Protection of BNT162b2 Vaccine Booster against Covid-19 in Israel
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Abstract
BACKGROUND: On July 30, 2021, the administration of a third (booster) dose of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) was approved in Israel for persons who were 60 years of age or older and who had received a second dose of vaccine at least 5 months earlier. Data are needed regarding the effect of the booster dose on the rate of confirmed coronavirus 2019 disease (Covid-19) and the rate of severe illness. METHODS: We extracted data for the period from July 30 through August 31, 2021, from the Israeli Ministry of Health database regarding 1,137,804 persons who were 60 years of age or older and had been fully vaccinated (i.e., had received two doses of BNT162b2) at least 5 months earlier. In the primary analysis, we compared the rate of confirmed Covid-19 and the rate of severe illness between those who had received a booster injection at least 12 days earlier (booster group) and those who had not received a booster injection (nonbooster group). In a secondary analysis, we evaluated the rate of infection 4 to 6 days after the booster dose as compared with the rate at least 12 days after the booster. In all the analyses, we used Poisson regression after adjusting for possible confounding factors. RESULTS: At least 12 days after the booster dose, the rate of confirmed infection was lower in the booster group than in the nonbooster group by a factor of 11.3 (95% confidence interval [CI], 10.4 to 12.3); the rate of severe illness was lower by a factor of 19.5 (95% CI, 12.9 to 29.5). In a secondary analysis, the rate of confirmed infection at least 12 days after vaccination was lower than the rate after 4 to 6 days by a factor of 5.4 (95% CI, 4.8 to 6.1). CONCLUSIONS: In this study involving participants who were 60 years of age or older and had received two doses of the BNT162b2 vaccine at least 5 months earlier, we found that the rates of confirmed Covid-19 and severe illness were substantially lower among those who received a booster (third) dose of the BNT162b2 vaccine.
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Plenty of articles have demonstrated the efficacy of two-dose vaccination and additional boosters in reducing mortality and severe cases.
“As plenty of articles have demonstrated the efficacy of two-dose vaccination and additional boosters in reducing mortality and severe cases [13,14,35-37]”
From Protective effect of COVID-19 vaccination against long COVID syndrome: A systematic review and meta-analysis (2023) · cites this paper as [37]
The Results (Effect of the Booster Dose; page not provided) report substantially fewer severe Covid-19 cases among booster recipients than among participants who had received only two doses. The paper does not report mortality as an outcome, and its comparison does not establish the effect of two doses versus no vaccination. It therefore supports the booster-and-severe-illness part of the cited statement, but not the full claim. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe third dose of BNT162b2 increases immunogenicity against SARS-CoV-2, as reflected by a rapid and broad immune response.
“Studies have demonstrated that the third dose increases immunogenicity against SARS-CoV-2 as reflected by a rapid and broad immune response to the third BNT162b2 dose7,11.”
From Waning effectiveness of the third dose of the BNT162b2 mRNA COVID-19 vaccine (2022) · cites this paper as [7]
The passage labeled Abstract > Conclusions (page not provided) reports that initial studies suggested a roughly tenfold increase in antibody neutralization after a BNT162b2 booster. Methods > Study Design (page not provided) says neutralization levels increase after several days. The paper does not establish a broad immune response; its own study measured infection and severe illness, not immunogenicity. (LLM, conf=0.85)
Experimental — accuracy not yet measuredBooster vaccines seem promising both in preventing infection and severe progression.
“Since booster vaccines seem promising both in preventing infection and severe progression [35-37]”
From Protective effect of COVID-19 vaccination against long COVID syndrome: A systematic review and meta-analysis (2023) · cites this paper as [37]
The lack of pre-defined PCR testing protocols implemented in the study population presented a challenge and could lead to potential biases relating to healthcare seeking behaviour.
“The lack of pre-defined PCR testing protocols implemented in the study population also presented a challenge. This limitation has been discussed extensively in previous covid-19 observational studies and could lead to potential biases relating to healthcare seeking behaviour.6 11 38 39”
Results from clinical trials with over 5,000 people who had received BioNTech/Pfizer booster injections showed that protection conferred by the vaccine was 95.6%.
“However, results from clinical trials with over 5,000 people who had received BioNTech/Pfizer booster injections showed that protection conferred by the vaccine was 95.6%.392–394”
From Advances in COVID-19 mRNA vaccine development (2022) · cites this paper as [393]
An Israeli study looking at the population ≥60 years of age receiving a single booster of BNT162b2 given at least 5 months after completion of the prime-boost primary regimen demonstrated 95% fewer reports of severe illness and significantly lower rate of confirmed COVID-19 cases.
