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. 2023 Nov;28(48):2300173.
doi: 10.2807/1560-7917.ES.2023.28.48.2300173.

Relative vaccine effectiveness of mRNA COVID-19 boosters in people aged at least 75 years during the spring-summer (monovalent vaccine) and autumn-winter (bivalent vaccine) booster campaigns: a prospective test negative case-control study, United Kingdom, 2022

Anastasia Chatzilena  1   2   3 , Catherine Hyams  1   4   2 , Rob Challen  2   3 , Robin Marlow  4 , Jade King  5 , David Adegbite  2 , Jane Kinney  2 , Madeleine Clout  2 , Nick Maskell  6 , Jennifer Oliver  2 , Adam Finn  1   7   2 , Leon Danon  1   2   3 ; Avon CAP Research Group  8
Affiliations

Relative vaccine effectiveness of mRNA COVID-19 boosters in people aged at least 75 years during the spring-summer (monovalent vaccine) and autumn-winter (bivalent vaccine) booster campaigns: a prospective test negative case-control study, United Kingdom, 2022

Anastasia Chatzilena et al. Euro Surveill. 2023 Nov.

Abstract

BackgroundUnderstanding the relative vaccine effectiveness (rVE) of new COVID-19 vaccine formulations against SARS-CoV-2 infection is a public health priority. A precise analysis of the rVE of monovalent and bivalent boosters given during the 2022 spring-summer and autumn-winter campaigns, respectively, in a defined population remains of interest.AimWe assessed rVE against hospitalisation for the spring-summer (fourth vs third monovalent mRNA vaccine doses) and autumn-winter (fifth BA.1/ancestral bivalent vs fourth monovalent mRNA vaccine dose) boosters.MethodsWe performed a prospective single-centre test-negative design case-control study in ≥ 75-year-old people hospitalised with COVID-19 or other acute respiratory disease. We conducted regression analyses controlling for age, sex, socioeconomic status, patient comorbidities, community SARS-CoV-2 prevalence, vaccine brand and time between baseline dose and hospitalisation.ResultsWe included 682 controls and 182 cases in the spring-summer booster analysis and 572 controls and 152 cases in the autumn-winter booster analysis. A monovalent mRNA COVID-19 vaccine as fourth dose showed 46.6% rVE (95% confidence interval (CI): 13.9-67.1) vs those not fully boosted. A bivalent mRNA COVID-19 vaccine as fifth dose had 46.7% rVE (95% CI: 18.0-65.1), compared with a fourth monovalent mRNA COVID-19 vaccine dose.ConclusionsBoth fourth monovalent and fifth BA.1/ancestral mRNA bivalent COVID-19 vaccine doses demonstrated benefit as a booster in older adults. Bivalent mRNA boosters offered similar protection against hospitalisation with Omicron infection to monovalent mRNA boosters given earlier in the year. These findings support immunisation programmes in several European countries that advised the use of BA.1/ancestral bivalent booster doses.

Keywords: COVID-19; SARS-CoV-2; respiratory infection; vaccination.

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Conflict of interest statement

Conflict of interest: CH is Principal Investigator of the AvonCAP study which is an investigator-led University of Bristol study funded by Pfizer and has previously received support from the NIHR in an Academic Clinical Fellowship. JO and LD are Co-Investigators on the AvonCAP Study. AF is a member of the Joint Committee on Vaccination and Immunization (JCVI) and, until December 2022 was chair of the World Health Organization European Technical Advisory Group of Experts on Immunization (ETAGE) committee. In addition to receiving funding from Pfizer as Chief Investigator of this study, he leads another project investigating transmission of respiratory bacteria in families jointly funded by Pfizer and the Gates Foundation. The other authors have no relevant conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study flow diagram, inclusion and exclusion criteria, case–control study on COVID-19 booster vaccine effectiveness, United Kingdom, April 2022–January 2023 (n = 9,868)
Figure 2
Figure 2
Study timeline, case–control study on COVID-19 booster vaccine effectiveness, United Kingdom, 2022
See this image and copyright information in PMC

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