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. 2022 Apr 22;13(1):2202.
doi: 10.1038/s41467-022-29858-5.

Comparing COVID-19-related hospitalization rates among individuals with infection-induced and vaccine-induced immunity in Israel

Jacob G Waxman #  1 , Maya Makov-Assif #  2 , Ben Y Reis  3   4   5 , Doron Netzer  6 , Ran D Balicer  2   5   7 , Noa Dagan  2   5   8   9 , Noam Barda  8   9   10
Affiliations

Comparing COVID-19-related hospitalization rates among individuals with infection-induced and vaccine-induced immunity in Israel

Jacob G Waxman et al. Nat Commun. .

Abstract

With the COVID-19 pandemic ongoing, accurate assessment of population immunity and the effectiveness of booster and enhancer vaccine doses is critical. We compare COVID-19-related hospitalization incidence rates in 2,412,755 individuals across four exposure levels: non-recent vaccine immunity (two BNT162b2 COVID-19 vaccine doses five or more months prior), boosted vaccine immunity (three BNT162b2 doses), infection-induced immunity (previous COVID-19 without a subsequent BNT162b2 dose), and enhanced infection-induced immunity (previous COVID-19 with a subsequent BNT162b2 dose). Rates, adjusted for potential demographic, clinical and health-seeking-behavior confounders, were assessed from July-November 2021 when the Delta variant was predominant. Compared with non-recent vaccine immunity, COVID-19-related hospitalization incidence rates were reduced by 89% (87-91%) for boosted vaccine immunity, 66% (50-77%) for infection-induced immunity and 75% (61-83%) for enhanced infection-induced immunity. We demonstrate that infection-induced immunity (enhanced or not) provides more protection against COVID-19-related hospitalization than non-recent vaccine immunity, but less protection than booster vaccination. Additionally, our results suggest that vaccinating individuals with infection-induced immunity further enhances their protection.

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Conflict of interest statement

J.G.W, N.D., M.M.A., and R.D.B. report institutional grants to the Clalit Research Institute from Pfizer outside the submitted work and unrelated to COVID-19, with no direct or indirect personal benefits. BYR reports grants from NIH outside the submitted work. All other authors report no competing interests.

Figures

Fig. 1
Fig. 1. Study population flow chart.
Size and percentage change of study population resulting from each inclusion and exclusion criteria.
Fig. 2
Fig. 2. Reduction in incidence rate of COVID-19-related hospitalization compared to non-recent vaccine immunity (dashed blue line at x = 0).
Data are presented as point estimates of the percentage reduction in incidence rate (1−IRR) and 95% confidence intervals. N (person-days at risk) = 143,612,328 for boosted vaccine immunity, 9,759,128 for infection-induced immunity, 9,266,031 for enhanced infection-induced immunity and 72,914,787 for non-recent vaccine immunity (reference, dashed blue line).
See this image and copyright information in PMC

References

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Supplementary concepts