Effectiveness of the second COVID-19 booster against Omicron: a large-scale cohort study in Chile

• Published in: Nature communications Vol. 14; no. 1; p. 6836
• Main Authors: Jara, Alejandro, Cuadrado, Cristobal, Undurraga, Eduardo A, García, Christian, Nájera, Manuel, Bertoglia, María Paz, Vergara, Verónica, Fernández, Jorge, García-Escorza, Heriberto, Araos, Rafael
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group 27.10.2023; Nature Publishing Group UK; Nature Portfolio
• Subjects: Cohort analysis; COVID-19; COVID-19 vaccines; Effectiveness; Homology; Immunization; mRNA; Pandemics; Severe acute respiratory syndrome coronavirus 2; Vaccine efficacy; Vaccines; Viral diseases; Chile
• ISSN: 2041-1723; 2041-1723
• DOI: 10.1038/s41467-023-41942-y

Abstract In light of the ongoing COVID-19 pandemic and the emergence of new SARS-CoV-2 variants, understanding the effectiveness of various booster vaccination regimens is pivotal. In Chile, using a prospective national cohort of 3.75 million individuals aged 20 or older, we evaluate the effectiveness against COVID-19-related intensive care unit (ICU) admissions and death of mRNA-based second vaccine boosters for four different three-dose background regimes: BNT162b2 primary series followed by a homologous booster, and CoronaVac primary series followed by an mRNA booster, a homologous booster, and a ChAdOx-1 booster. We estimate the vaccine effectiveness weekly from February 14 to August 15, 2022, by determining hazard ratios of immunization over non-vaccination, accounting for relevant confounders. The overall adjusted effectiveness of a second mRNA booster shot is 88.2% (95%CI, 86.2–89.9) against ICU admissions and 90.5% (95%CI 89.4–91.4) against death. Vaccine effectiveness shows a mild decrease for all regimens and outcomes, probably linked to the introduction of BA.4 and BA.5 Omicron sub-lineages and the waning of immunity. Based on our findings, individuals might not need additional boosters for at least 6 months after receiving a second mRNA booster shot in this setting.