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Association of Primary and Booster Vaccination and Prior Infection With SARS-CoV-2 Infection and Severe COVID-19 Outcomes | Infectious Diseases | JAMA | JAMA Network

Estimates of effectiveness are shown by solid curves, and 95% CIs are shown by shaded bands. The steep upward trends seen early in panels A-C, but not in panel D, represent the ramp-up period of vaccination. Each curve is truncated at 15 months or when the number at risk hits 15% of the relevant sample. D, Comparison of prior infection with survival to no prior infection among all participants (vaccinated and not), with 98.6% of all participants surviving the prior infection. Home testing for infection is not included. Further detail can be found in eTable 1 in the Supplement.

Source: Lin D, Gu Y, Xu Y, et al (2022).

More evidence was produces today showing how efficatious the anti-COVID vaccines are at preventing serious illness and death from COVID-19 and, incidentally, how dangerous and reckless has been the pro-Trump campaign to minimise the risks and raise the level of vaccine hesitancy in the US pupulation, led by Trumpanzee far-right loonies, evangelical Chritian preachers and televangelists and politically-motivated conspiracy theorists.

This evidence came in the form of a paper published in JAMA Network reporting on a cohort study of 10.6 million North Carolina Residents between March 2020 and June 2022, which concluded that:

…receipt of a primary COVID-19 vaccine series compared with being unvaccinated, receipt of a booster compared with primary vaccination, and prior SARS-CoV-2 infection compared with no prior infection were all significantly associated with lower risk of SARS-CoV-2 infection and resulting hospitalization and death.

In an editorial in JAMA Network accompanying publication of the paper the editor said:

The authors report that as of June 3, 2022, a total of 67% of the study population had been vaccinated and 2 771 364 SARS-CoV-2 infections were reported, with a hospitalization rate of 6.3% and mortality rate of 1.4%. Based on the analysis and findings, there are several important takeaways from this study. First, the results reinforced that first-generation COVID-19 vaccines were highly and durably effective against severe disease as measured by hospitalizations and deaths, but did not protect against milder infections beyond a few months, even with booster vaccinations. Emerging new variants, including Omicron, are associated with less protection against infection. However, even modest protection against SARS-CoV-2 infection may provide important benefits by reducing surges that can overwhelm health care systems, keeping schools and workplaces open, and protecting vulnerable populations at risk for severe outcomes following infection, including older adults and those with underlying medical conditions.

Second, prior infection was associated with a reduction in risk of infection and severe outcomes among those with or without prior vaccination. Additionally, among people with prior documented infection who had completed a primary vaccine series, booster vaccination was associated with additional protection, including 39.3% vaccine effectiveness against hospitalization after 3 months. Although prior infection alone is associated with lower risk of reinfection, vaccination also provides protection against ongoing transmission and has additional benefits, including attenuating severity of disease and reducing the risk of disabling postacute sequelae of COVID-19.^9,14

Third, this study reinforced the growing complexities of COVID-19 and the strengths and limitations of routine surveillance systems. State-based surveillance systems have large sample sizes that allow detection of uncommon events and multiple subgroup analyses. However, they often lack granular details on underlying medical conditions or other factors that allow for better control of confounding or effect modification. Lin et al found that waning of booster dose vaccine effectiveness occurred over 4 to 6 months, but this may be partially due to patients with certain high-risk conditions, such as those who are significantly immunocompromised, getting third doses earlier than the general population. Among individuals who received a primary mRNA vaccine series, understanding comparability between those who received homologous and heterologous mRNA boosters would also be helpful to strengthen inference around benefits of receiving mixed vaccine products that was observed in this study.

In the abstrct to their paper, the authors state:

Key Points

Question How does the association of COVID-19 vaccination and prior SARS-CoV-2 infection with subsequent SARS-CoV-2 infection and severe COVID-19 outcomes change over time?

Findings In a cohort study of 10.6 million North Carolina residents from March 2020 to June 2022, receipt of a primary COVID-19 vaccine series compared with being unvaccinated, receipt of a booster compared with primary vaccination, and prior SARS-CoV-2 infection compared with no prior infection were all significantly associated with lower risk of SARS-CoV-2 infection and resulting hospitalization and death. The estimates for the associated protection decreased over time, especially for the outcome of infection, and varied by type of circulating variant.

Meaning Receipt of COVID-19 vaccines and boosters, as well as prior SARS-CoV-2 infection, were associated with protection against SARS-CoV-2 infection (including Omicron) and severe COVID-19 outcomes, although the associated protection waned over time.

