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Abstract

Background

Long-term effectiveness data on bivalent COVID-19 boosters are limited.

Aim

We evaluated the long-term protection of bivalent boosters against severe COVID-19 among ≥ 65-year-olds in Finland.

Methods

In this register-based cohort analysis, we compared the risk of three severe COVID-19 outcomes among ≥ 65-year-olds who received a bivalent booster (Original/Omicron BA.1 or Original/BA.4–5; exposed group) between 1/9/2022 and 31/8/2023 to those who did not (unexposed). We included individuals vaccinated with at least two monovalent COVID-19 vaccine doses before 1/9/2022 and ≥ 3 months ago. The analysis was divided into two periods: 1/9/2022–28/2/2023 (BA.5 and BQ.1.X predominating) and 1/3/2023–31/8/2023 (XBB predominating). The hazards for the outcomes between exposed and unexposed individuals were compared with Cox regression.

Results

We included 1,191,871 individuals. From 1/9/2022 to 28/2/2023, bivalent boosters were associated with a reduced risk of hospitalisation due to COVID-19 (hazard ratio (HR): 0.45; 95% confidence interval (CI): 0.37–0.55), death due to COVID-19 (HR: 0.49; 95% CI: 0.38–0.62), and death in which COVID-19 was a contributing factor (HR: 0.40; 95% CI: 0.31–0.51) during 14–60 days since vaccination. From 1/3/2023 to 31/8/2023, bivalent boosters were associated with lower risks of all three severe COVID-19 outcomes during 61–120 days since a bivalent booster (e.g. HR: 0.53; 95% CI: 0.39–0.71 for hospitalisation due to COVID-19); thereafter no notable risk reduction was observed. No difference was found between Original/Omicron BA.1 and Original/BA.4–5 boosters.

Conclusion

Bivalent boosters initially reduced the risk of severe COVID-19 outcomes by ca 50% among ≥ 65-year-olds, but protection waned over time. These findings help guide vaccine development and vaccination programmes.

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2024-09-12
2024-10-18
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.37.2300587
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References