“An Israeli study looking at the population ≥60 years of age receiving a single booster of BNT162b2 given at least 5 months after completion of the p-b primary regimen demonstrated 95% fewer reports of severe illness and significantly lower rate of confirmed COVID-19 cases.111”
From COVID-19 mRNA vaccines: Platforms and current developments (2022) · cites this paper as [111]
Third (booster) doses provide a rapid and substantial increase in protection against both mild and severe disease.
“However, third (booster) doses provide a rapid and substantial increase in protection against both mild and severe disease.”
From Effectiveness of COVID-19 vaccines against the Omicron (B.1.1.529) variant of concern (2021) · cites this paper as [24]
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Cites
BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting
Dagan, N., Barda, N., Kepten, E., Miron, O., Perchik, S., Katz, M. A., Hernán, M. A., Lipsitch, M., Reis, B., & Balicer, R. D. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2101765 · Cited by 2,527 · see citing works
Haas, E. J., Angulo, F. J., McLaughlin, J. M., Anis, E., Singer, S. R., Khan, F., Brooks, N., Smaja, M., Mircus, G., Pan, K., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00947-8 · Cited by 1,564 · see citing works
Self-citationCorrelation of SARS-CoV-2-breakthrough infections to time-from-vaccine
Mizrahi, B., Lotan, R., Kalkstein, N., Peretz, A., Perez, G., Ben-Tov, A., Chodick, G., Gazit, S., & Patalon, T. (2021) · Nature Communications · doi:10.1038/s41467-021-26672-3 · Cited by 261 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 12
- [2]2. Goldberg Y, Mandel M, Bar-On YM, et al. Waning immunity of the BNT162b2 vaccine: a nationwide study from Israel. August 30, 2021. (https://www.medrxiv.org/content/10.1101/2021.08.24.21262423v1). preprint. · DOI
- [5]5. Wall EC, Wu M, Harvey R, et al. Neutralising antibody activity against SARS-CoV-2 VOCs B.1.617.2 and B.1.351 by BNT162b2 vaccination. Lancet 2021;397:2331-2333.
- [6]6. Pfizer quarterly corporate performance — second quarter 2021. Pfizer, July 28, 2021. (https://investors.pfizer.com/events-and-presentations/event-details/2021/Pfizer-Quarterly-Corporate-Performance--Second-Quarter-2021/default.aspx).
- [7]7. Khoury DS, Cromer D, Reynaldi A, et al. Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection. Nat Med 2021;27:1205-1211.
- [8]8. Muhsen K, Na’aminh W, Lapidot Y, et al. A nationwide analysis of population group differences in the COVID-19 epidemic in Israel, February 2020–February 2021. Lancet Reg Health Eur 2021;7:100130-100130.
- [10]10. Lustig Y, Sapir E, Regev-Yochay G, et al. BNT162b2 COVID-19 vaccine and correlates of humoral immune responses and dynamics: a prospective, single-centre, longitudinal cohort study in health-care workers. Lancet Respir Med 2021;9:999-1009.
- [11]11. Walsh EE, Frenck RW Jr, Falsey AR, et al. Safety and immunogenicity of two RNA-based Covid-19 vaccine candidates. N Engl J Med 2020;383:2439-2450.
- [12]12. McAloon C, Collins Á, Hunt K, et al. Incubation period of COVID-19: a rapid systematic review and meta-analysis of observational research. BMJ Open 2020;10(8):e039652-e039652.
- [13]13. Xin H, Wong JY, Murphy C, et al. The incubation period distribution of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. Clin Infect Dis 2021. June 12 (Epub ahead of print).
- [15]15. Kleinman LC, Norton EC. What’s the risk? A simple approach for estimating adjusted risk measures from nonlinear models including logistic regression. Health Serv Res 2009;44:288-302.
