The Omicron variant of severe acute respiratory syndrome coronavirus 2 is a new variant of concern (VOC) and an emerging subvariant that exhibits heightened infectivity, transmissibility, and immune evasion, escalating the incidence of moderate to severe coronavirus disease 2019 (COVID‐19). It resists monoclonal antibodies and diminishes vaccine efficacy. Notably, new sublineages have outpaced earlier predominant sublineages. Although the primary vaccination series and initial boosters were robust against previous VOCs, their efficacy waned against Omicron and its subvariants. In this systematic review, we assessed real‐world evidence on the immunogenicity, clinical efficacy, and safety of a second booster or fourth COVID‐19 vaccine dose against the Omicron VOC and its subvariants. A comprehensive literature search was conducted in Medline/PubMed, Google Scholar, bioRxiv, and medRxiv, and relevant studies published between 2022 and 30 May 2023 were reviewed. We found a total of 40 relevant articles focusing on a second booster dose for COVID‐19, including clinical trials and observational studies, involving 3,972,856 patients. The results consistently revealed that an additional second booster dose restored and prolonged waning immunity, activating both humoral and cellular responses against Omicron and its subvariants. A second booster treatment correlated with enduring protection against COVID‐19, notably preventing substantial symptomatic disease and mortality associated with severe Omicron infection. Both monovalent messenger RNA (mRNA) and nonmRNA vaccines demonstrated similar efficacy and safety, with bivalent mRNA vaccines exhibiting broader protection against emerging subvariants of Omicron. The safety profiles of second booster were favourable with only mild systemic and local symptoms reported in some recipients. In conclusion, this systematic review underscores the additional COVID‐19 vaccine boosters, particularly with bivalent or multivalent mRNA vaccines, for countering the highly infectious emerging subvariants of Omicron.

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Assessing COVID-19 vaccine effectiveness against Omicron subvariants: Report from a meeting of the World Health Organization

Cited by 27 publications

References 38 publications

Monitoring COVID‐19 vaccine effectiveness against COVID‐19 hospitalisation and death using electronic health registries in ≥65 years old population in six European countries, October 2021 to November 2022

Monitoring COVID‐19 vaccine effectiveness against COVID‐19 hospitalisation and death using electronic health registries in ≥65 years old population in six European countries, October 2021 to November 2022

Low booster uptake in cancer patients despite health benefits

Immunogenicity, clinical efficacy and safety of additional second COVID‐19 booster vaccines against Omicron and its subvariants: A systematic review

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