Risk factors affecting COVID-19 vaccine effectiveness identified from 290 cross-country observational studies until February 2022: a meta-analysis and meta-regression.

Autor: Petráš M; Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic. marek.petras@lf3.cuni.cz., Máčalík R; Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic., Janovská D; Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic., Čelko AM; Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic., Dáňová J; Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic., Selinger E; Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic.; Centre for Public Health Promotion, National Institute of Public Health, 100 00, Prague, Czech Republic., Doleček J; Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic., Neradová S; Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic., Franklová M; Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague, Czech Republic., Dlouhý P; Department of Hygiene, Third Faculty of Medicine, Charles University, 100 00, Prague, Czech Republic., Rosina J; Department of Medical Biophysics and Informatics, Third Faculty of Medicine, Charles University, 100 00, Prague, Czech Republic.; Department of Health Care and Population Protection, Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01, Kladno, Czech Republic., Lesná IK; Laboratory for Atherosclerosis Research, Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, 140 21, Prague, Czech Republic.; Department of Anesthesia and Intensive Medicine, First Faculty of Medicine, Charles University and University Military Hospital, 100 00, Prague, Czech Republic.
Jazyk: angličtina
Zdroj: BMC medicine [BMC Med] 2022 Nov 25; Vol. 20 (1), pp. 461. Date of Electronic Publication: 2022 Nov 25.
DOI: 10.1186/s12916-022-02663-z
Abstrakt: Background: Observational studies made it possible to assess the impact of risk factors on the long-term effectiveness of mRNA and adenoviral vector (AdV) vaccines against COVID-19.
Methods: A computerized literature search was undertaken using the MEDLINE, EMBASE, and MedRxiv databases to identify eligible studies, with no language restrictions, published up to 28 February 2022. Eligible were observational studies assessing vaccine effectiveness (VE) by disease severity with reference groups of unvaccinated participants or participants immunized with one, two, or three vaccine doses. Our study was carried out in compliance with the PRISMA and MOOSE guidelines. The risk of study bias was identified using the Newcastle-Ottawa Quality Assessment Scale. The GRADE guidelines were applied to assess the strength of evidence for the primary outcome. The synthesis was conducted using a meta-analysis and meta-regression.
Results: Out of a total of 14,155 publications, 290 studies were included. Early VE of full vaccination against COVID-19 of any symptomatology and severity decreased from 96% (95% CI, 95-96%) for mRNA and from 86% (95% CI, 83-89%) for AdV vaccines to 67% for both vaccine types in the last 2 months of 2021. A similar 1-year decline from 98 to 86% was found for severe COVID-19 after full immunization with mRNA, but not with AdV vaccines providing persistent 82-87% effectiveness. Variant-reduced VE was only associated with Omicron regardless of disease severity, vaccine type, or vaccination completeness. The level of protection was reduced in participants aged >65 years, with a comorbidity or those in long-term care or residential homes independently of the number of doses received. The booster effect of the third mRNA dose was unclear because incompletely restored effectiveness, regardless of disease severity, declined within a short-term interval of 4 months.
Conclusions: Full vaccination provided an early high, yet waning level of protection against COVID-19 of any severity with a strong impact on the high-risk population. Moreover, the potential risk of new antigenically distinct variants should not be underestimated, and any future immunization strategy should include variant-updated vaccines.
(© 2022. The Author(s).)
Databáze: MEDLINE
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