- [16]16. Puranik A, Lenehan PJ, Silvert E, et al. Comparison of two highly-effective mRNA vaccines for COVID-19 during periods of Alpha and Delta variant prevalence. August 21, 2021. (https://www.medrxiv.org/content/10.1101/2021.08.06.21261707v3). preprint. · DOI
- [17]17. Tang P, Hasan MR, Chemaitelly H, et al. BNT162b2 and mRNA-1273 COVID-19 vaccine effectiveness against the Delta (B.1.617.2) variant in Qatar. August 11, 2021. (https://www.medrxiv.org/content/10.1101/2021.08.11.21261885v1). preprint. · DOI
Cited by
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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 · see citing works
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 · see citing works
Self-citationmRNA-based COVID-19 vaccine boosters induce neutralizing immunity against SARS-CoV-2 Omicron variant
Garcia-Beltran, W. F., St. Denis, K. J., Hoelzemer, A., Lam, E. C., Nitido, A. D., Sheehan, M. L., Berrios, C., Ofoman, O., Chang, C. C., Hauser, B. M., et al. (2022) · Cell · doi:10.1016/j.cell.2021.12.033 · Cited by 1,045 · see citing works
Barda, N., Dagan, N., Cohen, C., Hernán, M. A., Lipsitch, M., Kohane, I. S., Reis, B. Y., & Balicer, R. D. (2021) · The Lancet · doi:10.1016/s0140-6736(21)02249-2 · Cited by 860 · see citing works
Advances in COVID-19 mRNA vaccine development
Fang, E., Liu, X., Li, M., Zhang, Z., Song, L., Zhu, B., Wu, X., Liu, J., Zhao, D., & Li, Y. (2022) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-022-00950-y · Cited by 601 · see citing works
Thompson, M. G., Natarajan, K., Irving, S. A., Rowley, E. A., Griggs, E. P., Gaglani, M., Klein, N. P., Grannis, S. J., DeSilva, M. B., Stenehjem, E., et al. (2022) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7104e3 · Cited by 398 · see citing works
Andrews, N., Stowe, J., Kirsebom, F., Toffa, S., Sachdeva, R., Gower, C., Ramsay, M., & Lopez Bernal, J. (2022) · Nature Medicine · doi:10.1038/s41591-022-01699-1 · Cited by 453 · see citing works
Watanabe, A., Iwagami, M., Yasuhara, J., Takagi, H., & Kuno, T. (2023) · Vaccine · doi:10.1016/j.vaccine.2023.02.008 · Cited by 304 · see citing works
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Szabó, G. T., Mahiny, A. J., & Vlatkovic, I. (2022) · Molecular Therapy · doi:10.1016/j.ymthe.2022.02.016 · Cited by 308 · see citing works
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Magen, O., Waxman, J. G., Makov-Assif, M., Vered, R., Dicker, D., Hernán, M. A., Lipsitch, M., Reis, B. Y., Balicer, R. D., & Dagan, N. (2022) · New England Journal of Medicine · doi:10.1056/nejmoa2201688 · Cited by 279 · see citing works
Ssentongo, P., Ssentongo, A. E., Voleti, N., Groff, D., Sun, A., Ba, D. M., Nunez, J., Parent, L. J., Chinchilli, V. M., & Paules, C. I. (2022) · BMC Infectious Diseases · doi:10.1186/s12879-022-07418-y · Cited by 260 · see citing works
Ferdinands, J. M., Rao, S., Dixon, B. E., Mitchell, P. K., DeSilva, M. B., Irving, S. A., Lewis, N., Natarajan, K., Stenehjem, E., Grannis, S. J., et al. (2022) · BMJ · doi:10.1136/bmj-2022-072141 · Cited by 185 · see citing works
Gazit, S., Shlezinger, R., Perez, G., Lotan, R., Peretz, A., Ben-Tov, A., Herzel, E., Alapi, H., Cohen, D., Muhsen, K., et al. (2022) · Clinical Infectious Diseases · doi:10.1093/cid/ciac262 · Cited by 283 · see citing works
Waning effectiveness of the third dose of the BNT162b2 mRNA COVID-19 vaccine
Patalon, T., Saciuk, Y., Peretz, A., Perez, G., Lurie, Y., Maor, Y., & Gazit, S. (2022) · Nature Communications · doi:10.1038/s41467-022-30884-6 · Cited by 143 · see citing works
“Studies have demonstrated that the third dose increases immunogenicity against SARS-CoV-2 as reflected by a rapid and broad immune response to the third BNT162b2 dose.(7,11) Our results suggested a time dependent response with a primary increase in VE followed by waning of effectiveness.”