  1. Qu P, Faraone JN, Evans JP, Zheng YM, Yu L, Ma Q, et al. Durability of Booster mRNA Vaccine against SARS-CoV-2 BA.2.12.1, BA.4, and BA.5 Subvariants. N Engl J Med. 2022;387(14):1329-31.  https://doi.org/10.1056/NEJMc2210546  PMID: 36069925 
  2. European Medicines Agency (EMA). Adapted vaccine targeting BA.4 and BA.5 Omicron variants original SARS-CoV-2 recommended for approval. Amsterdam: European Medicines Agency; 2022. Available from: https://www.ema.europa.eu/en/news/adapted-vaccine-targeting-ba4-ba5-omicron-variants-original-sars-cov-2-recommended-approval
  3. Andersson NW, Thiesson EM, Baum U, Pihlström N, Starrfelt J, Faksová K, et al. Comparative effectiveness of bivalent BA.4-5 and BA.1 mRNA booster vaccines among adults aged ≥50 years in Nordic countries: nationwide cohort study. BMJ. 2023;382:e075286.  https://doi.org/10.1136/bmj-2022-075286  PMID: 37491022 
  4. Tenforde MW, Weber ZA, Natarajan K, Klein NP, Kharbanda AB, Stenehjem E, et al. Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19-Associated Emergency Department or Urgent Care Encounters and Hospitalizations Among Immunocompetent Adults - VISION Network, Nine States, September-November 2022. MMWR Morb Mortal Wkly Rep. 2022;71(5152):1616-24.  https://doi.org/10.15585/mmwr.mm715152e1  PMID: 36580430 
  5. Surie D, DeCuir J, Zhu Y, Gaglani M, Ginde AA, Douin DJ, et al. Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19-Associated Hospitalization Among Immunocompetent Adults Aged ≥65 Years - IVY Network, 18 States, September 8-November 30, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(5152):1625-30.  https://doi.org/10.15585/mmwr.mm715152e2  PMID: 36580424 
  6. Fabiani M, Mateo-Urdiales A, Sacco C, Fotakis EA, Rota MC, Petrone D, et al. Protection against severe COVID-19 after second booster dose of adapted bivalent (original/Omicron BA.4-5) mRNA vaccine in persons ≥ 60 years, by time since infection, Italy, 12 September to 11 December 2022. Euro Surveill. 2023;28(8):2300105.  https://doi.org/10.2807/1560-7917.ES.2023.28.8.2300105  PMID: 36820640 
  7. Grewal R, Buchan SA, Nguyen L, Nasreen S, Austin PC, Brown KA, et al. Effectiveness of mRNA COVID-19 monovalent and bivalent vaccine booster doses against Omicron severe outcomes among adults aged ≥50 years in Ontario, Canada: a Canadian Immunization Research Network (CIRN) Study. J Infect Dis. 2024;229(2):394-7.  https://doi.org/10.1093/infdis/jiad419  PMID: 37798119 
  8. Lin D-Y, Xu Y, Gu Y, Zeng D, Sunny SK, Moore Z. Durability of Bivalent Boosters against Omicron Subvariants. N Engl J Med. 2023;388(19):1818-20.  https://doi.org/10.1056/NEJMc2302462  PMID: 37043647 
  9. Arbel R, Peretz A, Sergienko R, Friger M, Beckenstein T, Duskin-Bitan H, et al. Effectiveness of a bivalent mRNA vaccine booster dose to prevent severe COVID-19 outcomes: a retrospective cohort study. Lancet Infect Dis. 2023;23(8):914-21.  https://doi.org/10.1016/S1473-3099(23)00122-6  PMID: 37062302 
  10. Kirsebom FCM, Harman K, Lunt RJ, Andrews N, Groves N, Abdul Aziz N, et al. Vaccine effectiveness against hospitalisation estimated using a test-negative case-control study design, and comparative odds of hospital admission and severe outcomes with COVID-19 sub-lineages BQ.1, CH.1.1. and XBB.1.5 in England. Lancet Reg Health Eur. 2023;35:100755.  https://doi.org/10.1016/j.lanepe.2023.100755  PMID: 38115965 
  11. Stecher M, Kristoffersen AB, Lie K, Andersen SR, Meijerink H, Starrfelt J. Effectiveness and durability of a second COVID-19 booster against severe outcomes among older people in Norway: a population-based cohort study comparing mono- and bivalent booster doses. Int J Epidemiol. 2023;52(6):1716-24.  https://doi.org/10.1093/ije/dyad114  PMID: 37608733 
  12. Fabiani M, Mateo-Urdiales A, Sacco C, Rota MC, Fotakis EA, Petrone D, et al. . Relative effectiveness of bivalent Original/Omicron BA.4-5 mRNA vaccine in preventing severe COVID-19 in persons 60 years and above during SARS-CoV-2 Omicron XBB.1.5 and other XBB sublineages circulation, Italy, April to June 2023. Euro Surveill. 2023;28(32):2300397.  https://doi.org/10.2807/1560-7917.ES.2023.28.32.2300397  PMID: 37561053 
  13. Finish Institute for Health and Welfare (THL). No need for booster round for coronavirus vaccinations in the spring – population-level protection against serious disease remains good - Press release - THL. Helsinki: THL; 2023. Available from: https://thl.fi/en/web/thlfi-en/-/thl-no-need-for-booster-round-for-coronavirus-vaccinations-in-the-spring-population-level-protection-against-serious-disease-remains-good?redirect=%2Fen%2Fweb%2Fthlfi-en%2Fwhats-new%2Fpress-releases-and-news%2Fpress-release
  14. Folkhälsomyndigheten. Fortsatt vaccination mot covid-19 under 2023 för personer 65 år och äldre samt för yngre med riskfaktorer — Folkhälsomyndigheten. [Continued vaccination against COVID-19 in 2023 for people aged 65 and over and for younger people with risk factors]. Solna: Folkhälsomyndigheten; 2022. Available from: https://www.folkhalsomyndigheten.se/nyheter-och-press/nyhetsarkiv/2022/december/fortsatt-vaccination-mot-covid-19-under-2023-for-personer-65-ar-och-aldre-samt-for-yngre-med-riskfaktorer/
  15. Baum U, Poukka E, Palmu AA, Salo H, Lehtonen TO, Leino T. Effectiveness of vaccination against SARS-CoV-2 infection and Covid-19 hospitalisation among Finnish elderly and chronically ill-An interim analysis of a nationwide cohort study. PLoS One. 2021;16(11):e0258704.  https://doi.org/10.1371/journal.pone.0258704  PMID: 34793476 
