Protection against SARS-CoV-2 after Covid-19 Vaccination and Previous Infection
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Abstract
BACKGROUND: The duration and effectiveness of immunity from infection with and vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are relevant to pandemic policy interventions, including the timing of vaccine boosters. METHODS: We investigated the duration and effectiveness of immunity in a prospective cohort of asymptomatic health care workers in the United Kingdom who underwent routine polymerase-chain-reaction (PCR) testing. Vaccine effectiveness (≤10 months after the first dose of vaccine) and infection-acquired immunity were assessed by comparing the time to PCR-confirmed infection in vaccinated persons with that in unvaccinated persons, stratified according to previous infection status. We used a Cox regression model with adjustment for previous SARS-CoV-2 infection status, vaccine type and dosing interval, demographic characteristics, and workplace exposure to SARS-CoV-2. RESULTS: Of 35,768 participants, 27% (9488) had a previous SARS-CoV-2 infection. Vaccine coverage was high: 95% of the participants had received two doses (78% had received BNT162b2 vaccine [Pfizer-BioNTech] with a long interval between doses, 9% BNT162b2 vaccine with a short interval between doses, and 8% ChAdOx1 nCoV-19 vaccine [AstraZeneca]). Between December 7, 2020, and September 21, 2021, a total of 2747 primary infections and 210 reinfections were observed. Among previously uninfected participants who received long-interval BNT162b2 vaccine, adjusted vaccine effectiveness decreased from 85% (95% confidence interval [CI], 72 to 92) 14 to 73 days after the second dose to 51% (95% CI, 22 to 69) at a median of 201 days (interquartile range, 197 to 205) after the second dose; this effectiveness did not differ significantly between the long-interval and short-interval BNT162b2 vaccine recipients. At 14 to 73 days after the second dose, adjusted vaccine effectiveness among ChAdOx1 nCoV-19 vaccine recipients was 58% (95% CI, 23 to 77) - considerably lower than that among BNT162b2 vaccine recipients. Infection-acquired immunity waned after 1 year in unvaccinated participants but remained consistently higher than 90% in those who were subsequently vaccinated, even in persons infected more than 18 months previously. CONCLUSIONS: Two doses of BNT162b2 vaccine were associated with high short-term protection against SARS-CoV-2 infection; this protection waned considerably after 6 months. Infection-acquired immunity boosted with vaccination remained high more than 1 year after infection. (Funded by the U.K. Health Security Agency and others; ISRCTN Registry number, ISRCTN11041050.).
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mRNA-based vaccine technology has the potential to induce strong immune responses, as exemplified by the success of SARS-CoV-2 vaccines.
“mRNA-based vaccine technology has the potential to introduce strong immune responses, as exemplified by the recent success of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines195.”
From The current state of the art and future trends in RAS-targeted cancer therapies (2022) · cites this paper as [195]
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- Authors
- Hall, V., Foulkes, S., Insalata, F., Kirwan, P., Saei, A., Atti, A., Wellington, E., Khawam, J., Munro, K., Cole, M., Tranquillini, C., Taylor-Kerr, A., Hettiarachchi, N., Calbraith, D., Sajedi, N., Milligan, I., Themistocleous, Y., Corrigan, D., Cromey, L., Price, L., Stewart, S., de Lacy, E., Norman, C., Linley, E., Otter, A. D., Semper, A., Hewson, J., D’Arcangelo, S., Chand, M., Brown, C. S., Brooks, T., Islam, J., Charlett, A., & Hopkins, S.
- Affiliations
- National Institute for Health and Care Research (GB)
- UK Health Security Agency (GB)
- University of Cambridge (GB)
- Public Health Agency (GB)
- Glasgow Caledonian University (GB)
- From the U.K. Health Security Agency (V.H., S.F., F.I., P.K., A. Saei, A.A., E.W., J.K., K.M., M. Cole, C.T., A.T.-K., N.H., D. Calbraith, N.S., I.M., Y.T., E. Linley, A.D.O., A. Semper, J.H., S.D., M. Chand, C.S.B., T.B., J.I., A.C., S.H.), Guy’s and St. Thomas’ NHS Foundation Trust (M. Chand), and the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, in partnership with Public Health England (A.C.), London, the Health Protection Research NIHR Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (V.H., C.S.B., S.H.), the Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge (P.K.), the Public Health Agency Northern Ireland, Belfast (D. Corrigan, L.C.), Glasgow Caledonian University and Public Health Scotland, Glasgow (L.P., S.S.), Public Health Wales (E. Lacy) and Health and Care Research Wales (C.N.), Cardiff, and the NIHR Healt...
- Health and Care Research Wales (GB)
- Public Health England (GB)
- Corresponding author
- Hopkins, Susan
- ORCID
- Hall, Victoria
- Foulkes, Sarah
- Insalata, Ferdinando
- Kirwan, Peter
- Saei, Ayoub
- Atti, Ana
- Munro, Katie
- Cole, Michelle
- Tranquillini, Caio
- Hettiarachchi, Nipunadi
- Sajedi, Noshin
- Milligan, Iain
- Themistocleous, Yrene
- Price, Lesley
- Stewart, Sally
- Linley, Ezra
- Otter, Ashley D.
- Semper, Amanda
- Hewson, Jacqueline
- Chand, Meera
- Brown, Colin S.
- Brooks, Tim
- Islam, Jasmin
- Hopkins, Susan
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2022-03-31
- Volume
- 386
- Issue
- 13
- Pages
- 1207-1220
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC8908850
- OpenAlex
- W4212835565
- Cited by
- 711
- References
- 39
- Citations by year
- 2026: 28 · 2025: 79 · 2024: 161 · 2023: 224 · 2022: 218 · 2021: 1
- FWCI
- 83.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- ResearchOnline (Glasgow Caledonian University) (submittedVersion, other-oa)
- St Andrews Research Repository (St Andrews Research Repository) (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by-nd)
- Apollo
- Funders
- Francis Crick Institute (10827, CC2087)
- Health and Care Research Wales
- UK Research and Innovation (MR/W02067X/1)
- Public Health Wales
- National Institute for Health Research Health Protection Research Unit
- National Institute for Health and Care Research (NIHR300791, NIHR300669)
- University of Oxford
- University of Bristol
- Public Health England
- Medical Research Council (MC_UU_00002/11)
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Keywords
- SARS-CoV-2, COVID-19 vaccination, vaccine effectiveness, duration of immunity, prior SARS-CoV-2 infection, reinfection, BNT162b2, ChAdOx1 nCoV-19 vaccine, breakthrough infection, SARS-CoV-2 antibodies, booster vaccination
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Vaccines, COVID-19 Nucleic Acid Testing, Vaccine Efficacy, BNT162 Vaccine, ChAdOx1 nCoV-19, United Kingdom, Health Personnel, Humans, Prospective Studies, Vaccination, Adaptive Immunity, Asymptomatic Diseases
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