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Protection from previous natural infection compared with mRNA vaccination against SARS-CoV-2 infection and severe COVID-19 in Qatar: a retrospective cohort study.
Lancet Microbe. 2022 12; 3(12):e944-e955.LM

Abstract

BACKGROUND

Understanding protection conferred by natural SARS-CoV-2 infection versus COVID-19 vaccination is important for informing vaccine mandate decisions. We compared protection conferred by natural infection versus that from the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccines in Qatar.

METHODS

We conducted two matched retrospective cohort studies that emulated target trials. Data were obtained from the national federated databases for COVID-19 vaccination, SARS-CoV-2 testing, and COVID-19-related hospitalisation and death between Feb 28, 2020 (pandemic onset in Qatar) and May 12, 2022. We matched individuals with a documented primary infection and no vaccination record (natural infection cohort) with individuals who had received two doses (primary series) of the same vaccine (BNT162b2-vaccinated or mRNA-1273-vaccinated cohorts) at the start of follow-up (90 days after the primary infection). Individuals were exact matched (1:1) by sex, 10-year age group, nationality, comorbidity count, and timing of primary infection or first-dose vaccination. Incidence of SARS-CoV-2 infection and COVID-19-related hospitalisation and death in the natural infection cohorts was compared with incidence in the vaccinated cohorts, using Cox proportional hazards regression models with adjustment for matching factors.

FINDINGS

Between Jan 5, 2021 (date of second-dose vaccine roll-out) and May 12, 2022, 104 500 individuals vaccinated with BNT162b2 and 61 955 individuals vaccinated with mRNA-1273 were matched to unvaccinated individuals with a documented primary infection. During follow-up, 7123 SARS-CoV-2 infections were recorded in the BNT162b2-vaccinated cohort and 3583 reinfections were recorded in the matched natural infection cohort. 4282 SARS-CoV-2 infections were recorded in the mRNA-1273-vaccinated cohort and 2301 reinfections were recorded in the matched natural infection cohort. The overall adjusted hazard ratio (HR) for SARS-CoV-2 infection was 0·47 (95% CI 0·45-0·48) after previous natural infection versus BNT162b2 vaccination, and 0·51 (0·49-0·54) after previous natural infection versus mRNA-1273 vaccination. The overall adjusted HR for severe (acute care hospitalisations), critical (intensive care unit hospitalisations), or fatal COVID-19 cases was 0·24 (0·08-0·72) after previous natural infection versus BNT162b2 vaccination, and 0·24 (0·05-1·19) after previous natural infection versus mRNA-1273 vaccination. Severe, critical, or fatal COVID-19 was rare in both the natural infection and vaccinated cohorts.

INTERPRETATION

Previous natural infection was associated with lower incidence of SARS-CoV-2 infection, regardless of the variant, than mRNA primary-series vaccination. Vaccination remains the safest and most optimal tool for protecting against infection and COVID-19-related hospitalisation and death, irrespective of previous infection status.

FUNDING

The Biomedical Research Program and the Biostatistics, Epidemiology, and Biomathematics Research Core, Weill Cornell Medicine-Qatar; Qatar Ministry of Public Health; Hamad Medical Corporation; Sidra Medicine; Qatar Genome Programme; and Qatar University Biomedical Research Center.

