Estimation of Vaccine Effectiveness Against SARS-CoV-2-associated Hospitalization Using Sentinel Surveillance in South Africa

Overview

Journal Int J Epidemiol

Specialty Public Health

Date 2024 Sep 21

PMID 39305220

Authors

Nicola Chiwandire

Sibongile Walaza

Anne von Gottberg

Nicole Wolter

Mignon du Plessis

Fahima Moosa

Michelle J Groome

Jeremy Nel

Ebrahim Variava

Halima Dawood

Mvuyo Makhasi

Leora R Feldstein

Perrine Marcenac

Kathryn E Lafond

Aaron M Samuels

Cheryl Cohen

Affiliations

Soon will be listed here.

Abstract

Background: COVID-19 vaccine effectiveness (VE) studies leveraging systematic surveillance in sub-Saharan Africa are limited. We assessed the effectiveness of two vaccines (Pfizer BNT162b2 and Johnson & Johnson Ad26.COV2.S) against SARS-CoV-2-associated hospitalization in South African adults aged ≥18 years.

Methods: We conducted a test-negative case-control study using pneumonia surveillance data in South Africa. Inpatients with physician-diagnosed lower respiratory tract infection or suspected COVID-19, testing SARS-CoV-2 positive or negative from June 2021-March 2022, were cases or controls, respectively. Fully vaccinated individuals received one Ad26.COV2.S dose or two BNT162b2 doses ≥14-days before enrollment. VE was estimated using multivariable logistic regression for Delta- and Omicron BA.1/BA.2-predominant periods, stratified by age and HIV status.

Results: The study included 925 cases and 1890 controls; 38 (4%) cases and 186 (10%) controls were fully vaccinated with BNT162b2, and 30 (3%) cases and 94 (5%) controls with Ad26.COV2.S. The vaccine effectiveness of BNT162b2 against SARS-CoV-2-associated hospitalization over Delta and Omicron BA.1/BA.2 periods was 91% (95% CI: 52%, 98%) and 33% (-16%, 86%), respectively. The vaccine effectiveness of Ad26.COV2.S against hospitalization over Delta and Omicron BA.1/BA.2 periods was 72% (-36% ,94%), and -19% (-130%, 39%), respectively. The vaccine effectiveness of BNT162b2 against hospitalization over the Delta period was 94% (50%, 99%) and 89% (27%, 98%) among adults aged ≥60 years and HIV-uninfected, respectively.

Conclusions: The BNT162b2 vaccine was effective against SARS-CoV-2-associated hospitalization during the Delta period for adults aged ≥18 years, ≥60 years and those HIV-uninfected. VE for Ad26.COV2.S was inconclusive, potentially due to limited sample size or residual confounding. These findings highlight the utility of sentinel surveillance for estimating VE.

References

Moyes J, Cohen C, Pretorius M, Groome M, von Gottberg A, Wolter N . Epidemiology of respiratory syncytial virus-associated acute lower respiratory tract infection hospitalizations among HIV-infected and HIV-uninfected South African children, 2010-2011. J Infect Dis. 2013; 208 Suppl 3:S217-26. DOI: 10.1093/infdis/jit479. View

Woldemeskel B, Karaba A, Garliss C, Beck E, Wang K, Laeyendecker O . The BNT162b2 mRNA Vaccine Elicits Robust Humoral and Cellular Immune Responses in People Living With Human Immunodeficiency Virus (HIV). Clin Infect Dis. 2021; 74(7):1268-1270. PMC: 8406881. DOI: 10.1093/cid/ciab648. View

Collie S, Champion J, Moultrie H, Bekker L, Gray G . Effectiveness of BNT162b2 Vaccine against Omicron Variant in South Africa. N Engl J Med. 2021; 386(5):494-496. PMC: 8757569. DOI: 10.1056/NEJMc2119270. View

Sun K, Tempia S, Kleynhans J, von Gottberg A, McMorrow M, Wolter N . Rapidly shifting immunologic landscape and severity of SARS-CoV-2 in the Omicron era in South Africa. Nat Commun. 2023; 14(1):246. PMC: 9842214. DOI: 10.1038/s41467-022-35652-0. View

Mistry P, Barmania F, Mellet J, Peta K, Strydom A, Viljoen I . SARS-CoV-2 Variants, Vaccines, and Host Immunity. Front Immunol. 2022; 12:809244. PMC: 8761766. DOI: 10.3389/fimmu.2021.809244. View

Ao D, Lan T, He X, Liu J, Chen L, Baptista-Hon D . SARS-CoV-2 Omicron variant: Immune escape and vaccine development. MedComm (2020). 2022; 3(1):e126. PMC: 8925644. DOI: 10.1002/mco2.126. View

