Effects of previous infection, vaccination, and hybrid immunity against symptomatic Alpha, Beta, and Delta SARS-CoV-2 infections: an observational studyResearch in context
Heba N. Altarawneh,
Hiam Chemaitelly,
Houssein H. Ayoub,
Patrick Tang,
Mohammad R. Hasan,
Hadi M. Yassine,
Hebah A. Al-Khatib,
Asmaa A. Al Thani,
Peter Coyle,
Zaina Al-Kanaani,
Einas Al-Kuwari,
Andrew Jeremijenko,
Anvar Hassan Kaleeckal,
Ali Nizar Latif,
Riyazuddin Mohammad Shaik,
Hanan F. Abdul-Rahim,
Gheyath K. Nasrallah,
Mohamed Ghaith Al-Kuwari,
Adeel A. Butt,
Hamad Eid Al-Romaihi,
Mohamed H. Al-Thani,
Abdullatif Al-Khal,
Roberto Bertollini,
Laith J. Abu-Raddad
Affiliations
Heba N. Altarawneh
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization 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; Corresponding author. Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
Hiam Chemaitelly
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization 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
Houssein H. Ayoub
Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar
Patrick Tang
Department of Pathology, Sidra Medicine, Doha, Qatar
Mohammad R. Hasan
Department of Pathology, Sidra Medicine, Doha, Qatar
Hadi M. Yassine
Biomedical Research Center, QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
Hebah A. Al-Khatib
Biomedical Research Center, QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
Asmaa A. Al Thani
Biomedical Research Center, QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
Peter Coyle
Biomedical Research Center, QU Health, Qatar University, Doha, Qatar; Hamad Medical Corporation, Doha, Qatar; Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, United Kingdom
Zaina Al-Kanaani
Hamad Medical Corporation, Doha, Qatar
Einas Al-Kuwari
Hamad Medical Corporation, Doha, Qatar
Andrew Jeremijenko
Hamad Medical Corporation, Doha, Qatar
Anvar Hassan Kaleeckal
Hamad Medical Corporation, Doha, Qatar
Ali Nizar Latif
Hamad Medical Corporation, Doha, Qatar
Riyazuddin Mohammad Shaik
Hamad Medical Corporation, Doha, Qatar
Hanan F. Abdul-Rahim
Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
Gheyath K. Nasrallah
Biomedical Research Center, QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
Mohamed Ghaith Al-Kuwari
Primary Health Care Corporation, Doha, Qatar
Adeel A. Butt
Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA; Hamad Medical Corporation, Doha, Qatar; Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
Hamad Eid Al-Romaihi
Ministry of Public Health, Doha, Qatar
Mohamed H. Al-Thani
Ministry of Public Health, Doha, Qatar
Abdullatif Al-Khal
Hamad Medical Corporation, Doha, Qatar
Roberto Bertollini
Ministry of Public Health, Doha, Qatar
Laith J. Abu-Raddad
Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization 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; College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar; Corresponding author. Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
Summary: Background: Protection against SARS-CoV-2 symptomatic infection and severe COVID-19 of previous infection, mRNA two-dose vaccination, mRNA three-dose vaccination, and hybrid immunity of previous infection and vaccination were investigated in Qatar for the Alpha, Beta, and Delta variants. Methods: Six national, matched, test-negative, case-control studies were conducted between January 18 and December 18, 2021 on a sample of 239,120 PCR-positive tests and 6,103,365 PCR-negative tests. Findings: Effectiveness of previous infection against Alpha, Beta, and Delta reinfection was 89.5% (95% CI: 85.5–92.3%), 87.9% (95% CI: 85.4–89.9%), and 90.0% (95% CI: 86.7–92.5%), respectively. Effectiveness of two-dose BNT162b2 vaccination against Alpha, Beta, and Delta infection was 90.5% (95% CI, 83.9–94.4%), 80.5% (95% CI: 79.0–82.0%), and 58.1% (95% CI: 54.6–61.3%), respectively. Effectiveness of three-dose BNT162b2 vaccination against Delta infection was 91.7% (95% CI: 87.1–94.7%). Effectiveness of hybrid immunity of previous infection and two-dose BNT162b2 vaccination was 97.4% (95% CI: 95.4–98.5%) against Beta infection and 94.5% (95% CI: 92.8–95.8%) against Delta infection. Effectiveness of previous infection and three-dose BNT162b2 vaccination was 98.1% (95% CI: 85.7–99.7%) against Delta infection. All five forms of immunity had >90% protection against severe, critical, or fatal COVID-19 regardless of variant. Similar effectiveness estimates were observed for mRNA-1273. A mathematical model accurately predicted hybrid immunity protection by assuming that the individual effects of previous infection and vaccination acted independently. Interpretation: Hybrid immunity, offering the strongest protection, was mathematically predicted by assuming that the immunities obtained from previous infection and vaccination act independently, without synergy or redundancy. Funding: The Biomedical Research Program and the Biostatistics, Epidemiology, and the Biomathematics Research Core, both at Weill Cornell Medicine-Qatar, Ministry of Public Health, Hamad Medical Corporation, Sidra Medicine, Qatar Genome Programme, Qatar University Biomedical Research Center, and Qatar University Internal Grant ID QUCG-CAS-23/24-114.
