Effectiveness of BNT162b2 Vaccine Booster Against SARS-CoV-2 Infection and Breakthrough Complications, Israel

Aharona Glatman-Freedman; Michal Bromberg; Yael Hershkovitz; Hanna Sefty; Zalman Kaufman; Rita Dichtiar; Lital Keinan-Boker

Disclosures

Emerging Infectious Diseases. 2022;28(5):948-956.

Discussion

Our results demonstrate that, after the BNT16b2 booster dose, VE against SARS-CoV-2 infection reached levels that were observed shortly after the second vaccine dose.^[6] VE point estimates of >90% were observed in week 2 in persons 16–59 years of age and in week 3 in persons ≥60 years of age. Similar delay in achieving high VE among elderly persons was also shown after the second BNT162b2 vaccine dose.^[6] Highest-level VE was maintained for up to 11 weeks, as shown in persons ≥60 years of age included in our study. The decline in VE that occurred afterward was initially mild, still maintaining VE point estimates ≥90% for up to week 17 of the evaluation period in persons ≥60 years of age. The decline in VE became steeper during the last 2 weeks of the evaluation period.

The B.1.617.2 (Delta) variant was the most prevalent variant in Israel through November 2021. However, the last 2 evaluation weeks, which occurred in December 2021 (Appendix Table 2), coincided with the beginning of a new wave of illness and the sharp rise in the B.1.1.529 (Omicron) variant in Israel. Waning immunity was shown several months after the second BNT162b2 vaccine dose^[2,3,10]and was temporarily associated with the rise of the B.1.617.2 (Delta) variant in Israel. However, a fresh 2-dose BNT162b2 vaccination regimen was found to be highly effective against the B.1.617.2 (Delta) variant.

Table 1. Rate reduction of hospitalizations among SARS-CoV-2–positive persons who received the BNT162b2 COVID-19 vaccine booster dose, Israel*
Age group, y	Time of first positive SARS-CoV-2 PCR test after index date, wk	Unvaccinated SARS-CoV-2–positive persons		Vaccinated SARS-CoV-2–positive persons		Adjusted 1 – IRR, % (95% CI)†
Age group, y		Hospitalized	Total	Hospitalized	Total	Adjusted 1 – IRR, % (95% CI)†
16–59	2	889	22,545	4	1,343	92.2 (77.9–97.3)
	3	770	18,232	3	455	83.9 (46.7–95.1)
	4	590	12,962	2	293	84.6 (47.1–95.5)
	5	414	8,555	1	210	90.1 (44.5–98.2)
	6	259	5,531	1	138	84.3 (15.1–97.1)
	7	175	3,573	0	131	100.0
	8	120	2,626	1	83	74.0 (−52.5 to 95.6)
	9	92	2,013	0	54	100.0
	10	72	1,714	0	57	100.0
	11	69	1,401	0	66	100.0
	12	68	1,385	0	90	100.0
	13	72	1,442	0	118	100.0
	14	62	1,569	1	154	84.4 (5.9–97.4)
	15	64	2,145	4	351	62.8 (−0.6 to 86.2)
	16	71	4,088	1	884	94.0 (47.9–99.3)
	2–16 combined	1,662	41,135	18	4,427	89.2 (79.1–94.4)
>60	2	644	1,985	98	1,314	77.5 (71.5–82.3)
	3	666	2,200	39	464	73.0 (64.4–79.5)
	4	647	2,160	36	375	68.2 (52.7–78.6)
	5	619	2,164	25	319	73.2 (48.2–86.2)
	6	593	2,033	20	296	77.3 (62.5–86.3)
	7	501	1,724	29	271	64.5 (50.2–74.7)
	8	375	1,276	23	221	65.3 (40.2–79.9)
	9	254	869	6	147	86.7 (72.6–93.6)
	10	163	577	10	86	64.1 (27.1–82.3)
	11	108	376	9	63	54.9 (−35.9 to 85.1)
	12	80	258	4	44	71.0 (21.5–89.3)
	13	56	208	3	52	80.2 (54.4–91.4)
	14	56	183	3	49	81.9 (45.8–94.0)
	15	58	170	6	47	67.5 (32.6–84.4)
	16	53	162	5	44	65.7 (23.4–84.6)
	17	46	151	1	56	94.4 (57.3–99.2)
	18	42	147	1	69	95.0 (72.1–99.1)
	19	38	184	5	125	82.6 (57.7–92.8)
	20	46	305	13	432	81.4 (67.0–89.5)
	2–20 combined	1,976	6,673	336	4,474	75.1 (71.3–78.5)

*COVID-19, coronavirus disease; IRR, incidence rate ratio; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
†Adjusted for sex and epidemiologic week.

