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Efficacy of SARS-CoV-2 vaccines and the dose–response relationship with three major antibodies: a systematic review and meta-analysis of randomised controlled trials
Open accessAbstract
BACKGROUND: The efficacy of SARS-CoV-2 vaccines in preventing severe COVID-19 illness and death is uncertain due to the rarity of data in individual trials. How well the antibody concentrations can predict the efficacy is also uncertain. We aimed to assess the efficacy of these vaccines in preventing SARS-CoV-2 infections of different severities and the dose-response relationship between the antibody concentrations and efficacy. METHODS: We did a systematic review and meta-analysis of randomised controlled trials (RCTs). We searched PubMed, Embase, Scopus, Web of Science, Cochrane Library, WHO, bioRxiv, and medRxiv for papers published between Jan 1, 2020 and Sep 12, 2022. RCTs on the efficacy of SARS-CoV-2 vaccines were eligible. Risk of bias was assessed using the Cochrane tool. A frequentist, random-effects model was used to combine efficacy for common outcomes (ie, symptomatic and asymptomatic infections) and a Bayesian random-effects model was used for rare outcomes (ie, hospital admission, severe infection, and death). Potential sources of heterogeneity were investigated. The dose-response relationships of neutralising, spike-specific IgG and receptor binding domain-specific IgG antibody titres with efficacy in preventing SARS-CoV-2 symptomatic and severe infections were examined by meta-regression. This systematic review is registered with PROSPERO, CRD42021287238. FINDINGS: 28 RCTs (n=286 915 in vaccination groups and n=233 236 in placebo groups; median follow-up 1-6 months after last vaccination) across 32 publications were included in this review. The combined efficacy of full vaccination was 44·5% (95% CI 27·8-57·4) for preventing asymptomatic infections, 76·5% (69·8-81·7) for preventing symptomatic infections, 95·4% (95% credible interval 88·0-98·7) for preventing hospitalisation, 90·8% (85·5-95·1) for preventing severe infection, and 85·8% (68·7-94·6) for preventing death. There was heterogeneity in the efficacy of SARS-CoV-2 vaccines against asymptomatic and symptomatic infections but insufficient evidence to suggest whether the efficacy could differ according to the type of vaccine, age of the vaccinated individual, and between-dose interval (p>0·05 for all). Vaccine efficacy against symptomatic infection waned over time after full vaccination, with an average decrease of 13·6% (95% CI 5·5-22·3; p=0·0007) per month but can be enhanced by a booster. We found a significant non-linear relationship between each type of antibody and efficacy against symptomatic and severe infections (p<0·0001 for all), but there remained considerable heterogeneity in the efficacy, which cannot be explained by antibody concentrations. The risk of bias was low in most studies. INTERPRETATION: The efficacy of SARS-CoV-2 vaccines is higher for preventing severe infection and death than for preventing milder infection. Vaccine efficacy wanes over time but can be enhanced by a booster. Higher antibody titres are associated with higher estimates of efficacy but precise predictions are difficult due to large unexplained heterogeneity. These findings provide an important knowledge base for interpretation and application of future studies on these issues. FUNDING: Shenzhen Science and Technology Programs.
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“In our review, we found a pooled VE of 71% against SARS-CoV-2 infection, whereas systematic reviews of randomised clinical trials reported higher pooled vaccine efficacy of 83% [26] and 77% [27].”
