Introduction/Objective. The duration of vaccine-induced protection against
SARS-CoV-2 is shown to be limited. The aim of this study was to assess
vaccine effectiveness (VE) of a third dose of four different COVID-19
vaccines during Delta variant predominance in Serbia. Methods. The data for
the period from Aug 18th to Oct 1st 2021, were used to estimate the
incidence rates of the SARS-CoV-2 infection, COVID-19-related
hospitalization, and intensive care unit (ICU) admission. The study included
41,186 fully vaccinated subjects, of which 13,589 had received the third
dose. VE was estimated based on the incidence rate ratio following
vaccination with three versus two doses. Results. We found that a third
dose of all investigated vaccines reduces the incidence of both SARS-CoV-2
infection and severe illness that requires hospitalization or ICU admission.
The highest VE against infection demonstrated BNT162b2, followed by
Gam-COVID-Vac and BBIBP-CorV. Third dose vaccination reduced the risk of
hospitalization (incidence rate IR = 0 for Gam-COVID-Vac and BBIBP-CorV),
and ICU admission (IR = 0 for all vaccines). The hazard distributions for
SARS-CoV-2 infection and hospitalization following vaccination with three
versus two doses were significantly different. Conclusion. These findings
indicate that an additional, third dose of studied vaccine boosters
protection against all investigated outcomes.