Vaccine effectiveness and duration of protection against symptomatic and severe Covid-19 during the first year of vaccination in France

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Abstract

Background

SARS-CoV-2 continues to spread despite fast vaccine rollout, which could be attributed to waning immunity or to a reduced protection against some variants. A thorough characterization of vaccine protection and its duration in time is needed to inform vaccination policies and enhance public trust.

Methods

We matched three national databases with exhaustive information on screening, vaccination and hospitalizations in France over the year 2021. We performed a two-step analysis to estimate vaccine effectiveness against severe forms of Covid-19 in people aged 50 years or over, combining: (i) a test-negative case–control design to assess vaccine effectiveness against symptomatic infections; and (ii) a survival analysis to assess the additional protection against severe outcomes (hospitalizations and inpatient deaths) in infected individuals.

Results

We found a high vaccine effectiveness in people aged 50 years or more, reaching 82% against symptomatic infections and 94% against severe outcomes, after a full vaccination scheme.

Vaccine effectiveness against symptomatic infections strongly decreased over time, dropping to 53% after six months, but remained high against severe forms (90% after six months). The booster dose allowed restoring high protection levels. Vaccine protection and its evolution in time, showed little difference against the variants that circulated prior to December 2021 in France, including the Delta variant.

Conclusion

Though vaccine immunity decreases over time, vaccination remains crucial to provide individual protection against severe diseases. This decline can be reversed by the injection of a booster dose.

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  1. SciScore for 10.1101/2022.02.17.22270791: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.


    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, the observational nature of the data itself also brings about some limitations. We used a test-negative design in order to reduce selection biases that are difficult to measure such as health-seeking behaviour, access to testing and case ascertainment. This method has been proven useful in our study context. In particular, it allowed limiting the effect of the evolution of screening policies on the propensity of getting tested (Appendix 1). Yet, test-negative designs rely on strong assumptions, the applicability of which is difficult to assess and may have varied over the study period (Jackson and Nelson, 2013; Dean et al, 2021). The control variables that are used to limit the selection bias in the use of vaccination may not be sufficient, as a given vaccination status at a given time may reflect unobserved factors. For example, among people aged 50 years or over, those vaccinated at the beginning of the study period are likely to be more vulnerable (persons in retirement homes or with comorbidities), whereas those unvaccinated at the end of the study period are likely to be special (persons for whom vaccination is contraindicated, or persons against vaccination). In our study, we observed an increased risk of infection in the first days after vaccination, before protective immunity has been reached. This finding, observed elsewhere (Lopez Bernal et al. 2021a; Chung et al. 2021), seems to be due to a higher baseline risk of infection among those who were initially p...

    Results from TrialIdentifier: No clinical trial numbers were referenced.


    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.


    Results from JetFighter: We did not find any issues relating to colormaps.


    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.


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