BackgroundVaccination with BNT162b2 reduces transmission of SARS-CoV-2 to household contacts in Israel
Prunas, O., Warren, J. L., Crawford, F. W., Gazit, S., Patalon, T., Weinberger, D. M., & Pitzer, V. E. (2022) · Science · doi:10.1126/science.abl4292 · Cited by 153 · see citing works
Waning Effectiveness of the Third Dose of the BNT162b2 mRNA COVID-19 Vaccine
Patalon, T., Saciuk, Y., Peretz, A., Perez, G., Lurie, Y., Maor, Y., & Gazit, S. (2022) · doi:10.1101/2022.02.25.22271494 · Cited by 143 · see citing works
Patalon, T., Gazit, S., Pitzer, V. E., Prunas, O., Warren, J. L., & Weinberger, D. M. (2022) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2021.7382 · Cited by 141 · see citing works
Katikireddi, S. V., Cerqueira-Silva, T., Vasileiou, E., Robertson, C., Amele, S., Pan, J., Taylor, B., Boaventura, V., Werneck, G. L., Flores-Ortiz, R., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02754-9 · Cited by 124 · see citing works
Gilboa, M., Regev-Yochay, G., Mandelboim, M., Indenbaum, V., Asraf, K., Fluss, R., Amit, S., Mendelson, E., Doolman, R., Afek, A., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.31778 · Cited by 128 · see citing works
Self-citationPersistent B cell memory after SARS-CoV-2 vaccination is functional during breakthrough infections
Terreri, S., Piano Mortari, E., Vinci, M. R., Russo, C., Alteri, C., Albano, C., Colavita, F., Gramigna, G., Agrati, C., Linardos, G., et al. (2022) · Cell Host & Microbe · doi:10.1016/j.chom.2022.01.003 · Cited by 117 · see citing works
Gazit, S., Saciuk, Y., Perez, G., Peretz, A., Pitzer, V. E., & Patalon, T. (2022) · BMJ · doi:10.1136/bmj-2022-071113 · Cited by 87 · see citing works
Protective activity of mRNA vaccines against ancestral and variant SARS-CoV-2 strains
Ying, B., Whitener, B., VanBlargan, L. A., Hassan, A. O., Shrihari, S., Liang, C.-Y., Karl, C. E., Mackin, S., Chen, R. E., Kafai, N. M., et al. (2022) · Science Translational Medicine · doi:10.1126/scitranslmed.abm3302 · Cited by 85 · see citing works
Monge, S., Rojas-Benedicto, A., Olmedo, C., Mazagatos, C., José Sierra, M., Limia, A., Martín-Merino, E., Larrauri, A., Hernán, M. A., Moreno, D., et al. (2022) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(22)00292-4 · Cited by 81 · see citing works
Waning COVID-19 Vaccine Effectiveness for BNT162b2 and CoronaVac in Malaysia: An Observational Study
Suah, J. L., Husin, M., Tok, P. S. K., Tng, B. H., Thevananthan, T., Low, E. V., Appannan, M. R., Muhamad Zin, F., Mohd Zin, S., Yahaya, H., et al. (2022) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2022.03.028 · Cited by 76 · see citing works
Waning of SARS-CoV-2 booster viral-load reduction effectiveness
Levine-Tiefenbrun, M., Yelin, I., Alapi, H., Herzel, E., Kuint, J., Chodick, G., Gazit, S., Patalon, T., & Kishony, R. (2022) · Nature Communications · doi:10.1038/s41467-022-28936-y · Cited by 63 · see citing works
Pratama, N. R., Wafa, I. A., Budi, D. S., Sutanto, H., Asmarawati, T. P., Barlian Effendi, G., & Wungu, C. D. K. (2022) · Vaccines · doi:10.3390/vaccines10122180 · Cited by 30 · see citing works
Romero-Ibarguengoitia, M. E., Rivera-Salinas, D., Hernández-Ruíz, Y. G., Armendariz-Vázquez, A. G., González-Cantú, A., Barco-Flores, I. A., González-Facio, R., Montelongo-Cruz, L. P., Del Rio-Parra, G. F., Garza-Herrera, M. R., et al. (2021) · doi:10.1101/2021.10.20.21265269 · Cited by 29 · see citing works
Uwamino, Y., Kurafuji, T., Takato, K., Sakai, A., Tanabe, A., Noguchi, M., Yatabe, Y., Arai, T., Ohno, A., Tomita, Y., et al. (2022) · Vaccine · doi:10.1016/j.vaccine.2022.06.016 · Cited by 21 · see citing works
Naito, T., Tsuchida, N., Kusunoki, S., Kaneko, Y., Tobita, M., Hori, S., & Ito, S. (2022) · Expert Review of Vaccines · doi:10.1080/14760584.2022.2093722 · Cited by 22 · see citing works
- Authors
- Bar-On, Y. M., Goldberg, Y., Mandel, M., Bodenheimer, O., Freedman, L., Kalkstein, N., Mizrahi, B., Alroy-Preis, S., Ash, N., Milo, R., & Huppert, A.
- Affiliations
- From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion–Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) — all in Israel.
- Tel Aviv University (IL)
- Corresponding author
- Goldberg, Yair
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2021-10-07
- Volume
- 385
- Issue
- 15
- Pages
- 1393-1400
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC8461568
- OpenAlex
- W3201177512
- Cited by
- 1,169
- References
- 3
- Citations by year
- 2026: 17 · 2025: 45 · 2024: 82 · 2023: 195 · 2022: 597 · 2021: 233
- FWCI
- 87.73
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- New England Journal of Medicine (publishedVersion)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- BNT162b2, COVID-19 pandemic, booster vaccination, mRNA vaccines, vaccine efficacy, older adults, confirmed infections, severe illness, Israel, SARS-CoV-2
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Vaccines, BNT162 Vaccine, Aged, Aged, 80 and over, Female, Humans, Immunization, Secondary, Israel, Male, Middle Aged, Poisson Distribution, Databases, Factual, Patient Acuity
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