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• W4385481520 abstract "The omicron (B.1.1.529) variant of SARS-CoV-2 has presented several challenges for accurately estimating vaccine effectiveness in preventing infections. These challenges include many asymptomatic cases, under-testing, home-testing, and under-reporting.1Arbel R Peretz A Sergienko R et al.Effectiveness of a bivalent mRNA vaccine booster dose to prevent severe COVID-19 outcomes: a retrospective cohort study.Lancet Infect Dis. 2023; (published online April 13.)https://doi.org/10.1016/S1473-3099(23)00122-6Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar Moreover, the importance of testing and tracking infections that are asymptomatic or present with light symptoms is unclear.2Arbel R Sergienko R Friger M et al.Effectiveness of a second BNT162b2 booster vaccine against hospitalization and death from COVID-19 in adults aged over 60 years.Nat Med. 2022; 28: 1486-1490Crossref PubMed Scopus (62) Google Scholar Celine Tan and colleagues3Tan CY Chiew CJ Pang D et al.Protective immunity of SARS-CoV-2 infection and vaccines against medically attended symptomatic omicron BA.4, BA.5, and XBB reinfections in Singapore: a national cohort study.Lancet Infect Dis. 2023; 23: 799-805Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar recently suggested and published a novel outcome in assessing vaccine effectiveness: medically attended symptomatic SARS-CoV-2 infections. This approach seems to overcome the challenges in evaluating vaccine effectiveness for infections. First, for the cohort studied by Tan and colleagues, all cases are reported in the Singapore national health system; second, referring to medically attended events infers an actual burden on patients' health and health system resources. In The Lancet Infectious Diseases, Tan and colleagues4Tan CY Chiew CJ Pang D et al.Effectiveness of bivalent mRNA vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals: a retrospective cohort study.Lancet Infect Dis. 2023; (published online Aug 2.)https://doi.org/10.1016/S1473-3099(23)00373-0Google Scholar compare the protective effect of the monovalent and bivalent vaccines in preventing medically attended symptomatic SARS-CoV-2 infections and COVID-19 related hospital admissions when administered as a fourth dose. The results highlight the futility of the monovalent booster in protecting from medically attended symptomatic SARS-CoV-2 infections in SARS-CoV-2-naive participants and limited protection in previously infected individuals. However, the bivalent booster showed a high vaccine effectiveness (hazard ratio 0·17 [95% CI 0·16–0·18]) compared with the monovalent vaccine (1·05 [1·03–1·07]) against medically attended symptomatic SARS-CoV-2 infections across both groups. The bivalent booster also showed an advantage in preventing COVID-19-related hospital admissions, with high vaccine effectiveness across both groups (0·10 [0·07–0·15]) compared with the monovalent vaccine effectiveness (0·84 [0·78–0·91]).4Tan CY Chiew CJ Pang D et al.Effectiveness of bivalent mRNA vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals: a retrospective cohort study.Lancet Infect Dis. 2023; (published online Aug 2.)https://doi.org/10.1016/S1473-3099(23)00373-0Google Scholar In the post-pandemic era the world is entering, it is vital to understand the absolute benefit of vaccinations. An analysis of a US study5Lin DY Xu Y Gu Y et al.Effectiveness of bivalent boosters against severe omicron infection.N Engl J Med. 2023; 388: 764-766Crossref PubMed Scopus (21) Google Scholar has shown that the number needed to vaccinate to avoid one COVID-19 death in participants younger than 65 years exceeds 100 000, with an associated cost of US$12 000 000.6Arbel R Hammerman A Netzer D Bivalent boosters against severe omicron infection.N Engl J Med. 2023; 388: 1726-1727Crossref PubMed Scopus (0) Google Scholar Therefore, the analysis by Tan and colleagues4Tan CY Chiew CJ Pang D et al.Effectiveness of bivalent mRNA vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals: a retrospective cohort study.Lancet Infect Dis. 2023; (published online Aug 2.)https://doi.org/10.1016/S1473-3099(23)00373-0Google Scholar of number needed to vaccinate to prevent medically attended symptomatic SARS-CoV-2 infections, which shows favourable numbers needed to vaccinate ranging from 40 to 105 in the various subgroups by age and previous infections, is another important contribution of this study. Previous studies have shown