  16. Baum U, Poukka E, Leino T, Kilpi T, Nohynek H, Palmu AA. High vaccine effectiveness against severe COVID-19 in the elderly in Finland before and after the emergence of Omicron. BMC Infect Dis. 2022;22(1):816.  https://doi.org/10.1186/s12879-022-07814-4  PMID: 36335289 
  17. Kirsebom FCM, Andrews N, Stowe J, Ramsay M, Lopez Bernal J. Duration of protection of ancestral-strain monovalent vaccines and effectiveness of bivalent BA.1 boosters against COVID-19 hospitalisation in England: a test-negative case-control study. Lancet Infect Dis. 2023;23(11):1235-43.  https://doi.org/10.1016/S1473-3099(23)00365-1  PMID: 37453440 
  18. Yan VKC, Cheng FWT, Chui CSL, Lai FTT, Wong CKH, Li X, et al. Effectiveness of BNT162b2 and CoronaVac vaccines in preventing SARS-CoV-2 Omicron infections, hospitalizations, and severe complications in the pediatric population in Hong Kong: a case-control study. Emerg Microbes Infect. 2023;12(1):2185455.  https://doi.org/10.1080/22221751.2023.2185455  PMID: 36852582 
  19. Hagiya H, Nakano Y, Furukawa M, Sunada N, Hasegawa T, Sakurada Y, et al. Early-stage antibody kinetics after the third dose of BNT162b2 mRNA COVID-19 vaccination measured by a point-of-care fingertip whole blood testing. Sci Rep. 2022;12(1):20628.  https://doi.org/10.1038/s41598-022-24464-3  PMID: 36450786 
  20. Uriu K, Ito J, Zahradnik J, Fujita S, Kosugi Y, Schreiber G, et al. . Enhanced transmissibility, infectivity, and immune resistance of the SARS-CoV-2 omicron XBB.1.5 variant. Lancet Infect Dis. 2023;23(3):280-1.  https://doi.org/10.1016/S1473-3099(23)00051-8  PMID: 36736338 
  21. Miller J, Hachmann NP, Collier AY, Lasrado N, Mazurek CR, Patio RC, et al. Substantial Neutralization Escape by SARS-CoV-2 Omicron Variants BQ.1.1 and XBB.1. N Engl J Med. 2023;388(7):662-4.  https://doi.org/10.1056/NEJMc2214314  PMID: 36652339 
  22. Lasrado N, et al. Waning Immunity Against XBB.1.5 Following Bivalent mRNA Boosters.http://biorxiv.org/lookup/doi/10.1101/2023.01.22.525079 (2023) doi:10.1101/2023.01.22.525079 . https://doi.org/10.1101/2023.01.22.525079 
  23. Qu P, Faraone JN, Evans JP, Zheng YM, Carlin C, Anghelina M, et al. Enhanced evasion of neutralizing antibody response by Omicron XBB.1.5, CH.1.1, and CA.3.1 variants. Cell Rep. 2023;42(5):112443.  https://doi.org/10.1016/j.celrep.2023.112443  PMID: 37104089 
  24. Finish Institute for Health and Welfare (THL). Coronavirus cases, hospital treatment situation and deaths. Helsinki: THL. [Accessed 28 Feb 2024]. Available from: https://www.thl.fi/episeuranta/tautitapaukset/coronamap.html
  25. Muhonen M, Melin M, Kontio M, Lindh E, Nohynek H, Poukka E. Leino T. Koronarokotukset syystalvella 2023. [Coronavirus vaccinations in autumn winter 2023. Recommendation and evidence base]. Working document 30/2023. Helsinki: Finish Institute for Health and Welfare; 2023. Available from: https://www.julkari.fi/bitstream/handle/10024/146904/URN_ISBN_978-952-408-137-5.pdf?sequence=1&isAllowed=y
  26. Bobrovitz N, Ware H, Ma X, Li Z, Hosseini R, Cao C, et al. Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression. Lancet Infect Dis. 2023;23(5):556-67.  https://doi.org/10.1016/S1473-3099(22)00801-5  PMID: 36681084 
  27. Kirsebom FCM, et al. Effectiveness of the Adjuvanted Sanofi/GSK (VidPrevtyn Beta) and Pfizer-BioNTech (Comirnaty Original/Omicron BA.4-5) Bivalent Vaccines against Hospitalisation amongst Adults Aged 75 Years and Older in England, Estimated Using a Test-Negative Case Control Study Design.http://medrxiv.org/lookup/doi/10.1101/2023.09.28.23296290 (2023) doi:10.1101/2023.09.28.23296290 . https://doi.org/10.1101/2023.09.28.23296290 
  28. Zhou Z, Barrett J, He X. Immune Imprinting and Implications for COVID-19. Vaccines (Basel). 2023;11(4):875.  https://doi.org/10.3390/vaccines11040875  PMID: 37112787 
  29. Offit PA. Bivalent Covid-19 Vaccines - A Cautionary Tale. N Engl J Med. 2023;388(6):481-3.  https://doi.org/10.1056/NEJMp2215780  PMID: 36630616 
Relative effectiveness of bivalent boosters against severe COVID-19 outcomes among people aged ≥ 65 years in Finland, September 2022 to August 2023
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Eero+Poukka&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Poukka Eero</a>, <a href="/search?value1=Jori+Per%C3%A4l%C3%A4&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Perälä Jori</a>, <a href="/search?value1=Hanna+Nohynek&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nohynek Hanna</a>, <a href="/search?value1=Sirkka+Goebeler&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Goebeler Sirkka</a>, <a href="/search?value1=Kari+Auranen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Auranen Kari</a>, <a href="/search?value1=Tuija+Leino&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Leino Tuija</a>, <a href="/search?value1=Ulrike+Baum&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Baum Ulrike</a></span>. Relative effectiveness of bivalent boosters against severe COVID-19 outcomes among people aged ≥ 65 years in Finland, September 2022 to August 2023. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(37):pii=2300587. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.37.2300587" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.37.2300587</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 25 Oct 2023;&nbsp;&nbsp; <span class="generated">Accepted</span>: 28 Apr 2024 </span> </p>
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