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GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schünemann, H. J. (2008) · BMJ · doi:10.1136/bmj.39489.470347.ad · Cited by 23,305
Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., et al. (2021) · BMJ · doi:10.1136/bmj.n160 · Cited by 13,262
Gelman, A. (2006) · Bayesian Analysis · doi:10.1214/06-ba117a · Cited by 4,050
Khoury, D. S., Cromer, D., Reynaldi, A., Schlub, T. E., Wheatley, A. K., Juno, J. A., Subbarao, K., Kent, S. J., Triccas, J. A., & Davenport, M. P. (2021) · Nature Medicine · doi:10.1038/s41591-021-01377-8 · Cited by 3,742
Effectiveness of COVID-19 vaccines against the Omicron (B.1.1.529) variant of concern
Andrews, N., Stowe, J., Kirsebom, F., Toffa, S., Rickeard, T., Gallagher, E., Gower, C., Kall, M., Groves, N., O’Connell, A.-M., et al. (2021) · doi:10.1101/2021.12.14.21267615 · Cited by 2,420
Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19
Sadoff, J., Gray, G., Vandebosch, A., Cárdenas, V., Shukarev, G., Grinsztejn, B., Goepfert, P. A., Truyers, C., Fennema, H., Spiessens, B., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2101544 · Cited by 2,397
Logunov, D. Y., Dolzhikova, I. V., Shcheblyakov, D. V., Tukhvatulin, A. I., Zubkova, O. V., Dzharullaeva, A. S., Kovyrshina, A. V., Lubenets, N. L., Grousova, D. M., Erokhova, A. S., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00234-8 · Cited by 1,747
Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months
Thomas, S. J., Moreira, E. D., Kitchin, N., Absalon, J., Gurtman, A., Lockhart, S., Perez, J. L., Pérez Marc, G., Polack, F. P., Zerbini, C., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2110345 · Cited by 1,640
Efficacy of the ChAdOx1 nCoV-19 Covid-19 Vaccine against the B.1.351 Variant
Madhi, S. A., Baillie, V., Cutland, C. L., Voysey, M., Koen, A. L., Fairlie, L., Padayachee, S. D., Dheda, K., Barnabas, S. L., Bhorat, Q. E., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2102214 · Cited by 1,257
Feikin, D. R., Higdon, M. M., Abu-Raddad, L. J., Andrews, N., Araos, R., Goldberg, Y., Groome, M. J., Huppert, A., O'Brien, K. L., Smith, P. G., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)00152-0 · Cited by 1,237
Research works printed but not linked: 1
- Andrews, 2022, COVID-19 vaccine effectiveness against the omicron (B.1.1.529) variant, N Engl J Med, 386, 1532, 10.1056/NEJMoa2119451 · DOI · Paper page
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Choi, Y., Kim, H. J., Park, J., Lee, M., Kim, S. Y., Koyanagi, A., Smith, L., Kim, M. S., Rahmati, M., Lee, H., et al. (2024) · Nature Communications · doi:10.1038/s41467-024-48825-w · Cited by 60
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Metadata
- Authors
- Yang, Z.-R., Jiang, Y.-W., Li, F.-X., Liu, D., Lin, T.-F., Zhao, Z.-Y., Wei, C., Jin, Q.-Y., Li, X.-M., Jia, Y.-X., Zhu, F.-C., Yang, Z.-Y., Sha, F., Feng, Z.-J., & Tang, J.-L.
- Affiliations
- Chinese Academy of Sciences (CN)
- Sun Yat-sen University (CN)
- Chinese University of Hong Kong (HK)
- Corresponding author
- Yang, Zu-Yao
- Sha, Feng
- Venue
- The Lancet Microbe
- Publisher
- Elsevier BV
- Published
- 2023-04
- Volume
- 4
- Issue
- 4
- Pages
- e236-e246
- ISSN
- 2666-5247 (ISSN-L)
- PMC
- PMC9974155
- OpenAlex
- W4322603953
- Cited by
- 138
- References
- 65
- Citations by year
- 2026: 20 · 2025: 36 · 2024: 48 · 2023: 34
- FWCI
- 6.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Microbe (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- COVID-19 vaccines, COVID-19 vaccine efficacy, dose-response relationship, neutralizing antibodies, anti-spike IgG, asymptomatic infection, symptomatic infection, hospitalization prevention, vaccine-induced immunity, SARS-CoV-2, COVID-19 mortality, SARS-CoV-2 variants
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Vaccines, Humans, Immunoglobulin G, Randomized Controlled Trials as Topic, Asymptomatic Infections
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