Cohen C, Walaza S, Moyes J, Groome M, Tempia S, Pretorius M . Epidemiology of viral-associated acute lower respiratory tract infection among children <5 years of age in a high HIV prevalence setting, South Africa, 2009-2012. Pediatr Infect Dis J. 2014; 34(1):66-72. PMC: 4276570. DOI: 10.1097/INF.0000000000000478. View

Dos Santos C, Valiati N, Noronha T, Porto V, Pacheco A, Freitas L . The effectiveness of COVID-19 vaccines against severe cases and deaths in Brazil from 2021 to 2022: a registry-based study. Lancet Reg Health Am. 2023; 20:100465. PMC: 10010656. DOI: 10.1016/j.lana.2023.100465. View

Bekker L, Garrett N, Goga A, Fairall L, Reddy T, Yende-Zuma N . Effectiveness of the Ad26.COV2.S vaccine in health-care workers in South Africa (the Sisonke study): results from a single-arm, open-label, phase 3B, implementation study. Lancet. 2022; 399(10330):1141-1153. PMC: 8930006. DOI: 10.1016/S0140-6736(22)00007-1. View

10.

Polack F, Thomas S, Kitchin N, Absalon J, Gurtman A, Lockhart S . Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020; 383(27):2603-2615. PMC: 7745181. DOI: 10.1056/NEJMoa2034577. View

11.

Vermeulen M, Mhlanga L, Sykes W, Cable R, Coleman C, Pietersen N . The evolution and interpretation of seroprevalence of SARS-CoV-2 antibodies among South African blood donors from the Beta to Omicron variant-driven waves. Vox Sang. 2023; 119(3):242-251. DOI: 10.1111/vox.13571. View

12.

Callaway E . Fast-evolving COVID variants complicate vaccine updates. Nature. 2022; 607(7917):18-19. DOI: 10.1038/d41586-022-01771-3. View

13.

Stuurman A, Bollaerts K, Alexandridou M, Biccler J, Diez Domingo J, Nohynek H . Vaccine effectiveness against laboratory-confirmed influenza in Europe - Results from the DRIVE network during season 2018/19. Vaccine. 2020; 38(41):6455-6463. DOI: 10.1016/j.vaccine.2020.07.063. View

14.

Tartof S, Slezak J, Fischer H, Hong V, Ackerson B, Ranasinghe O . Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study. Lancet. 2021; 398(10309):1407-1416. PMC: 8489881. DOI: 10.1016/S0140-6736(21)02183-8. View

15.

Sadoff J, Gray G, Vandebosch A, Cardenas V, Shukarev G, Grinsztejn B . Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19. N Engl J Med. 2021; 384(23):2187-2201. PMC: 8220996. DOI: 10.1056/NEJMoa2101544. View

16.

Arashiro T, Arima Y, Muraoka H, Sato A, Oba K, Uehara Y . Coronavirus Disease 19 (COVID-19) Vaccine Effectiveness Against Symptomatic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection During Delta-Dominant and Omicron-Dominant Periods in Japan: A Multicenter Prospective Case-control.... Clin Infect Dis. 2022; 76(3):e108-e115. PMC: 9384625. DOI: 10.1093/cid/ciac635. View

17.

Jackson M . Use of self-reported vaccination status can bias vaccine effectiveness estimates from test-negative studies. Vaccine X. 2021; 1:100003. PMC: 6668222. DOI: 10.1016/j.jvacx.2018.100003. View

18.

Ntshoe G, McAnerney J, Tempia S, Blumberg L, Moyes J, Buys A . Influenza epidemiology and vaccine effectiveness among patients with influenza-like illness, viral watch sentinel sites, South Africa, 2005-2009. PLoS One. 2014; 9(4):e94681. PMC: 3988097. DOI: 10.1371/journal.pone.0094681. View

19.

Martin C, Pan D, Melbourne C, Teece L, Aujayeb A, Baggaley R . Risk factors associated with SARS-CoV-2 infection in a multiethnic cohort of United Kingdom healthcare workers (UK-REACH): A cross-sectional analysis. PLoS Med. 2022; 19(5):e1004015. PMC: 9187071. DOI: 10.1371/journal.pmed.1004015. View

20.

Gonzalez de Aledo M, Canizares A, Vazquez-Rodriguez P, Castro A, Moldes L, Lopez S . Safety and Immunogenicity of SARS-CoV-2 vaccines in people with HIV. AIDS. 2022; 36(5):691-695. DOI: 10.1097/QAD.0000000000003161. View