Comparative Safety and Effectiveness of Heterologous CoronaVac-ChAdOx1 versus Homologous CoronaVac Vaccination in a Real-World Setting: A Retrospective Cohort Study

Abstract

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has outpaced vaccine availability and delivery from vaccine manufacturers, and thus, a scarcity of vaccines happened to many countries around the world. In Thailand, the mixing of different types of vaccines was approved and clinically implemented partially due to concerns about the availability and efficacy of one vaccine. Objective: This study aimed to investigate the effectiveness and safety of heterologous CoronaVac-ChAdOx1 nCoV-19 vaccines compared with the usual regimen of homologous CoronaVac-CoronaVac. A retrospective cohort study was conducted by dividing patients into the CoronaVac-CoronaVac group and the CoronaVac-ChAdOx1 group. Results: A total of 875 patients received vaccinations at Srisangwan Hospital between April to October 2021 and were included for analysis. The patients in both homologous and heterologous groups had low rates of COVID-19 infection. In addition, the hospitalization rates in the 40 days after the second vaccination were low in both regimens. Minimal adverse events (AE) were reported in both groups, including local AE (e.g., discomfort at the injection site, rash, soreness, swelling, and redness) and systemic AE (e.g., fever, headache, weariness, nausea, vomiting, diarrhoea, and myalgia). Moreover, several factors were associated with lower adverse events following immunization (AEFIs), including age ≥ 50 years, male, and body weight ≥ 50 kg. In contrast, thyroid disease, diabetes mellitus, allergic rhinitis, and psychiatric disorders were independent risk factors associated with an increase in AEFIs. Conclusions: The heterologous CoronaVac-ChAdOx1 and homologous CoronaVac-CoronaVac regimens were promising vaccination strategies for the prevention of SARS-CoV-2 infection. However, the heterologous CoronaVac-ChAdOx1 potentially caused fewer AEFIs compared with the homologous CoronaVac-CoronaVac regimen.

Keywords: ChAdOx1; CoronaVac; heterologous vaccine regimen; homologous vaccine regimen; real-world setting.

Figure 1

Flowchart of participants in this study.

Figure 2

The effectiveness of COVID-19 vaccination against COVID-19 infection after 14 days of second dose injection, as assessed using the log-rank test.

Figure 3

Hazard ratios for AEFIs after COVID-19 vaccination, as assessed using the multivariate Cox proportional hazards model (adjusted for propensity score, which included body weight, age, diabetes mellitus, hypertension, history of drug allergy, and allergic rhinitis).

Figure 4

Hazard ratio for any local reactions after COVID-19 vaccination, as assessed using the multivariate Cox proportional hazards model (adjusted for propensity score, which included body weight, age, diabetes mellitus, hypertension, history of drug allergy, and allergic rhinitis).

Figure 5

Hazard ratio for any systemic reactions after COVID-19 vaccination, as assessed using the multivariate Cox proportional hazards model (adjusted for propensity score, which included body weight, age, diabetes mellitus, hypertension, history of drug allergy, and allergic rhinitis).