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Authors+Show Affiliations

Chemaitelly H
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar; WHO Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA. Electronic address: hsc2001@qatar-med.cornell.edu.
Ayoub HH
Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar.
AlMukdad S
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar; WHO Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar.
Coyle P
Hamad Medical Corporation, Doha, Qatar; Biomedical Research Center, QU Health, Qatar University, Doha, Qatar; Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK.
Tang P
Department of Pathology, Sidra Medicine, Doha, Qatar.
Yassine HM
Biomedical Research Center, QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
Al-Khatib HA
Biomedical Research Center, QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
Smatti MK
Biomedical Research Center, QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
Hasan MR
Department of Pathology, Sidra Medicine, Doha, Qatar.
Al-Kanaani Z
Hamad Medical Corporation, Doha, Qatar.
Al-Kuwari E
Hamad Medical Corporation, Doha, Qatar.
Jeremijenko A
Hamad Medical Corporation, Doha, Qatar.
Kaleeckal AH
Hamad Medical Corporation, Doha, Qatar.
Latif AN
Hamad Medical Corporation, Doha, Qatar.
Shaik RM
Hamad Medical Corporation, Doha, Qatar.
Abdul-Rahim HF
Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
Nasrallah GK
Biomedical Research Center, QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
Al-Kuwari MG
Primary Health Care Corporation, Doha, Qatar.
Butt AA
Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA; Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA; Hamad Medical Corporation, Doha, Qatar.
Al-Romaihi HE
Ministry of Public Health, Doha, Qatar.
Al-Thani MH
Ministry of Public Health, Doha, Qatar.
Al-Khal A
Hamad Medical Corporation, Doha, Qatar.
Bertollini R
Ministry of Public Health, Doha, Qatar.
Abu-Raddad LJ
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar; WHO Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA; Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar. Electronic address: lja2002@qatar-med.cornell.edu.

MeSH

HumansCOVID-19ReinfectionRetrospective StudiesRNA, MessengerSARS-CoV-2BNT162 VaccineCOVID-19 TestingCOVID-19 VaccinesQatarPublic Health

