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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

42 Pages Posted: 18 Nov 2021

See all articles by Daniel Feikin

Daniel Feikin

World Health Organization (WHO) - Department of Immunization, Vaccines and Biologicals (IVB)

Melissa M. Higdon

Johns Hopkins Bloomberg School of Public Health - Department of International Health, International Vaccine Access Center

Laith J. Abu-Raddad

Cornell University, Qatar - Infectious Diseases Epidemiology Group; Cornell University - Department of Healthcare Policy and Research; Hamad Bin Khalifa University - College of Health and Life Sciences

Nick Andrews

Public Health England Colindale; UK Health Security Agency - COVID-19 Surveillance Cell

Rafael Araos

Ministry of Health, Chile; Facultad de Medicina Clínica Alemana Universidad del Desarrollo

Yair Goldberg

Sheba Medical Center - The Gertner Institute for Epidemiology & Health Policy Research

Michelle Groome

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases; University of the Witwatersrand - School of Pathology

Amit Huppert

Sheba Medical Center - Central Virology Laboratory; Chaim Sheba Medical Center - Bio-statistical and Bio-mathematical Unit

Katherine O'Brien

World Health Organization (WHO); Johns Hopkins Bloomberg School of Public Health - Department of International Health, International Vaccine Access Center

Peter G. Smith

MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine

Annelies Wilder-Smith

World Health Organization (WHO) - Department of Immunizations, Vaccines and Biologicals

Scott L Zeger

Johns Hopkins University - Department of Epidemiology

Maria D. Knoll

Johns Hopkins Bloomberg School of Public Health - Department of International Health, International Vaccine Access Center

Minal Patel

affiliation not provided to SSRN

More...

Abstract

Background: Knowing whether and to what extent COVID-19 vaccine effectiveness wanes is critical to informing vaccine policy, such as the need for and timing of booster doses.  

Methods: We performed a systematic review from June 17 to October 27, 2021, using a structured search strategy of multiple databases.  Studies with vaccine efficacy or effectiveness (VE) estimates for any WHO Emergency-Use-Listed COVID-19 vaccine at discrete time intervals after full vaccination and meeting pre-defined screening criteria underwent full-text review and risk of bias assessment.  Random effects meta-regression was used to estimate the average change in VE from one to six months after full vaccination.  

Findings: Of 9,261 studies screened, 217 underwent full text review, and 14 were included in analyses. Vaccines evaluated were Pfizer/BioNTech-Comirnaty (n=11), Moderna-mRNA-1273 (n=8), Janssen-Ad26.COV2.S (n=3), and AstraZeneca-Vaxzevria (n=2).  On average, VE against SARS-CoV-2 infection decreased between 1 and 6 months after full vaccination by 18·5 percentage points (95% CI 8·4-33·4, p=0·0006) among persons of all ages and 19·9 percentage points (95% CI 9·2-36·7, p=0·0007) among older persons; for symptomatic COVID-19 disease, VE decreased by 25·4 (95% CI 13·7-42·5) and 32·0 percentage points (95% CI 11·0-69·0), respectively; and for severe COVID-19 disease, VE decreased by 8·0 (95% CI 3·6-15·2) and 9·7 percentage points (95% CI 5·9-14·7), respectively. The majority of VE estimates against severe disease remained over 70% for all time points.   

Interpretation: COVID-19 vaccine efficacy or effectiveness against COVID-19 severe disease remained high (>70%) in most studies in the six months after full vaccination, although it did decrease some (on average, 8-10 percentage points) between one and six months after full vaccination. In contrast, VE against SARS-CoV-2 infection and symptomatic COVID-19 disease decreased approximately 20-30 percentage points during the six months after vaccination. The decrease in VE is likely due, at least in part, to waning immunity, although we cannot rule out the effect of bias.  Continued follow-up of VE beyond six months is critical for updating COVID-19 vaccine policy. . 

