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Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease: results of a systematic review and meta-regression.
Feikin, Daniel R; Higdon, Melissa M; Abu-Raddad, Laith J; Andrews, Nick; Araos, Rafael; Goldberg, Yair; Groome, Michelle J; Huppert, Amit; O'Brien, Katherine L; Smith, Peter G; Wilder-Smith, Annelies; Zeger, Scott; Deloria Knoll, Maria; Patel, Minal K.
  • Feikin DR; Department of Immunisations, Vaccines, and Biologicals, WHO, Geneva, Switzerland. Electronic address: feikind@who.int.
  • Higdon MM; International Vaccine Access Center, Department of International Health, John Hopkins Bloomberg School of Public Health, Baltimore, MA, USA.
  • Abu-Raddad LJ; Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Doha, Qatar.
  • Andrews N; UK Health Security Agency, London, UK.
  • Araos R; Instituto de Ciencias e Innovacion en Medicina, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile; Advanced Centre for Chronic Diseases, Santiago, Chile.
  • Goldberg Y; Technion Israel Institute of Technology, Haife, Israel.
  • Groome MJ; National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  • Huppert A; The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Aviv University, Tel Aviv, Israel.
  • O'Brien KL; Department of Immunisations, Vaccines, and Biologicals, WHO, Geneva, Switzerland.
  • Smith PG; MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK.
  • Wilder-Smith A; Department of Immunisations, Vaccines, and Biologicals, WHO, Geneva, Switzerland.
  • Zeger S; Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MA, USA.
  • Deloria Knoll M; International Vaccine Access Center, Department of International Health, John Hopkins Bloomberg School of Public Health, Baltimore, MA, USA.
  • Patel MK; Department of Immunisations, Vaccines, and Biologicals, WHO, Geneva, Switzerland.
Lancet ; 399(10328): 924-944, 2022 03 05.
Article in English | MEDLINE | ID: covidwho-1768606
ABSTRACT

BACKGROUND:

Knowing whether COVID-19 vaccine effectiveness wanes is crucial for informing vaccine policy, such as the need for and timing of booster doses. We aimed to systematically review the evidence for the duration of protection of COVID-19 vaccines against various clinical outcomes, and to assess changes in the rates of breakthrough infection caused by the delta variant with increasing time since vaccination.

METHODS:

This study was designed as a systematic review and meta-regression. We did a systematic review of preprint and peer-reviewed published article databases from June 17, 2021, to Dec 2, 2021. Randomised controlled trials of COVID-19 vaccine efficacy and observational studies of COVID-19 vaccine effectiveness were eligible. Studies with vaccine efficacy or effectiveness estimates at discrete time intervals of people who had received full vaccination and that met predefined screening criteria underwent full-text review. We used random-effects meta-regression to estimate the average change in vaccine efficacy or effectiveness 1-6 months after full vaccination.

FINDINGS:

Of 13 744 studies screened, 310 underwent full-text review, and 18 studies were included (all studies were carried out before the omicron variant began to circulate widely). Risk of bias, established using the risk of bias 2 tool for randomised controlled trials or the risk of bias in non-randomised studies of interventions tool was low for three studies, moderate for eight studies, and serious for seven studies. We included 78 vaccine-specific vaccine efficacy or effectiveness evaluations (Pfizer-BioNTech-Comirnaty, n=38; Moderna-mRNA-1273, n=23; Janssen-Ad26.COV2.S, n=9; and AstraZeneca-Vaxzevria, n=8). On average, vaccine efficacy or effectiveness against SARS-CoV-2 infection decreased from 1 month to 6 months after full vaccination by 21·0 percentage points (95% CI 13·9-29·8) among people of all ages and 20·7 percentage points (10·2-36·6) among older people (as defined by each study, who were at least 50 years old). For symptomatic COVID-19 disease, vaccine efficacy or effectiveness decreased by 24·9 percentage points (95% CI 13·4-41·6) in people of all ages and 32·0 percentage points (11·0-69·0) in older people. For severe COVID-19 disease, vaccine efficacy or effectiveness decreased by 10·0 percentage points (95% CI 6·1-15·4) in people of all ages and 9·5 percentage points (5·7-14·6) in older people. Most (81%) vaccine efficacy or effectiveness estimates against severe disease remained greater than 70% over time.

INTERPRETATION:

COVID-19 vaccine efficacy or effectiveness against severe disease remained high, although it did decrease somewhat by 6 months after full vaccination. By contrast, vaccine efficacy or effectiveness against infection and symptomatic disease decreased approximately 20-30 percentage points by 6 months. The decrease in vaccine efficacy or effectiveness is likely caused by, at least in part, waning immunity, although an effect of bias cannot be ruled out. Evaluating vaccine efficacy or effectiveness beyond 6 months will be crucial for updating COVID-19 vaccine policy.

FUNDING:

Coalition for Epidemic Preparedness Innovations.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Immunization Schedule / Immunization, Secondary / COVID-19 Vaccines / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Vaccines / Variants Limits: Humans Language: English Journal: Lancet Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Immunization Schedule / Immunization, Secondary / COVID-19 Vaccines / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Vaccines / Variants Limits: Humans Language: English Journal: Lancet Year: 2022 Document Type: Article