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

36375482

Citation

Chemaitelly, Hiam, et al. "Protection From Previous Natural Infection Compared With mRNA Vaccination Against SARS-CoV-2 Infection and Severe COVID-19 in Qatar: a Retrospective Cohort Study." The Lancet. Microbe, vol. 3, no. 12, 2022, pp. e944-e955.
Chemaitelly H, Ayoub HH, AlMukdad S, et al. Protection from previous natural infection compared with mRNA vaccination against SARS-CoV-2 infection and severe COVID-19 in Qatar: a retrospective cohort study. Lancet Microbe. 2022;3(12):e944-e955.
Chemaitelly, H., Ayoub, H. H., AlMukdad, S., Coyle, P., Tang, P., Yassine, H. M., Al-Khatib, H. A., Smatti, M. K., Hasan, M. R., Al-Kanaani, Z., Al-Kuwari, E., Jeremijenko, A., Kaleeckal, A. H., Latif, A. N., Shaik, R. M., Abdul-Rahim, H. F., Nasrallah, G. K., Al-Kuwari, M. G., Butt, A. A., ... Abu-Raddad, L. J. (2022). Protection from previous natural infection compared with mRNA vaccination against SARS-CoV-2 infection and severe COVID-19 in Qatar: a retrospective cohort study. The Lancet. Microbe, 3(12), e944-e955. https://doi.org/10.1016/S2666-5247(22)00287-7
Chemaitelly H, et al. Protection From Previous Natural Infection Compared With mRNA Vaccination Against SARS-CoV-2 Infection and Severe COVID-19 in Qatar: a Retrospective Cohort Study. Lancet Microbe. 2022;3(12):e944-e955. PubMed PMID: 36375482.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Protection from previous natural infection compared with mRNA vaccination against SARS-CoV-2 infection and severe COVID-19 in Qatar: a retrospective cohort study. AU - Chemaitelly,Hiam, AU - Ayoub,Houssein H, AU - AlMukdad,Sawsan, AU - Coyle,Peter, AU - Tang,Patrick, AU - Yassine,Hadi M, AU - Al-Khatib,Hebah A, AU - Smatti,Maria K, AU - Hasan,Mohammad R, AU - Al-Kanaani,Zaina, AU - Al-Kuwari,Einas, AU - Jeremijenko,Andrew, AU - Kaleeckal,Anvar Hassan, AU - Latif,Ali Nizar, AU - Shaik,Riyazuddin Mohammad, AU - Abdul-Rahim,Hanan F, AU - Nasrallah,Gheyath K, AU - Al-Kuwari,Mohamed Ghaith, AU - Butt,Adeel A, AU - Al-Romaihi,Hamad Eid, AU - Al-Thani,Mohamed H, AU - Al-Khal,Abdullatif, AU - Bertollini,Roberto, AU - Abu-Raddad,Laith J, Y1 - 2022/11/11/ PY - 2022/04/08/received PY - 2022/05/24/revised PY - 2022/09/21/accepted PY - 2022/11/15/pubmed PY - 2022/12/7/medline PY - 2022/11/14/entrez SP - e944 EP - e955 JF - The Lancet. Microbe JO - Lancet Microbe VL - 3 IS - 12 N2 - BACKGROUND: Understanding protection conferred by natural SARS-CoV-2 infection versus COVID-19 vaccination is important for informing vaccine mandate decisions. We compared protection conferred by natural infection versus that from the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccines in Qatar. METHODS: We conducted two matched retrospective cohort studies that emulated target trials. Data were obtained from the national federated databases for COVID-19 vaccination, SARS-CoV-2 testing, and COVID-19-related hospitalisation and death between Feb 28, 2020 (pandemic onset in Qatar) and May 12, 2022. We matched individuals with a documented primary infection and no vaccination record (natural infection cohort) with individuals who had received two doses (primary series) of the same vaccine (BNT162b2-vaccinated or mRNA-1273-vaccinated cohorts) at the start of follow-up (90 days after the primary infection). Individuals were exact matched (1:1) by sex, 10-year age group, nationality, comorbidity count, and timing of primary infection or first-dose vaccination. Incidence of SARS-CoV-2 infection and COVID-19-related hospitalisation and death in the natural infection cohorts was compared with incidence in the vaccinated cohorts, using Cox proportional hazards regression models with adjustment for matching factors. FINDINGS: Between Jan 5, 2021 (date of second-dose vaccine roll-out) and May 12, 2022, 104 500 individuals vaccinated with BNT162b2 and 61 955 individuals vaccinated with mRNA-1273 were matched to unvaccinated individuals with a documented primary infection. During follow-up, 7123 SARS-CoV-2 infections were recorded in the BNT162b2-vaccinated cohort and 3583 reinfections were recorded in the matched natural infection cohort. 4282 SARS-CoV-2 infections were recorded in the mRNA-1273-vaccinated cohort and 2301 reinfections were recorded in the matched natural infection cohort. The overall adjusted hazard ratio (HR) for SARS-CoV-2 infection was 0·47 (95% CI 0·45-0·48) after previous natural infection versus BNT162b2 vaccination, and 0·51 (0·49-0·54) after previous natural infection versus mRNA-1273 vaccination. The overall adjusted HR for severe (acute care hospitalisations), critical (intensive care unit hospitalisations), or fatal COVID-19 cases was 0·24 (0·08-0·72) after previous natural infection versus BNT162b2 vaccination, and 0·24 (0·05-1·19) after previous natural infection versus mRNA-1273 vaccination. Severe, critical, or fatal COVID-19 was rare in both the natural infection and vaccinated cohorts. INTERPRETATION: Previous natural infection was associated with lower incidence of SARS-CoV-2 infection, regardless of the variant, than mRNA primary-series vaccination. Vaccination remains the safest and most optimal tool for protecting against infection and COVID-19-related hospitalisation and death, irrespective of previous infection status. FUNDING: The Biomedical Research Program and the Biostatistics, Epidemiology, and Biomathematics Research Core, Weill Cornell Medicine-Qatar; Qatar Ministry of Public Health; Hamad Medical Corporation; Sidra Medicine; Qatar Genome Programme; and Qatar University Biomedical Research Center. SN - 2666-5247 UR - https://www.unboundmedicine.com/medline/citation/36375482/Protection_from_previous_natural_infection_compared_with_mRNA_vaccination_against_SARS_CoV_2_infection_and_severe_COVID_19_in_Qatar:_a_retrospective_cohort_study_ DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓9 ↑41]

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