The Incidence of SARS-CoV-2 Reinfection in Persons With Naturally Acquired Immunity With and Without Subsequent Receipt of a Single Dose of BNT162b2 Vaccine

Gazit, Sivan; Shlezinger, Roei; Perez, Galit; Lotan, Roni; Peretz, Asaf; Ben‐Tov, Amir; Herzel, Esma; Alapi, Hillel; Cohen, Dani; Muhsen, Khitam; Chodick, Gabriel; Patalon, Tal

doi:10.7326/m21-4130

Cited by 56 publications

(64 citation statements)

References 41 publications

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“…Immunogenicity studies conducted during the pre-Omicron period show a single BNT162b2 vaccine dose among previously-infected individuals elicited robust antibody and T cell responses, exceeding two-dose response in the infectionnaïve. [31][32][33][34] In epidemiological studies conducted pre-Omicron, one or two BNT162b2 doses in Israel reduced the pre-Omicron re-infection risk by ~80% compared to unvaccinated, previously-infected individuals, 35,36 and in the United Kingdom hybrid protection relative to unvaccinated, previously-uninfected individuals exceeded 90% for >1 year. 14 In Sweden, one-and two-dose hybrid protection reduced the pre-Omicron re-infection risk by 58% and 66%, persisting up to 9 months for the latter, compared to unvaccinated, previously-infected individuals.…”

Section: Discussionmentioning

confidence: 99%

Protection against Omicron re-infection conferred by prior heterologous SARS-CoV-2 infection, with and without mRNA vaccination

Carazo

Skowronski

Brisson

et al. 2022

Preprint

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ImportanceOmicron is phylogenetically- and antigenically-distinct from earlier SARS-CoV-2 variants and the original vaccine strain. Protection conferred by prior SARS-CoV-2 infection against Omicron re-infection, and the added value of vaccination, require quantification.ObjectiveTo estimate protection against Omicron re-infection and hospitalization conferred by prior heterologous SARS-CoV-2 (non-Omicron) infection and/or up to three doses of (ancestral, Wuhan-like) mRNA vaccine.DesignTest-negative study between December 26 (epi-week 52), 2021 and March 12 (epi-week 10), 2022.SettingPopulation-based, province of Quebec, CanadaParticipantsCommunity-dwelling ≥12-year-olds tested for SARS-CoV-2.ExposuresPrior laboratory-confirmed infection with/without mRNA vaccination.OutcomesLaboratory-confirmed SARS-CoV-2 re-infection and hospitalization, presumed Omicron by genomic surveillance. The odds of prior non-Omicron infection with/without vaccination were compared among Omicron cases/hospitalizations versus test-negative controls (single randomly-selected per individual). Adjusted odds ratios controlled for age, sex, testing-indication and epi-week. Analyses were stratified by severity and time since last non-Omicron infection or vaccine dose.ResultsWithout vaccination, prior non-Omicron infection reduced the Omicron re-infection risk by 44% (95%CI:38-48), decreasing from 66% (95%CI:57-73) at 3-5 months to 35% (95%CI:21-47) at 9-11 months post-infection and <30% thereafter. The more severe the prior infection, the greater the risk reduction: 8% (95%CI:17-28), 43% (95%CI:37-49) and 68% (95%CI:51-80) for prior asymptomatic, symptomatic ambulatory or hospitalized infections. mRNA vaccine effectiveness against Omicron infection was consistently significantly higher among previously-infected vs. non-infected individuals at 65% (95%CI:63-67) vs. 20% (95%CI:16-24) for one-dose; 68% (95%CI:67-70) vs. 42% (95%CI:41-44) for two doses; and 83% (95%CI:81-84) vs. 73% (95%CI:72-73) for three doses.Infection-induced protection against Omicron hospitalization was 81% (95%CI: 66-89) increasing to 86% (95%CI:77-99) with one, 94% (95%CI:91-96) with two and 97%(95%CI:94-99) with three mRNA vaccine doses. Two-dose effectiveness against hospitalization among previously-infected individuals did not wane across 11 months and did not significantly differ from three-dose effectiveness despite longer follow-up (median 158 and 27 days, respectively).Conclusions and relevancePrior heterologous SARS-CoV-2 infection provided substantial and sustained protection against Omicron hospitalization, greatest among those also vaccinated. In the context of program goals to prevent severe outcomes and preserve healthcare system capacity, >2 doses of ancestral Wuhan-like vaccine may be of marginal incremental value to previously-infected individuals.

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Section: Discussionmentioning

confidence: 99%

Protection against Omicron re-infection conferred by prior heterologous SARS-CoV-2 infection, with and without mRNA vaccination

Carazo

Skowronski

Brisson

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…In a nationally representative survey of Americans, 19% believed that gaining immunity through contracting the disease is better than vaccination (Stecula et al, 2020). This claim found some scientific support in a large Israeli study (Gazit et al, 2022), which showed people who once had a COVID-19 infection were less likely than never-infected, vaccinated people to contract the Delta variant, develop symptoms from it, or become hospitalized with serious COVID-19 symptoms. In fact, however, data from the same study suggested that previously infected people should still receive at least one dose of the mRNA vaccine as it provides a much higher protection against reinfection than remaining unvaccinated for those who once had the virus.…”

