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Duration of Protection against Mild and Severe Disease by Covid-19 Vaccines.
N Engl J Med. 2022 01 27; 386(4):340-350.NEJM

Abstract

BACKGROUND

Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), have been used since December 2020 in the United Kingdom. Real-world data have shown the vaccines to be highly effective against Covid-19 and related severe disease and death. Vaccine effectiveness may wane over time since the receipt of the second dose of the ChAdOx1-S (ChAdOx1 nCoV-19) and BNT162b2 vaccines.

METHODS

We used a test-negative case-control design to estimate vaccine effectiveness against symptomatic Covid-19 and related hospitalization and death in England. Effectiveness of the ChAdOx1-S and BNT162b2 vaccines was assessed according to participant age and status with regard to coexisting conditions and over time since receipt of the second vaccine dose to investigate waning of effectiveness separately for the B.1.1.7 (alpha) and B.1.617.2 (delta) variants.

RESULTS

Vaccine effectiveness against symptomatic Covid-19 with the delta variant peaked in the early weeks after receipt of the second dose and then decreased by 20 weeks to 44.3% (95% confidence interval [CI], 43.2 to 45.4) with the ChAdOx1-S vaccine and to 66.3% (95% CI, 65.7 to 66.9) with the BNT162b2 vaccine. Waning of vaccine effectiveness was greater in persons 65 years of age or older than in those 40 to 64 years of age. At 20 weeks or more after vaccination, vaccine effectiveness decreased less against both hospitalization, to 80.0% (95% CI, 76.8 to 82.7) with the ChAdOx1-S vaccine and 91.7% (95% CI, 90.2 to 93.0) with the BNT162b2 vaccine, and death, to 84.8% (95% CI, 76.2 to 90.3) and 91.9% (95% CI, 88.5 to 94.3), respectively. Greater waning in vaccine effectiveness against hospitalization was observed in persons 65 years of age or older in a clinically extremely vulnerable group and in persons 40 to 64 years of age with underlying medical conditions than in healthy adults.

CONCLUSIONS

We observed limited waning in vaccine effectiveness against Covid-19-related hospitalization and death at 20 weeks or more after vaccination with two doses of the ChAdOx1-S or BNT162b2 vaccine. Waning was greater in older adults and in those in a clinical risk group.

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Authors+Show Affiliations

Andrews N
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Tessier E
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Stowe J
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Gower C
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Kirsebom F
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Simmons R
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Gallagher E
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Thelwall S
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Groves N
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Dabrera G
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Myers R
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Campbell CNJ
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Amirthalingam G
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Edmunds M
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Zambon M
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Brown K
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Hopkins S
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Chand M
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Ladhani SN
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Ramsay M
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
Lopez Bernal J
From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.

MeSH

AdolescentAdultAge FactorsAgedBNT162 VaccineCOVID-19Case-Control StudiesChAdOx1 nCoV-19FemaleHospitalizationHumansImmunization, SecondaryImmunogenicity, VaccineMaleMiddle AgedPatient AcuityRisk FactorsSARS-CoV-2Time FactorsUnited KingdomVaccine Efficacy

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35021002

Citation

Andrews, Nick, et al. "Duration of Protection Against Mild and Severe Disease By Covid-19 Vaccines." The New England Journal of Medicine, vol. 386, no. 4, 2022, pp. 340-350.
Andrews N, Tessier E, Stowe J, et al. Duration of Protection against Mild and Severe Disease by Covid-19 Vaccines. N Engl J Med. 2022;386(4):340-350.
Andrews, N., Tessier, E., Stowe, J., Gower, C., Kirsebom, F., Simmons, R., Gallagher, E., Thelwall, S., Groves, N., Dabrera, G., Myers, R., Campbell, C. N. J., Amirthalingam, G., Edmunds, M., Zambon, M., Brown, K., Hopkins, S., Chand, M., Ladhani, S. N., ... Lopez Bernal, J. (2022). Duration of Protection against Mild and Severe Disease by Covid-19 Vaccines. The New England Journal of Medicine, 386(4), 340-350. https://doi.org/10.1056/NEJMoa2115481
Andrews N, et al. Duration of Protection Against Mild and Severe Disease By Covid-19 Vaccines. N Engl J Med. 2022 01 27;386(4):340-350. PubMed PMID: 35021002.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Duration of Protection against Mild and Severe Disease by Covid-19 Vaccines. AU - Andrews,Nick, AU - Tessier,Elise, AU - Stowe,Julia, AU - Gower,Charlotte, AU - Kirsebom,Freja, AU - Simmons,Ruth, AU - Gallagher,Eileen, AU - Thelwall,Simon, AU - Groves,Natalie, AU - Dabrera,Gavin, AU - Myers,Richard, AU - Campbell,Colin N J, AU - Amirthalingam,Gayatri, AU - Edmunds,Matt, AU - Zambon,Maria, AU - Brown,Kevin, AU - Hopkins,Susan, AU - Chand,Meera, AU - Ladhani,Shamez N, AU - Ramsay,Mary, AU - Lopez Bernal,Jamie, Y1 - 2022/01/12/ PY - 2022/1/13/pubmed PY - 2022/2/3/medline PY - 2022/1/12/entrez SP - 340 EP - 350 JF - The New England journal of medicine JO - N Engl J Med VL - 386 IS - 4 N2 - BACKGROUND: Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), have been used since December 2020 in the United Kingdom. Real-world data have shown the vaccines to be highly effective against Covid-19 and related severe disease and death. Vaccine effectiveness may wane over time since the receipt of the second dose of the ChAdOx1-S (ChAdOx1 nCoV-19) and BNT162b2 vaccines. METHODS: We used a test-negative case-control design to estimate vaccine effectiveness against symptomatic Covid-19 and related hospitalization and death in England. Effectiveness of the ChAdOx1-S and BNT162b2 vaccines was assessed according to participant age and status with regard to coexisting conditions and over time since receipt of the second vaccine dose to investigate waning of effectiveness separately for the B.1.1.7 (alpha) and B.1.617.2 (delta) variants. RESULTS: Vaccine effectiveness against symptomatic Covid-19 with the delta variant peaked in the early weeks after receipt of the second dose and then decreased by 20 weeks to 44.3% (95% confidence interval [CI], 43.2 to 45.4) with the ChAdOx1-S vaccine and to 66.3% (95% CI, 65.7 to 66.9) with the BNT162b2 vaccine. Waning of vaccine effectiveness was greater in persons 65 years of age or older than in those 40 to 64 years of age. At 20 weeks or more after vaccination, vaccine effectiveness decreased less against both hospitalization, to 80.0% (95% CI, 76.8 to 82.7) with the ChAdOx1-S vaccine and 91.7% (95% CI, 90.2 to 93.0) with the BNT162b2 vaccine, and death, to 84.8% (95% CI, 76.2 to 90.3) and 91.9% (95% CI, 88.5 to 94.3), respectively. Greater waning in vaccine effectiveness against hospitalization was observed in persons 65 years of age or older in a clinically extremely vulnerable group and in persons 40 to 64 years of age with underlying medical conditions than in healthy adults. CONCLUSIONS: We observed limited waning in vaccine effectiveness against Covid-19-related hospitalization and death at 20 weeks or more after vaccination with two doses of the ChAdOx1-S or BNT162b2 vaccine. Waning was greater in older adults and in those in a clinical risk group. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/35021002/full_citation DB - PRIME DP - Unbound Medicine ER -