TY - JOUR
T1 - Effect of second booster vaccinations and prior infection against SARS-CoV-2 in the UK SIREN healthcare worker cohort
AU - SIREN Study Group
AU - Kirwan, Peter D.
AU - Hall, Victoria J.
AU - Foulkes, Sarah
AU - Otter, Ashley D.
AU - Munro, Katie
AU - Sparkes, Dominic
AU - Howells, Anna
AU - Platt, Naomi
AU - Broad, Jonathan
AU - Crossman, David
AU - Norman, Chris
AU - Corrigan, Diane
AU - Jackson, Christopher H.
AU - Cole, Michelle
AU - Brown, Colin S.
AU - Atti, Ana
AU - Islam, Jasmin
AU - Lewis, Tracy
AU - Bain, Steve
AU - Thomas, Rebeccah
AU - Geen, John
AU - Pothecary, Carla
AU - Cutler, Sean
AU - Northfield, John
AU - Price, Cathy
AU - Tomlinson, Johanne
AU - Knight, Sarah
AU - Macnaughton, Emily
AU - Thompson, Catherine
AU - Akinbami, Omolola
AU - Brooks, Tim
AU - Chand, Meera
AU - Ramsay, Mary
AU - Saei, Ayoub
AU - Zambon, Maria
AU - Linley, Ezra
AU - Tonge, Simon
AU - Adaji, Enemona
AU - Conneely, Joanna
AU - Emmett, Hannah
AU - Hettiarachchi, Nipunadi
AU - Khawam, Jameel
AU - D'Arcangelo, Silvia
AU - Rowe, Cathy
AU - Semper, Amanda
AU - Gallagher, Eileen
AU - Presanis, Anne M.
AU - Charlett, Andre
AU - De Angelis, Daniela
AU - Hopkins, Susan
N1 - Publisher Copyright:
© 2023
PY - 2024/1
Y1 - 2024/1
N2 - Background: The protection of fourth dose mRNA vaccination against SARS-CoV-2 is relevant to current global policy decisions regarding ongoing booster roll-out. We aimed to estimate the effect of fourth dose vaccination, prior infection, and duration of PCR positivity in a highly-vaccinated and largely prior-COVID-19 infected cohort of UK healthcare workers. Methods: Participants underwent fortnightly PCR and regular antibody testing for SARS-CoV-2 and completed symptoms questionnaires. A multi-state model was used to estimate vaccine effectiveness (VE) against infection from a fourth dose compared to a waned third dose, with protection from prior infection and duration of PCR positivity jointly estimated. Findings: 1298 infections were detected among 9560 individuals under active follow-up between September 2022 and March 2023. Compared to a waned third dose, fourth dose VE was 13.1% (95% CI 0.9 to 23.8) overall; 24.0% (95% CI 8.5 to 36.8) in the first 2 months post-vaccination, reducing to 10.3% (95% CI −11.4 to 27.8) and 1.7% (95% CI −17.0 to 17.4) at 2–4 and 4–6 months, respectively. Relative to an infection >2 years ago and controlling for vaccination, 63.6% (95% CI 46.9 to 75.0) and 29.1% (95% CI 3.8 to 43.1) greater protection against infection was estimated for an infection within the past 0–6, and 6–12 months, respectively. A fourth dose was associated with greater protection against asymptomatic infection than symptomatic infection, whilst prior infection independently provided more protection against symptomatic infection, particularly if the infection had occurred within the previous 6 months. Duration of PCR positivity was significantly lower for asymptomatic compared to symptomatic infection. Interpretation: Despite rapid waning of protection, vaccine boosters remain an important tool in responding to the dynamic COVID-19 landscape; boosting population immunity in advance of periods of anticipated pressure, such as surging infection rates or emerging variants of concern. Funding: UK Health Security Agency, Medical Research Council, NIHR HPRU Oxford, Bristol, and others.
AB - Background: The protection of fourth dose mRNA vaccination against SARS-CoV-2 is relevant to current global policy decisions regarding ongoing booster roll-out. We aimed to estimate the effect of fourth dose vaccination, prior infection, and duration of PCR positivity in a highly-vaccinated and largely prior-COVID-19 infected cohort of UK healthcare workers. Methods: Participants underwent fortnightly PCR and regular antibody testing for SARS-CoV-2 and completed symptoms questionnaires. A multi-state model was used to estimate vaccine effectiveness (VE) against infection from a fourth dose compared to a waned third dose, with protection from prior infection and duration of PCR positivity jointly estimated. Findings: 1298 infections were detected among 9560 individuals under active follow-up between September 2022 and March 2023. Compared to a waned third dose, fourth dose VE was 13.1% (95% CI 0.9 to 23.8) overall; 24.0% (95% CI 8.5 to 36.8) in the first 2 months post-vaccination, reducing to 10.3% (95% CI −11.4 to 27.8) and 1.7% (95% CI −17.0 to 17.4) at 2–4 and 4–6 months, respectively. Relative to an infection >2 years ago and controlling for vaccination, 63.6% (95% CI 46.9 to 75.0) and 29.1% (95% CI 3.8 to 43.1) greater protection against infection was estimated for an infection within the past 0–6, and 6–12 months, respectively. A fourth dose was associated with greater protection against asymptomatic infection than symptomatic infection, whilst prior infection independently provided more protection against symptomatic infection, particularly if the infection had occurred within the previous 6 months. Duration of PCR positivity was significantly lower for asymptomatic compared to symptomatic infection. Interpretation: Despite rapid waning of protection, vaccine boosters remain an important tool in responding to the dynamic COVID-19 landscape; boosting population immunity in advance of periods of anticipated pressure, such as surging infection rates or emerging variants of concern. Funding: UK Health Security Agency, Medical Research Council, NIHR HPRU Oxford, Bristol, and others.
KW - Asymptomatic
KW - Cohort study
KW - Healthcare worker
KW - SARS-CoV-2
KW - Symptomatic
KW - Vaccine effectiveness
UR - http://www.scopus.com/inward/record.url?scp=85184716205&partnerID=8YFLogxK
U2 - 10.1016/j.lanepe.2023.100809
DO - 10.1016/j.lanepe.2023.100809
M3 - Article
AN - SCOPUS:85184716205
SN - 2666-7762
VL - 36
JO - The Lancet Regional Health - Europe
JF - The Lancet Regional Health - Europe
M1 - 100809
ER -