Early Estimates of Bivalent mRNA Booster Dose Vaccine Effectiveness in Preventing Symptomatic SARS-CoV-2 Infection Attributable to Omicron BA.5– and XBB/XBB.1.5–Related Sublineages Among Immunocompetent Adults — Increasing Community Access to Testing Program, United States, December 2022–January 2023

Link‐Gelles, Ruth; Ciesla, Allison Avrich; Roper, Lauren E.; Scobie, Heather M.; Ali, Akilah R.; Miller, Joseph D.; Wiegand, Ryan E.; Accorsi, Emma K.; Verani, Jennifer R.; Shang, Nong; Derado, Gordana; Britton, Amadea; Smith, Zachary; Fleming-Dutra, Katherine E.

doi:10.15585/mmwr.mm7205e1

Cited by 146 publications

(146 citation statements)

References 10 publications

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“…Within any antigen-exposure group, titers against XBB and XBB.1.5 were similar, though considerably lower than against BA.4/5, indicating significant antigenic divergence. Our neutralizing antibody results align with clinical data showing increased vaccine effectiveness of bivalent boosting against BA.5– and XBB/XBB.1.5–related infections compared to monovalent boosting [6, 7]. As most PVIs occurred when Omicron variants predominated, GMTs from V3+Bi, V3+PVI, and V4+Bi groups (Fig.…”

Section: Discussionsupporting

confidence: 87%

Bivalent COVID-19 vaccine antibody responses to Omicron variants suggest that responses to divergent variants would be improved with matched vaccine antigens

Wang

Goguet

Padilla

et al. 2023

Preprint

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We compared neutralizing antibody responses to BA.4/5, BQ.1.1, XBB, and XBB.1.5 Omicron SARS-CoV-2 variants after a bivalent or ancestral COVID-19 mRNA booster vaccine or post-vaccination infection. We found that the bivalent booster elicited moderately high antibody titers against BA.4/5 that were approximately two-fold higher against all Omicron variants than titers elicited by the monovalent booster. The bivalent booster elicited low but similar titers against both XBB and XBB.1.5 variants. These findings inform risk assessments for future COVID-19 vaccine recommendations and suggest that updated COVID-19 vaccines containing matched vaccine antigens to circulating divergent variants may be needed.

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Section: Discussionsupporting

confidence: 87%

Bivalent COVID-19 vaccine antibody responses to Omicron variants suggest that responses to divergent variants would be improved with matched vaccine antigens

Wang

Goguet

Padilla

et al. 2023

Preprint

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“…A matched cohort design was used by a french study 35 . Some studies had a test-negative case control design, where the odds of having received versus having not received a bivalent booster dose among case-patients (those who received a positive SARS-CoV-2 test result) and among control patients (those who received a negative SARS-CoV-2 test result) were compared 31 32 36 37 38 39 . The main outcome considered in this review was the relative vaccine effectiveness (rVE) of a bivalent booster dose compared with that of ≥1 monovalent vaccine doses administered.…”

Section: Resultsmentioning

confidence: 99%

Early real world evidence on the relative SARS-COV-2 vaccine effectiveness of bivalent COVID-19 booster doses: a rapid review

Schepisi

2023

Preprint

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The objective of this review is to give an overall view of COVID-19 bivalent vaccines knowledge and to explore their early available real world effectiveness evidence in the Omicron era. Presently, bivalent vaccines are generally offered to all groups eligible for their next booster, as defined by the national vaccination campaign, with varying policies between countries. The use of bivalent vaccines is supported by immunogenity studies, which, nevetheless, have led to contradictory conclusions, and are not generally designed to measure clinical impact. In order to critically appraise the available research on real world effectiveness, a systematic literature search was performed: out of 876 references examined, 14 studies were finally included and extracted. The findings of this review demonstrate modest to moderate additional protection of vaccination with bivalent BA.4-5 or BA.1 mRNA-booster vaccines against COVID-19 associated illness and hospitalization, -if compared with having received a monovalent dose as booster-, during a period when BA.5 and other Omicron sublineage viruses predominated globally,

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“…As compared to non-XBB/XBB.1.5 cases, cases with XBB/XBB.1.5 had 13% (1-23%) lower adjusted odds of having received a vaccine series ≥4 monovalent doses only, and 18% (9-26%) lower adjusted odds of having received mixed monovalent/bivalent series with ≥4 doses. Taken together, these observations suggest that although COVID-19 vaccination was associated with greater degrees of protection against XBB/XBB.1.5 infection than infection with other cocirculating lineages, the added benefits of recent boosting, [35][36][37] including with bivalent vaccine doses, 30 may not differ appreciably for protection against XBB/XBB.1.5 as compared to co-circulating lineages.…”

mentioning

confidence: 78%

Increased vaccine sensitivity of an emerging SARS-CoV-2 variant

Lewnard

Hong

Kim

et al. 2023

Preprint

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Host immune responses are a key source of selective pressure driving pathogen evolution. Emergence of many SARS-CoV-2 lineages has been associated with improvements in their ability to evade population immunity resulting from both vaccination and infection. Here we show diverging trends of escape from vaccine-derived and infection-derived immunity for the emerging XBB/XBB.1.5 Omicron lineage. Among 31,739 patients tested in ambulatory settings in Southern California from December, 2022 to February, 2023, adjusted odds of prior receipt of 2, 3, 4, and ≥5 COVID-19 vaccine doses were 10% (95% confidence interval: 1-18%), 11% (3-19%), 13% (3-21%), and 25% (15-34%) lower, respectively, among cases infected with XBB/XBB.1.5 than among cases infected with other co-circulating lineages. Similarly, prior vaccination was associated with greater protection against progression to hospitalization among cases with XBB/XBB.1.5 than among non-XBB/XBB.1.5 cases (70% [30-87%] and 48% [7-71%], respectively, for recipients of ≥4 doses). In contrast, cases infected with XBB/XBB.1.5 had 17% (11-24%) and 40% (19-65%) higher adjusted odds of having experienced 1 and ≥2 prior documented infections, respectively, including with pre-Omicron variants. As immunity acquired from SARS-CoV-2 infection becomes increasingly widespread, fitness costs associated with enhanced vaccine sensitivity in XBB/XBB.1.5 may be offset by increased ability to evade infection-derived host responses.

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Cited by 146 publications

References 10 publications

Bivalent COVID-19 vaccine antibody responses to Omicron variants suggest that responses to divergent variants would be improved with matched vaccine antigens

Bivalent COVID-19 vaccine antibody responses to Omicron variants suggest that responses to divergent variants would be improved with matched vaccine antigens

Early real world evidence on the relative SARS-COV-2 vaccine effectiveness of bivalent COVID-19 booster doses: a rapid review

Increased vaccine sensitivity of an emerging SARS-CoV-2 variant

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