fast-waning protection against infections.5Lin DY Xu Y Gu Y et al.Effectiveness of bivalent boosters against severe omicron infection.N Engl J Med. 2023; 388: 764-766Crossref PubMed Scopus (21) Google Scholar, 7Centers for Disease Control and PreventionCOVID-19 vaccine effectiveness updates.https://www.fda.gov/media/169536/downloadDate accessed: June 22, 2023Google Scholar Tan and colleagues' study showed no significantly waning effectiveness of the bivalent vaccines after 2 months.4Tan CY Chiew CJ Pang D et al.Effectiveness of bivalent mRNA vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals: a retrospective cohort study.Lancet Infect Dis. 2023; (published online Aug 2.)https://doi.org/10.1016/S1473-3099(23)00373-0Google Scholar However, this period seems insufficient to assess the waning immunity of protection against medically attended symptomatic SARS-CoV-2 infections. The study also did not assess the safety aspects of the boosters. However, another 2023 study has shown the safety of the monovalent and bivalent boosters.8Yamin D Yechezkel M Arbel R et al.Safety of monovalent and bivalent BNT162b2 mRNA COVID-19 vaccine boosters in at-risk populations in Israel: a large-scale, retrospective, self-controlled case series study.Lancet Infect Dis. 2023; (published online June 20.)https://doi.org/10.1016/S1473-3099(23)00207-4Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar In summary, Tan and colleagues' study contributes to some of the most crucial policy questions health systems worldwide are facing in this new era of post-emergency. First, should we stop using the monovalent vaccines? The evidence from this study supports findings from previous studies, and the answer seems to be yes. The USA has already stopped using the monovalent vaccines.9US Food & Drug AdministrationCoronavirus (COVID-19) update: FDA authorizes changes to simplify use of bivalent mRNA COVID-19 vaccines.https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-changes-simplify-use-bivalent-mrna-covid-19-vaccinesDate accessed: June 22, 2023Google Scholar However, in the EU, monovalent boosters are still indicated to prevent COVID-19 hospital admissions.10European Medicines AgencyECDC and EMA statement on updating COVID-19 vaccines to target new SARS-CoV-2 virus variants.https://www.ema.europa.eu/en/news/ema-ecdc-statement-updating-covid-19-vaccines-target-new-sars-cov-2-virus-variantsDate: June 6, 2023Date accessed: June 22, 2023Google Scholar Second, should we continue to vaccinate younger adults? The study did not show the absolute risk reduction to prevent COVID-19-related hospital admissions by age group, making it impossible to conclude whether vaccination with the bivalent booster as a fourth dose should be recommended to different age groups. However, the study did show a favourable number needed to vaccinate to prevent medically attended symptomatic SARS-CoV-2 infections across age groups. Therefore, vaccinating younger adults should be considered if the prevention of medically attended symptomatic SARS-CoV-2 infections is deemed useful. Third, should we vaccinate individuals with hybrid immunity? At this stage, most of the world's population has hybrid immunity. Tan and colleagues' study suggests that vaccinating individuals with the bivalent booster as a fourth dose is essential to prevent medically attended symptomatic SARS-CoV-2 infections and COVID-19 hospital admissions in both SARS-CoV-2-naive and previously infected individuals. Last, are infections an important outcome in the omicron era? The medically attended symptomatic SARS-CoV-2 infections measure seems to provide a more reliable and valuable alternative in this era of asymptomatic SARS-CoV-2 infections, under-testing, and under-reporting of infections. We declare no competing interests. Effectiveness of bivalent mRNA vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals: a retrospective cohort studyA fourth dose with the bivalent vaccine was substantially more effective against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission than four monovalent doses among both SARS-CoV-2-naive and previously infected individuals. Boosters with the bivalent vaccine might be preferred in this omicron-predominant pandemic, regardless of previous infection history. Full-Text PDF" @default.
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• W4385481520 title "The superiority of bivalent over monovalent booster vaccines" @default.
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