Abstract

Importance Data about the association of COVID-19 vaccination and prior SARS-CoV-2 infection with risk of SARS-CoV-2 infection and severe COVID-19 outcomes may guide prevention strategies.

Objective To estimate the time-varying association of primary and booster COVID-19 vaccination and prior SARS-CoV-2 infection with subsequent SARS-CoV-2 infection, hospitalization, and death.

Design, Setting, and Participants Cohort study of 10.6 million residents in North Carolina from March 2, 2020, through June 3, 2022.

Exposures COVID-19 primary vaccine series and boosters and prior SARS-CoV-2 infection.

Main Outcomes and Measures Rate ratio (RR) of SARS-CoV-2 infection and hazard ratio (HR) of COVID-19–related hospitalization and death.

Results The median age among the 10.6 million participants was 39 years; 51.3% were female, 71.5% were White, and 9.9% were Hispanic. As of June 3, 2022, 67% of participants had been vaccinated. There were 2 771 364 SARS-CoV-2 infections, with a hospitalization rate of 6.3% and mortality rate of 1.4%. The adjusted RR of the primary vaccine series compared with being unvaccinated against infection became 0.53 (95% CI, 0.52-0.53) for BNT162b2, 0.52 (95% CI, 0.51-0.53) for mRNA-1273, and 0.51 (95% CI, 0.50-0.53) for Ad26.COV2.S 10 months after the first dose, but the adjusted HR for hospitalization remained at 0.29 (95% CI, 0.24-0.35) for BNT162b2, 0.27 (95% CI, 0.23-0.32) for mRNA-1273, and 0.35 (95% CI, 0.29-0.42) for Ad26.COV2.S and the adjusted HR of death remained at 0.23 (95% CI, 0.17-0.29) for BNT162b2, 0.15 (95% CI, 0.11-0.20) for mRNA-1273, and 0.24 (95% CI, 0.19-0.31) for Ad26.COV2.S. For the BNT162b2 primary series, boosting in December 2021 with BNT162b2 had the adjusted RR relative to primary series of 0.39 (95% CI, 0.38-0.40) and boosting with mRNA-1273 had the adjusted RR of 0.32 (95% CI, 0.30-0.34) against infection after 1 month and boosting with BNT162b2 had the adjusted RR of 0.84 (95% CI, 0.82-0.86) and boosting with mRNA-1273 had the adjusted RR of 0.60 (95% CI, 0.57-0.62) after 3 months. Among all participants, the adjusted RR of Omicron infection compared with no prior infection was estimated at 0.23 (95% CI, 0.22-0.24) against infection, and the adjusted HRs were 0.10 (95% CI, 0.07-0.14) against hospitalization and 0.11 (95% CI, 0.08-0.15) against death after 4 months.

Conclusions and Relevance Receipt of primary COVID-19 vaccine series compared with being unvaccinated, receipt of boosters compared with primary vaccination, and prior infection compared with no prior infection were all significantly associated with lower risk of SARS-CoV-2 infection (including Omicron) and resulting hospitalization and death. The associated protection waned over time, especially against infection.

Lin D, Gu Y, Xu Y, et al.
Association of Primary and Booster Vaccination and Prior Infection With SARS-CoV-2 Infection and Severe COVID-19 Outcomes.
JAMA. 2022;328(14):1415–1426. doi:10.1001/jama.2022.17876

© 2022 American Medical Association.
Reprinted under the terms of the Copyright, Designs and Patents Act 1988, s60.

The benefits of vaccination and the risk of not being vaccinated is now unarguable, but the final sentence emphasises the importance of regular boosters as and when they become available, especially of those which have been updated to protect against the latest variants and subvarients. Pending a definitive vaccine against all SARS-C0V-2 virus strains, there is no real alternative but the keep our defences high with these regular boosters, much like we are currently doing with the influenza viruses where anual vaccination is needed because the virus readily mutates to form new varieties which can evade the immunity in the pupulation from the last wave of infections.

In the North Carolina cohort, only 67% of the cohort had been vaccinated. This means that one in three North Carolinans have no protection unless they have survived an earlier infection, which will provide some protection for a few months. These people can act as breeding grounds for new variants and as repositories for the virus ready to infect anyone with waning antibody levels.

The only way to reduce the effects of the pandemic on society is thus to keep the general level of protection in the population as high as possible and to reduce the number of people acting as these breeding grounds through better education to reduce the antisocial effect of the right-wing, Trumpanzee cult antivaxx disinformation campaigns.