Funding Information: Coalition for Epidemic Preparedness Innovations (CEPI)

Declaration of Interests: MMH reports research grants from World Health Organization (WHO, Coalition for Epidemic Preparedness Innovations (CEPI), Asian Development Bank (ADB), Bill & Melinda Gates Foundation (BMGF), and Pfizer (all paid to the institution). RA reports a contract from the United States Centers for Disease Control and Prevention, a grant from the Chile Ministry of Science, and consulting fees from Mayo Clinic and Chile Ministry of Health. YG reports research grants from the United States-Israel Binational Science Foundation (BSF) and Israel Science Foundation. MJG reports research grants from South African Medical Research Council and BMGF (all paid to the institution) and participation on a data safety monitoring board for a study on the effectiveness of COVID-19 vaccination against SARS-CoV-2-associated hospitalization and death. AH reports research grants from United States-Israel BSF. KLO serves as the Secretariat for the WHO Strategic Advisory Group of Experts on Immunization. MDK reports research grants from WHO, CEPI, ADB, and Pfizer (all paid to the institution) and consultancy fees from Merck. All other authors have nothing to declare.

Keywords: COVID-19, SARS-CoV2, Vaccination, immunity

Suggested Citation

Feikin, Daniel and Higdon, Melissa M. and Abu-Raddad, Laith J. and Andrews, Nick and Araos, Rafael and Goldberg, Yair and Groome, Michelle and Huppert, Amit and O'Brien, Katherine and Smith, Peter G. and Wilder-Smith, Annelies and Zeger, Scott L and Knoll, Maria D. and Patel, Minal, Duration of Effectiveness of Vaccines Against SARS-CoV-2 Infection and COVID-19 Disease: Results of a Systematic Review and Meta-Regression. Available at SSRN: https://ssrn.com/abstract=3961378 or http://dx.doi.org/10.2139/ssrn.3961378

Daniel Feikin (Contact Author)

World Health Organization (WHO) - Department of Immunization, Vaccines and Biologicals (IVB) ( email )

Geneva
Switzerland

Melissa M. Higdon

Johns Hopkins Bloomberg School of Public Health - Department of International Health, International Vaccine Access Center ( email )

United States

Laith J. Abu-Raddad

Cornell University, Qatar - Infectious Diseases Epidemiology Group ( email )

P.O. Box 24144
Doha
Qatar

Cornell University - Department of Healthcare Policy and Research

402 East 67th Street
New York, NY 10065
United States

Hamad Bin Khalifa University - College of Health and Life Sciences

Doha
Qatar

Nick Andrews

Public Health England Colindale ( email )

Wellington House
133-155 Waterloo Road
London, SE1 8UG
United Kingdom

UK Health Security Agency - COVID-19 Surveillance Cell ( email )

United Kingdom

Rafael Araos

Ministry of Health, Chile ( email )

Santiago
Chile

Facultad de Medicina Clínica Alemana Universidad del Desarrollo ( email )

Santiago de Chile
Chile

Yair Goldberg

Sheba Medical Center - The Gertner Institute for Epidemiology & Health Policy Research ( email )

Israel

Michelle Groome

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Johannesburg
South Africa

University of the Witwatersrand - School of Pathology ( email )

Johannesburg
South Africa

Amit Huppert

Sheba Medical Center - Central Virology Laboratory ( email )

Ramat-Gan
Israel

Chaim Sheba Medical Center - Bio-statistical and Bio-mathematical Unit ( email )

Tel Hashomer
Ramat-Gan
Israel

Katherine O'Brien

World Health Organization (WHO)

20 Avenue Appia
Geneva 27, CH-1211
Switzerland

Johns Hopkins Bloomberg School of Public Health - Department of International Health, International Vaccine Access Center ( email )

United States

Peter G. Smith

MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine ( email )

Annelies Wilder-Smith

World Health Organization (WHO) - Department of Immunizations, Vaccines and Biologicals ( email )

Switzerland

Scott L Zeger

Johns Hopkins University - Department of Epidemiology ( email )

MD
United States

Maria D. Knoll

Johns Hopkins Bloomberg School of Public Health - Department of International Health, International Vaccine Access Center ( email )

United States

Minal Patel

affiliation not provided to SSRN ( email )

No Address Available

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