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Effectiveness of the BNT162b2 mRNA Vaccine Compared with Hybrid Immunity in Populations Prioritized and Non-Prioritized for COVID-19 Vaccination in 2021–2022 : A Naturalistic Case-Control Study in Sweden

Spreco, Armin ; Dahlström, Örjan ; Jöud, Anna LU orcid ; Nordvall, Dennis ; Fagerström, Cecilia LU ; Blomqvist, Eva ; Gustafsson, Fredrik ; Hinkula, Jorma ; Schön, Thomas and Timpka, Toomas (2022) In Vaccines 10(8).
Abstract

The term hybrid immunity is used to denote the immunological status of vaccinated individuals with a history of natural infection. Reports of new SARS-CoV-2 variants of concern motivate continuous rethought and renewal of COVID-19 vaccination programs. We used a naturalistic case-control study design to compare the effectiveness of the BNT162b2 mRNA vaccine to hybrid immunity 180 days post-vaccination in prioritized and non-prioritized populations vaccinated before 31 July 2021 in three Swedish counties (total population 1,760,000). Subjects with a positive SARS-CoV-2 test recorded within 6 months before vaccination (n = 36,247; 6%) were matched to vaccinated-only controls. In the prioritized population exposed to the SARS-CoV-2 Alpha... (More)

The term hybrid immunity is used to denote the immunological status of vaccinated individuals with a history of natural infection. Reports of new SARS-CoV-2 variants of concern motivate continuous rethought and renewal of COVID-19 vaccination programs. We used a naturalistic case-control study design to compare the effectiveness of the BNT162b2 mRNA vaccine to hybrid immunity 180 days post-vaccination in prioritized and non-prioritized populations vaccinated before 31 July 2021 in three Swedish counties (total population 1,760,000). Subjects with a positive SARS-CoV-2 test recorded within 6 months before vaccination (n = 36,247; 6%) were matched to vaccinated-only controls. In the prioritized population exposed to the SARS-CoV-2 Alpha and Delta variants post-vaccination, the odds ratio (OR) for breakthrough infection was 2.2 (95% CI, 1.6–2.8; p < 0.001) in the vaccinated-only group compared with the hybrid immunity group, while in the later vaccinated non-prioritized population, the OR decreased from 4.3 (95% CI, 2.2–8.6; p < 0.001) during circulation of the Delta variant to 1.9 (95% CI, 1.7–2.1; p < 0.001) with the introduction of the Omicron variant (B.1.617.2). We conclude that hybrid immunity provides gains in protection, but that the benefits are smaller for risk groups and with circulation of the Omicron variant and its sublineages.

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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
case-control study design, COVID-19, effectiveness, epidemiology, hybrid immunity, vaccination program
in
Vaccines
volume
10
issue
8
article number
1273
publisher
MDPI AG
external identifiers
  • scopus:85137409223
  • pmid:36016162
ISSN
2076-393X
DOI
10.3390/vaccines10081273
language
English
LU publication?
yes
id
fc0fc5e2-961e-4f90-a88c-fff9ccba3587
date added to LUP
2022-11-23 11:34:44
date last changed
2024-05-29 22:28:58
@article{fc0fc5e2-961e-4f90-a88c-fff9ccba3587,
  abstract     = {{<p>The term hybrid immunity is used to denote the immunological status of vaccinated individuals with a history of natural infection. Reports of new SARS-CoV-2 variants of concern motivate continuous rethought and renewal of COVID-19 vaccination programs. We used a naturalistic case-control study design to compare the effectiveness of the BNT162b2 mRNA vaccine to hybrid immunity 180 days post-vaccination in prioritized and non-prioritized populations vaccinated before 31 July 2021 in three Swedish counties (total population 1,760,000). Subjects with a positive SARS-CoV-2 test recorded within 6 months before vaccination (n = 36,247; 6%) were matched to vaccinated-only controls. In the prioritized population exposed to the SARS-CoV-2 Alpha and Delta variants post-vaccination, the odds ratio (OR) for breakthrough infection was 2.2 (95% CI, 1.6–2.8; p &lt; 0.001) in the vaccinated-only group compared with the hybrid immunity group, while in the later vaccinated non-prioritized population, the OR decreased from 4.3 (95% CI, 2.2–8.6; p &lt; 0.001) during circulation of the Delta variant to 1.9 (95% CI, 1.7–2.1; p &lt; 0.001) with the introduction of the Omicron variant (B.1.617.2). We conclude that hybrid immunity provides gains in protection, but that the benefits are smaller for risk groups and with circulation of the Omicron variant and its sublineages.</p>}},
  author       = {{Spreco, Armin and Dahlström, Örjan and Jöud, Anna and Nordvall, Dennis and Fagerström, Cecilia and Blomqvist, Eva and Gustafsson, Fredrik and Hinkula, Jorma and Schön, Thomas and Timpka, Toomas}},
  issn         = {{2076-393X}},
  keywords     = {{case-control study design; COVID-19; effectiveness; epidemiology; hybrid immunity; vaccination program}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{8}},
  publisher    = {{MDPI AG}},
  series       = {{Vaccines}},
  title        = {{Effectiveness of the BNT162b2 mRNA Vaccine Compared with Hybrid Immunity in Populations Prioritized and Non-Prioritized for COVID-19 Vaccination in 2021–2022 : A Naturalistic Case-Control Study in Sweden}},
  url          = {{http://dx.doi.org/10.3390/vaccines10081273}},
  doi          = {{10.3390/vaccines10081273}},
  volume       = {{10}},
  year         = {{2022}},
}