Section: Perceptions and Attitudesmentioning

confidence: 99%

Vaccines and the social amplification of risk

2022

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In 2019, the World Health Organization (WHO) named “Vaccine Hesitancy” one of the top 10 threats to global health. Shortly afterward, the COVID‐19 pandemic emerged as the world's predominant health concern. COVID‐19 vaccines of several types have been developed, tested, and partially deployed with remarkable speed; vaccines are now the primary control measure and hope for a return to normalcy. However, hesitancy concerning these vaccines, along with resistance to masking and other control measures, remains a substantial obstacle. The previous waves of vaccine hesitancy that led to the WHO threat designation, together with recent COVID‐19 experience, provide a window for viewing new forms of social amplification of risk (SAR). Not surprisingly, vaccines provide fertile ground for questions, anxieties, concerns, and rumors. These appear in new globalized hyperconnected communications landscapes and in the context of complex human (social, economic, and political) systems that exhibit evolving concerns about vaccines and authorities. We look at drivers, impacts, and implications for vaccine initiatives in several recent historical examples and in the current efforts with COVID‐19 vaccination. Findings and insights were drawn from the Vaccine Confidence Project's decade long monitoring of media and social media and its related research efforts. The trends in vaccine confidence and resistance have implications for updating the social amplification of risk framework (SARF); in turn, SARF has practical implications for guiding efforts to alleviate vaccine hesitancy and to mitigate harms from intentional and unintentional vaccine scares.

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“…Previous observational studies have investigated the association between Coronavirus Disease 2019 (COVID-19) vaccination and severe acute respiratory corona virus 2 (SARS-CoV-2) reinfection, 1–3 but the duration and effect of protection from vaccination after a SARS-CoV-2 infection remains uncertain. Despite an estimated moderate to high natural protection against reinfection with non-Omicron variants of SARS-CoV-2, 4–6 data from Denmark and Qatar suggests a lower protection against reinfection with the Omicron (B.1.1.529) variant.…”

Section: Introductionmentioning

confidence: 99%

Vaccine effectiveness against SARS-CoV-2 reinfection during periods of Alpha (B.1.1.7), Delta (B.1.617.2) or Omicron (B.1.1.529) dominance: A Danish nationwide study

Nielsen

Moustsen-Helms

Schelde

et al. 2022

Preprint

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Introduction Individuals with a prior severe acute respiratory corona virus 2 (SARS-CoV-2) infection have a moderate to high degree of protection against reinfection, though seemingly less so when the Omicron variant of SARS-CoV-2 started to circulate. The aim of this study was to evaluate the vaccine effectiveness (VE) against SARS-CoV-2 reinfection, that is, in individuals with prior SARS-CoV-2 infection, during periods with different dominant SARS-CoV-2 variants. Methods A nationwide cohort study design including all individuals with a confirmed SARS-CoV-2 infection, who were alive and residing in Denmark between 1 January 2020 and 31 January 2022 were used. Using Danish nationwide registries, we obtained information on SARS-CoV-2 infections, Coronavirus Disease 2019 (COVID-19) vaccination, age, sex, comorbidity, staying at hospital and region of affiliation. The study population included were individuals with prior SARS-CoV-2 infection. Crude and adjusted estimates of VE against SARS-CoV-2 reinfection with 95% confidence intervals (CIs) were calculated using Poisson and Cox regression models, respectively. The VE estimates were calculated separately for three periods with different dominant SARS-CoV-2 variants (Alpha (B.1.1.7), Delta (B.1.617.2), or Omicron (B.1.1.529)) and by time since vaccination using unvaccinated as the reference. Findings The study population comprised of 209,814 individuals infected before or during the Alpha period, 292,978 before or during the Delta period and 245,530 before or during the Omicron period. Of these, 40,281 individuals had completed their primary vaccination series during the Alpha period (19.2%), 190,026 during the Delta period (64.9%) and 158,563 during the Omicron period (64.6%). VE against reinfection following any COVID-19 vaccine type administered in Denmark, peaked at 85% (95% CI: 37% to 97%) at 104 days or more after vaccination during the Alpha period, 88% (95% CI: 81% to 92%) 14-43 days after vaccination during the Delta period and 60% (95% CI: 58% to 62%) 14-43 days after vaccination during the Omicron period. Waning immunity was observed, and was most pronounced during the Omicron period. Interpretation This study shows that, in previously infected individuals, completing a primary vaccination series was associated with a significant protection against SARS-CoV-2 reinfection compared with no vaccination for all three variant periods. Even though vaccination seems to protect to a lesser degree against reinfection with the Omicron variant, these findings are of public health relevance as they show that previously infected individuals still benefit from COVID-19 vaccination in all three variant periods.

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The Incidence of SARS-CoV-2 Reinfection in Persons With Naturally Acquired Immunity With and Without Subsequent Receipt of a Single Dose of BNT162b2 Vaccine

Cited by 56 publications

References 41 publications

Protection against Omicron re-infection conferred by prior heterologous SARS-CoV-2 infection, with and without mRNA vaccination

Protection against Omicron re-infection conferred by prior heterologous SARS-CoV-2 infection, with and without mRNA vaccination

Vaccines and the social amplification of risk

Vaccine effectiveness against SARS-CoV-2 reinfection during periods of Alpha (B.1.1.7), Delta (B.1.617.2) or Omicron (B.1.1.529) dominance: A Danish nationwide study

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