Table 2. Rate reduction of severe or critical disease among SARS-CoV-2–positive persons who received the BNT162b2 COVID-19 vaccine booster dose, Israel*
Age group, y	Time of first positive SARS-CoV-2 PCR test after index date, wk	Unvaccinated SARS-CoV-2–positive persons		Vaccinated SARS-CoV-2–positive persons		Adjusted 1 – IRR, % (95% CI)†
Age group, y		Severe or critical disease	Total	Severe or critical disease	Total	Adjusted 1 – IRR, % (95% CI)†
16–59	2	422	22,545	2	1,343	92.0 (70.0–97.9)
	3	358	18,232	0	455	100.0
	4	262	12,962	0	293	100.0
	5	170	8,555	0	210	100.0
	6	113	5,531	0	138	100.0
	7	63	3,573	0	131	100.0
	8	40	2,626	0	83	100.0
	9	32	2,013	0	54	100.0
	10	27	1,714	0	57	100.0
	11	29	1,401	0	66	100.0
	12	24	1,385	0	90	100.0
	13	25	1,442	0	118	100.0
	14	21	1,569	0	154	100.0
	15	30	2,145	0	351	100.0
	16	30	4,088	0	884	100.0
	2–16 combined	727	41,135	2	4,427	97.3 (89.7–99.3)
≥60	2	450	1,985	56	1,314	81.9 (75.4–86.7)
	3	470	2,200	27	464	73.5 (61.0–82.0)
	4	464	2,160	18	375	77.8 (63.1–86.8)
	5	469	2,164	15	319	78.9 (66.8–86.6)
	6	447	2,033	9	296	86.6 (74.2–93.0)
	7	390	1,724	12	271	81.4 (63.1–90.6)
	8	299	1,276	13	221	75.6 (54.1–87.0)
	9	207	869	2	147	94.6 (85.3–98.0)
	10	128	577	9	86	58.6 (11.1–80.7)
	11	78	376	2	63	86.2 (39.1–96.9)
	12	52	258	3	44	69.0 (−15.3 to 91.7)
	13	40	208	1	52	91.0 (63.8–97.8)
	14	42	183	2	49	84.0 (44.8–95.3)
	15	45	170	3	47	78.5 (49.3–90.8)
	16	37	162	3	44	70.3 (30.0–87.4)
	17	32	151	1	56	91.7 (43.4–98.8)
	18	28	147	0	69	100.0
	19	33	184	4	125	83.6 (47.0–94.9)
	20	42	305	7	432	89.0 (75.8–95.0)
	2–20 combined	1,465	6,673	187	4,474	81.6 (78.3–84.3)

*COVID-19, coronavirus disease; IRR, incidence rate ratio; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
†Adjusted for sex and epidemiologic week.

Table 3. Rate reduction of deaths among SARS-CoV-2–positive persons who received the BNT162b2 COVID-19 vaccine booster dose, Israel*
Age group, y	Time of first positive SARS-CoV-2 PCR test after index date, wk	Unvaccinated SARS-CoV-2–positive persons		Vaccinated SARS-CoV-2–positive persons		Adjusted 1 – IRR, % (95% CI)†
Age group, y		Deaths	Total	Deaths	Total	Adjusted 1 – IRR, % (95% CI)†
16–59	2	45	22,545	0	1,343	100
	3	36	18,232	0	455	100
	4	27	12,962	0	293	100
	5	17	8,555	0	210	100
	6	11	5,531	0	138	100
	7	6	3,573	0	131	100
	8	5	2,626	0	83	100
	9	4	2,013	0	54	100
	10	3	1,714	0	57	100
	11	3	1,401	0	66	100
	12	3	1,385	0	90	100
	13	2	1,442	0	118	100
	14	1	1,569	0	154	100
	15	1	2,145	0	351	100
	16	1	4,088	0	884	100
	2–16 combined	72	41,135	0	4,427	100
≥60	2	243	1,985	31	1,314	81.9 (70.4–88.9)
	3	246	2,200	13	464	76.0 (55.3–87.2)
	4	226	2,160	13	375	68.1 (49.6–79.8)
	5	229	2,164	11	319	68.7 (42.7–82.9)
	6	201	2,033	7	296	76.5 (55.9–87.4)
	7	166	1,724	8	271	70.5 (29.4–87.7)
	8	122	1,276	8	221	63.1 (29.4–80.7)
	9	89	869	2	147	87.6 (53.7–96.7)
	10	59	577	5	86	49.1 (−44.3 to 82.1)
	11	30	376	0	63	100.0
	12	19	258	1	44	67.7 (−189.8 to 96.4)
	13	19	208	1	52	78.7 (−89.9 to 97.6)
	14	22	183	1	49	85.0 (8.5–97.5)
	15	21	170	1	47	85.3 (−21.3 to 98.2)
	16	17	162	0	44	100.0
	17	11	151	1	56	74.6 (−225.9 to 98.0)
	18	10	147	0	69	100.0
	19	7	184	2	125	56.5 (−144.3 to 92.3)
	20	8	305	3	432	70.7 (−2.7 to 91.7)
	2–20 combined	686	6,673	108	4,474	77.1 (71.2–81.8)

*COVID-19, coronavirus disease; IRR, incidence rate ratio; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
†Adjusted for sex and epidemiologic week.

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Effectiveness of BNT162b2 Vaccine Booster Against SARS-CoV-2 Infection and Breakthrough Complications, Israel

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