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. 2022 Apr;28(4):831-837.
doi: 10.1038/s41591-022-01699-1. Epub 2022 Jan 14.

Effectiveness of COVID-19 booster vaccines against COVID-19-related symptoms, hospitalization and death in England

Nick Andrews #  1   2 , Julia Stowe #  1   2 , Freja Kirsebom  1 , Samuel Toffa  1 , Ruchira Sachdeva  1 , Charlotte Gower  1 , Mary Ramsay  1   2 , Jamie Lopez Bernal  3   4   5
Affiliations

Effectiveness of COVID-19 booster vaccines against COVID-19-related symptoms, hospitalization and death in England

Nick Andrews et al. Nat Med. 2022 Apr.

Abstract

Booster vaccination with messenger RNA (mRNA) vaccines has been offered to adults in England starting on 14 September 2021. We used a test-negative case-control design to estimate the relative effectiveness of a booster dose of BNT162b2 (Pfizer-BioNTech) compared to only a two-dose primary course (at least 175 days after the second dose) or unvaccinated individuals from 13 September 2021 to 5 December 2021, when Delta variant was dominant in circulation. Outcomes were symptomatic coronavirus disease 2019 (COVID-19) and hospitalization. The relative effectiveness against symptomatic disease 14-34 days after a BNT162b2 or mRNA-1273 (Moderna) booster after a ChAdOx1-S (AstraZeneca) and BNT162b2 as a primary course ranged from around 85% to 95%. Absolute vaccine effectiveness ranged from 94% to 97% and was similar in all age groups. Limited waning was seen 10 or more weeks after the booster. Against hospitalization or death, absolute effectiveness of a BNT162b2 booster ranged from around 97% to 99% in all age groups irrespective of the primary course, with no evidence of waning up to 10 weeks. This study provides real-world evidence of substantially increased protection from the booster vaccine dose against mild and severe disease irrespective of the primary course.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Estimates of vaccine effectiveness against symptomatic disease after booster according to primary course.
a,b, Vaccine effectiveness estimates (95% CI) against symptomatic disease in time intervals after booster according to primary course in individuals aged 18–49 years (a) 50 years and older (b). Dose 2 was received at 175 days as the baseline.
Fig. 2
Fig. 2. Vaccine effectiveness estimates in time intervals after booster according to primary course against hospitalization or death.
a–c, Vaccine effectiveness estimates (95% CI) in time intervals after booster according to primary course against hospitalization in individuals aged 18–49 years (a) and 50 years and older (b) and against death in individuals aged 50 years and older (c). Unvaccinated individuals served as the baseline.
Extended Data Fig. 1
Extended Data Fig. 1
Distribution (%) and counts of cases and controls by interval from booster to onset.
Extended Data Fig. 2
Extended Data Fig. 2
Vaccine Effectiveness estimates (95% CI) against symptomatic disease in time intervals post booster according to primary course in individuals aged a) 18 to 49 years b) 50 years and over: Dose 3 at 2-6 days as baseline.
Extended Data Fig. 3
Extended Data Fig. 3
Vaccine Effectiveness estimates (95% CI) against symptomatic disease in time intervals post booster according to primary course in individuals aged a) 18 to 49 years b) 50 years and over: Unvaccinated baseline.
Extended Data Fig. 4
Extended Data Fig. 4
The distribution of intervals between dose 2 and the booster dose for cases and controls by age group and manufacturer.
See this image and copyright information in PMC

References

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Supplementary concepts