Effects of previous infection, vaccination, and hybrid immunity against symptomatic Alpha, Beta, and Delta SARS-CoV-2 infections: an observational study

<h3>Background </h3><p dir="ltr">Protection against SARS-CoV-2 symptomatic infection and severe COVID-19 of previous infection, mRNA two-dose vaccination, mRNA three-dose vaccination, and hybrid immunity of previous infection and vaccination were investigated in Qatar for...

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Main Author: Heba N. Altarawneh (19482436) (author)
Other Authors: Hiam Chemaitelly (439114) (author), Houssein H. Ayoub (9262512) (author), Patrick Tang (239534) (author), Mohammad R. Hasan (13777597) (author), Hadi M. Yassine (4675846) (author), Hebah A. Al-Khatib (6837266) (author), Asmaa A. Al Thani (10494576) (author), Peter Coyle (787159) (author), Zaina Al-Kanaani (4557205) (author), Einas Al-Kuwari (13777606) (author), Andrew Jeremijenko (11506565) (author), Anvar Hassan Kaleeckal (11847034) (author), Ali Nizar Latif (11570540) (author), Riyazuddin Mohammad Shaik (11847037) (author), Hanan F. Abdul-Rahim (13777600) (author), Gheyath K. Nasrallah (9200525) (author), Mohamed Ghaith Al-Kuwari (4264192) (author), Adeel A. Butt (3697705) (author), Hamad Eid Al-Romaihi (6837251) (author), Mohamed H. Al-Thani (11847049) (author), Abdullatif Al-Khal (11721410) (author), Roberto Bertollini (9538620) (author), Laith J. Abu-Raddad (9262524) (author)
Published: 2023
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Summary:<h3>Background </h3><p dir="ltr">Protection against SARS-CoV-2 symptomatic infection and severe COVID-19 of previous infection, mRNA two-dose vaccination, mRNA three-dose vaccination, and hybrid immunity of previous infection and vaccination were investigated in Qatar for the Alpha, Beta, and Delta variants. </p><h3>Methods </h3><p dir="ltr">Six national, matched, test-negative, case-control studies were conducted between January 18 and December 18, 2021 on a sample of 239,120 PCR-positive tests and 6,103,365 PCR-negative tests. </p><h3>Findings</h3><p dir="ltr">Effectiveness of previous infection against Alpha, Beta, and Delta reinfection was 89.5% (95% CI: 85.5–92.3%), 87.9% (95% CI: 85.4–89.9%), and 90.0% (95% CI: 86.7–92.5%), respectively. Effectiveness of two-dose BNT162b2 vaccination against Alpha, Beta, and Delta infection was 90.5% (95% CI, 83.9–94.4%), 80.5% (95% CI: 79.0–82.0%), and 58.1% (95% CI: 54.6–61.3%), respectively. Effectiveness of three-dose BNT162b2 vaccination against Delta infection was 91.7% (95% CI: 87.1–94.7%). Effectiveness of hybrid immunity of previous infection and two-dose BNT162b2 vaccination was 97.4% (95% CI: 95.4–98.5%) against Beta infection and 94.5% (95% CI: 92.8–95.8%) against Delta infection. Effectiveness of previous infection and three-dose BNT162b2 vaccination was 98.1% (95% CI: 85.7–99.7%) against Delta infection. All five forms of immunity had >90% protection against severe, critical, or fatal COVID-19 regardless of variant. Similar effectiveness estimates were observed for mRNA-1273. A mathematical model accurately predicted hybrid immunity protection by assuming that the individual effects of previous infection and vaccination acted independently. </p><h3>Interpretation </h3><p dir="ltr">Hybrid immunity, offering the strongest protection, was mathematically predicted by assuming that the immunities obtained from previous infection and vaccination act independently, without synergy or redundancy. </p><h3>Funding </h3><p dir="ltr">The Biomedical Research Program and the Biostatistics, Epidemiology, and the Biomathematics Research Core, both at Weill Cornell Medicine-Qatar, Ministry of Public Health, Hamad Medical Corporation, Sidra Medicine, Qatar Genome Programme, Qatar University Biomedical Research Center, and Qatar University Internal Grant ID QUCG-CAS-23/24-114.</p><h2>Other Information</h2><p dir="ltr">Published in: eBioMedicine<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1016/j.ebiom.2023.104734" target="_blank">https://dx.doi.org/10.1016/j.ebiom.2023.104734</a></p>