Cited by 96SARS-CoV-2 and COVID-19 ResearchCOVID-19 Clinical Research StudiesVaccine Coverage and Hesitancy

Effectiveness of ChAdOx1 nCoV-19 vaccine against SARS-CoV-2 infection during the delta (B.1.617.2) variant surge in India: a test-negative, case-control study and a mechanistic study of post-vaccination immune responses

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Thiruvengadam, Ramachandran, Awasthi, Amit, Medigeshi, Guruprasad, Bhattacharya, Sankar, Mani, Shailendra, Sivasubbu, Sridhar, Shrivastava, Tripti, Samal, Sweety +25 more·2022·The Lancet Infectious Diseases

Abstract

Background SARS-CoV-2 variants of concern (VOCs) have threatened COVID-19 vaccine effectiveness. We aimed to assess the effectiveness of the ChAdOx1 nCoV-19 vaccine, predominantly against the delta (B.1.617.2) variant, in addition to the cellular immune response to vaccination.Methods We did a test-negative, case-control study at two medical research centres in Faridabad, India. All individuals who had a positive RT-PCR test for SARS-CoV-2 infection between April 1, 2021, and May 31, 2021, were included as cases and individuals who had a negative RT-PCR test were included as controls after matching with cases on calendar week of RT-PCR test. The primary outcome was effectiveness of complete vaccination with the ChAdOx1 nCoV-19 vaccine against laboratory-confirmed SARS-CoV-2 infection. The secondary outcomes were effectiveness of a single dose against SARS-CoV-2 infection and effectiveness of a single dose and complete vaccination against moderate-to-severe disease among infected individuals. Additionally, we tested in-vitro live-virus neutralisation and T-cell immune responses to the spike protein of the wild-type SARS-CoV-2 and VOCs among healthy (anti-nucleocapsid antibody negative) recipients of the ChAdOx1 nCoV-19 vaccine.Findings Of 2379 cases of confirmed SARS-CoV-2 infection, 85 (3·6%) were fully vaccinated compared with 168 (8·5%) of 1981 controls (adjusted OR [aOR] 0·37 [95% CI 0·28-0·48]), giving a vaccine effectiveness against SARS-CoV-2 infection of 63·1% (95% CI 51·5-72·1). 157 (6·4%) of 2451 of cases and 181 (9·1%) of 1994) controls had received a single dose of the ChAdOx1 nCoV-19 vaccine (aOR 0·54 [95% CI 0·42-0·68]), thus vaccine effectiveness of a single dose against SARS-CoV-2 infection was 46·2% (95% CI 31·6-57·7). One of 84 cases with moderate-to-severe COVID-19 was fully vaccinated compared with 84 of 2295 cases with mild COVID-19 (aOR 0·19 [95% CI 0·01-0·90]), giving a vaccine effectiveness of complete vaccination against moderate-to-severe disease of 81·5% (95% CI 9·9-99·0). The effectiveness of a single dose against moderate-to-severe disease was 79·2% (95% CI 46·1-94·0); four of 87 individuals with moderate-to-severe COVID-19 had received a single dose compared with 153 of 2364 participants with mild disease (aOR 0·20 [95% CI 0·06-0·54]). Among 49 healthy, fully vaccinated individuals, neutralising antibody responses were lower against the alpha (B.1.1.7; geometric mean titre 244·7 [95% CI 151·8-394·4]), beta (B.1.351; 97·6 [61·2-155·8]), kappa (B.1.617.1; 112·8 [72·7-175·0]), and delta (88·4 [61·2-127·8]) variants than against wild-type SARS-CoV-2 (599·4 [376·9-953·2]). However, the antigen-specific CD4 and CD8 T-cell responses were conserved against both the delta variant and wild-type SARS-CoV-2.Interpretation The ChAdOx1 nCoV-19 vaccine remained effective against moderate-to-severe COVID-19, even during a surge that was dominated by the highly transmissible delta variant of SARS-CoV-2. Spike-specific T-cell responses were maintained against the delta variant. Such cellular immune protection might compensate for waning humoral immunity.Funding Department of Biotechnology India, Council of Scientific and Industrial Research India, and Fondation Botnar.

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  • Effectiveness of ChAdOx1 against Delta variant-associated severe disease has been estimated at ≥80% in multiple postlicensure studies, including in India.

    “Effectiveness of ChAdOx1 against Delta variant-associated severe disease has been estimated at ≥80% in multiple postlicensure studies63,64, including in India65.”

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  1. [2]WHO COVID-19 weekly epidemiological update https://www.who.int/docs/default-source/coronaviruse/situation-reports/20210511_Weekly_Epi_Update_39.pdf PMC11002403 38580376
  2. [25]Public Health England Effectiveness of COVID-19 vaccines against hospital admission with the delta (B.1.617.2) variant https://khub.net/documents/135939561/479607266/Effectiveness+of+COVID-19+vaccines+against+hospital+admission+with+the+Delta+%28B.1.617.2%29+variant.pdf/1c213463-3997-ed16-2a6f-14e5deb0b997?t=1623689315431 (preprint).
  3. [28]Tarke A Sidney J Methot N Impact of SARS-CoV-2 variants on the total CD4+ and CD8+ T cell reactivity in infected or vaccinated individuals Cell Rep Med 2 2021 100355 PMC8249675 34230917

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Authors
Thiruvengadam, R., Awasthi, A., Medigeshi, G., Bhattacharya, S., Mani, S., Sivasubbu, S., Shrivastava, T., Samal, S., Rathna Murugesan, D., Koundinya Desiraju, B., Kshetrapal, P., Pandey, R., Scaria, V., Kumar Malik, P., Taneja, J., Binayke, A., Vohra, T., Zaheer, A., Rathore, D., Ahmad Khan, N., Shaman, H., Ahmed, S., Kumar, R., Deshpande, S., Subramani, C., Wadhwa, N., Gupta, N., Pandey, A. K., Bhattacharya, J., Agrawal, A., Vrati, S., Bhatnagar, S., & Garg, P. K.
Affiliations
  • Translational Health Science and Technology Institute (IN)
  • Institute of Genomics and Integrative Biology (IN)
  • ESIC Hospital (IN)
  • Regional Centre for Biotechnology (IN)
  • National Institute of Immunology (IN)
  • International AIDS Vaccine Initiative (US)
Corresponding author
Garg, Pramod Kumar
Venue
The Lancet Infectious Diseases
Publisher
Elsevier BV
Published
2022-04
Volume
22
Issue
4
Pages
473-482
ISSN
1473-3099 (ISSN-L)
OpenAlex
W3216474128
Cited by
96
References
26
Citations by year
2026: 2 · 2025: 9 · 2024: 11 · 2023: 24 · 2022: 48 · 2021: 1
FWCI
6.65
Type
journal article
Language
en
Open access
Locations
  • The Lancet Infectious Diseases (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Fondation Botnar (CLP-0031)
  • Department of Biotechnology Ministry of Science and Technology (102/IFD/SAN/5477/2018-2019, BT/CS0010/CS/02/20, BT/PR40401/BIOBANK/03/2020)
  • Regional Centre for Biotechnology
  • CSIR (MLP-2005)
Topics
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
Keywords
ChAdOx1 nCoV-19 vaccine, SARS-CoV-2, COVID-19 vaccine effectiveness, Delta variant, variants of concern, test-negative case-control, T cell response, spike protein, single-dose vaccination, moderate to severe COVID-19, India
MeSH terms
COVID-19, SARS-CoV-2, COVID-19 Vaccines, ChAdOx1 nCoV-19, Antibody Formation, Humans, Vaccination, Case-Control Studies

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