Elapsed time since BNT162b2 vaccine and risk of SARS-CoV-2 infection: test negative design study
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Abstract
Objectives: To determine whether time elapsed since the second injection of the Pfizer-BioNTech BNT162b2 mRNA vaccine was significantly associated with the risk of covid-19 infection after vaccination in people who received two vaccine injections. Design: Test negative design study. Setting: Electronic health records of a large state mandated healthcare organisation, Israel. Participants: Adults aged ≥18 years who had received a reverse transcription polymerase chain reaction (RT-PCR) test between 15 May 2021 and 17 September 2021, at least three weeks after their second vaccine injection, had not received a third vaccine injection, and had no history of covid-19 infection. Main outcome measures: Positive result for the RT-PCR test. Individuals who tested positive for SARS-CoV-2 and controls were matched for week of testing, age category, and demographic group (ultra-orthodox Jews, individuals of Arab ancestry, and the general population). Conditional logistic regression was adjusted for age, sex, socioeconomic status, and comorbid conditions. Results: 83 057 adults received an RT-PCR test for SARS-CoV-2 during the study period and 9.6% had a positive result. Time elapsed since the vaccine injection was significantly longer in individuals who tested positive (P<0.001). Adjusted odds ratio for infection at time intervals >90 days since vaccination were significantly increased compared with the reference of <90 days: 2.37 (95% confidence interval 1.67 to 3.36) for 90-119 days, 2.66 (1.94 to 3.66) for 120-149 days, 2.82 (2.07 to 3.84) for 150-179 days, and 2.82 (2.07 to 3.85) for ≥180 days (P<0.001 for each 30 day interval). Conclusions: In this large population of adults tested for SARS-CoV-2 by RT-PCR after two doses of mRNA BNT162b2 vaccine, a gradual increase in the risk of infection was seen for individuals who received their second vaccine dose after at least 90 days.
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Protection against SARS-CoV-2 infection starts to wane within a few months of administration of the primary series of mRNA vaccines.
“protection against infection starts to wane within a few months of administration.8–11”
From Protection of the third-dose and fourth-dose mRNA vaccines against SARS-CoV-2 Omicron subvariant: a systematic review and meta-analysis (2023) · cites this paper as [8]
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- Authors
- Israel, A., Merzon, E., Schäffer, A. A., Shenhar, Y., Green, I., Golan-Cohen, A., Ruppin, E., Magen, E., & Vinker, S.
- Affiliations
- Leumit Health Services, Tel Aviv, Israel
- Tel Aviv University (IL)
- National Institutes of Health (US)
- Ben-Gurion University of the Negev (IL)
- Corresponding author
- Israel, Ariel
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2021-11-24
- Volume
- 375
- Pages
- e067873
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC9083235
- OpenAlex
- W3216422624
- Cited by
- 170
- References
- 24
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 19 · 2023: 30 · 2022: 73 · 2021: 30
- FWCI
- 12.04
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion, cc-by-nc-nd)
- Funders
- U.S. Department of Health and Human Services
- National Institutes of Health
- National Cancer Institute
- 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, mRNA vaccines, COVID-19 pandemic, waning vaccine effectiveness, breakthrough infection, vaccine protection duration, ultra-Orthodox Jews, Arab ancestry, Israel
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