Waning protection after vaccination and prior infection against COVID-19-related mortality over 18 months
(2023) In Clinical Microbiology and Infection 29(12). p.1573-1580- Abstract
OBJECTIVES: Evidence on waning patterns in protection from vaccine-induced, infection-induced, and hybrid immunity against death is scarce. The aim of this study is to assess the temporal trends in protection against mortality.
METHODS: Population-based case-control study nested in the total population of Scania Region, Sweden using individual-level registry data of COVID-19-related deaths (<30 days after positive SARS-CoV-2 test) between 27 December 2020 and 3 June 2022. Controls were matched for age, sex, and index date. Conditional logistic regression was used to estimate the preventable fraction (PF) from vaccination (PF
vac corresponding to vaccine effectiveness; ≥2 vaccine doses vs. 0 doses), prior infection (PF ... (More)OBJECTIVES: Evidence on waning patterns in protection from vaccine-induced, infection-induced, and hybrid immunity against death is scarce. The aim of this study is to assess the temporal trends in protection against mortality.
METHODS: Population-based case-control study nested in the total population of Scania Region, Sweden using individual-level registry data of COVID-19-related deaths (<30 days after positive SARS-CoV-2 test) between 27 December 2020 and 3 June 2022. Controls were matched for age, sex, and index date. Conditional logistic regression was used to estimate the preventable fraction (PF) from vaccination (PF
vac corresponding to vaccine effectiveness; ≥2 vaccine doses vs. 0 doses), prior infection (PF
inf), and hybrid immunity (PF
hybrid). PF was calculated as one minus odds ratio. Models were adjusted for comorbidities, long-term care facility residence, prior infection (for PF
vac), country of birth, socio-economic conditions, and time since last vaccination (for PF
inf).
RESULTS: In total, 14 936 individuals (1440 COVID-19-related deaths and 13 496 controls) were included in the case-control analyses (45% females, median age: 84 years). PF
vac was above 90% during the first month after vaccination, regardless of the number of vaccine doses. After 6 months, PF
vac of two doses waned to 34% (95% CI: -30% to 66%). PF
inf for people surviving a SARS-CoV-2 infection waned from 88% (-16% to 99%) 3 months after infection to 62% (34-79%) after 9 months. No differences in waning patterns in PF
vac were seen between virus variants, gender, and age.
DISCUSSION: Given the waning of protection against death, continuous surveillance of population immunity status, particularly among the most vulnerable population groups, could help to further fine-tune vaccination recommendations.
(Less)
- author
- Dietler, Dominik LU ; Kahn, Fredrik LU ; Inghammar, Malin LU and Björk, Jonas LU
- organization
- publishing date
- 2023-08-12
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Clinical Microbiology and Infection
- volume
- 29
- issue
- 12
- pages
- 1573 - 1580
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85169511640
- pmid:37580016
- ISSN
- 1469-0691
- DOI
- 10.1016/j.cmi.2023.08.007
- project
- Improved preparedness for future pandemics and other health crises through large-scale disease surveillance
- language
- English
- LU publication?
- yes
- id
- 76df4c4f-5fd6-4e28-a36f-5d624e9f2613
- date added to LUP
- 2023-10-12 15:38:31
- date last changed
- 2024-04-19 02:18:22
@article{76df4c4f-5fd6-4e28-a36f-5d624e9f2613, abstract = {{<p>OBJECTIVES: Evidence on waning patterns in protection from vaccine-induced, infection-induced, and hybrid immunity against death is scarce. The aim of this study is to assess the temporal trends in protection against mortality.</p><p>METHODS: Population-based case-control study nested in the total population of Scania Region, Sweden using individual-level registry data of COVID-19-related deaths (<30 days after positive SARS-CoV-2 test) between 27 December 2020 and 3 June 2022. Controls were matched for age, sex, and index date. Conditional logistic regression was used to estimate the preventable fraction (PF) from vaccination (PF<br> vac corresponding to vaccine effectiveness; ≥2 vaccine doses vs. 0 doses), prior infection (PF <br> inf), and hybrid immunity (PF<br> hybrid). PF was calculated as one minus odds ratio. Models were adjusted for comorbidities, long-term care facility residence, prior infection (for PF<br> vac), country of birth, socio-economic conditions, and time since last vaccination (for PF<br> inf).<br> </p><p>RESULTS: In total, 14 936 individuals (1440 COVID-19-related deaths and 13 496 controls) were included in the case-control analyses (45% females, median age: 84 years). PF<br> vac was above 90% during the first month after vaccination, regardless of the number of vaccine doses. After 6 months, PF<br> vac of two doses waned to 34% (95% CI: -30% to 66%). PF<br> inf for people surviving a SARS-CoV-2 infection waned from 88% (-16% to 99%) 3 months after infection to 62% (34-79%) after 9 months. No differences in waning patterns in PF<br> vac were seen between virus variants, gender, and age.<br> </p><p>DISCUSSION: Given the waning of protection against death, continuous surveillance of population immunity status, particularly among the most vulnerable population groups, could help to further fine-tune vaccination recommendations.</p>}}, author = {{Dietler, Dominik and Kahn, Fredrik and Inghammar, Malin and Björk, Jonas}}, issn = {{1469-0691}}, language = {{eng}}, month = {{08}}, number = {{12}}, pages = {{1573--1580}}, publisher = {{Wiley-Blackwell}}, series = {{Clinical Microbiology and Infection}}, title = {{Waning protection after vaccination and prior infection against COVID-19-related mortality over 18 months}}, url = {{http://dx.doi.org/10.1016/j.cmi.2023.08.007}}, doi = {{10.1016/j.cmi.2023.08.007}}, volume = {{29}}, year = {{2023}}, }