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      Effectiveness of COVID-19 vaccines against SARS-CoV-2 variants of concern: a systematic review and meta-analysis

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          Abstract

          Background

          It was urgent and necessary to synthesize the evidence for vaccine effectiveness (VE) against SARS-CoV-2 variants of concern (VOC). We conducted a systematic review and meta-analysis to provide a comprehensive overview of the effectiveness profile of COVID-19 vaccines against VOC.

          Methods

          Published randomized controlled trials (RCTs), cohort studies, and case-control studies that evaluated the VE against VOC (Alpha, Beta, Gamma, Delta, or Omicron) were searched until 4 March 2022. Pooled estimates and 95% confidence intervals (CIs) were calculated using random-effects meta-analysis. VE was defined as (1-estimate).

          Results

          Eleven RCTs (161,388 participants), 20 cohort studies (52,782,321 participants), and 26 case-control studies (2,584,732 cases) were included. Eleven COVID-19 vaccines (mRNA-1273, BNT162b2, ChAdOx1, Ad26.COV2.S, NVX-CoV2373, BBV152, CoronaVac, BBIBP-CorV, SCB-2019, CVnCoV, and HB02) were included in this analysis. Full vaccination was effective against Alpha, Beta, Gamma, Delta, and Omicron variants, with VE of 88.0% (95% CI, 83.0–91.5), 73.0% (95% CI, 64.3–79.5), 63.0% (95% CI, 47.9–73.7), 77.8% (95% CI, 72.7–82.0), and 55.9% (95% CI, 40.9–67.0), respectively. Booster vaccination was more effective against Delta and Omicron variants, with VE of 95.5% (95% CI, 94.2–96.5) and 80.8% (95% CI, 58.6–91.1), respectively. mRNA vaccines (mRNA-1273/BNT162b2) seemed to have higher VE against VOC over others; significant interactions ( p interaction < 0.10) were observed between VE and vaccine type (mRNA vaccines vs. not mRNA vaccines).

          Conclusions

          Full vaccination of COVID-19 vaccines is highly effective against Alpha variant, and moderate effective against Beta, Gamma, and Delta variants. Booster vaccination is more effective against Delta and Omicron variants. mRNA vaccines seem to have higher VE against Alpha, Beta, Gamma, and Delta variants over others.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12916-022-02397-y.

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          Most cited references87

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          Measuring inconsistency in meta-analyses.

          Julian P. T. Higgins, Simon Thompson, Jonathan Deeks … (2003)
          Article 0 comments Cited 9895 times – based on 0 reviews     Review now
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            The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

            Julian P. T. Higgins, Douglas G. Altman, Peter C. Gøtzsche … (2014)
            Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate
            Article 0 comments Cited 7279 times – based on 0 reviews     Review now
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              Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine

              Fernando P Polack, Stephen J. Thomas, Nicholas R.E. Kitchin … (2023)
              Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus disease 2019 (Covid-19) have afflicted tens of millions of people in a worldwide pandemic. Safe and effective vaccines are needed urgently. Methods In an ongoing multinational, placebo-controlled, observer-blinded, pivotal efficacy trial, we randomly assigned persons 16 years of age or older in a 1:1 ratio to receive two doses, 21 days apart, of either placebo or the BNT162b2 vaccine candidate (30 μg per dose). BNT162b2 is a lipid nanoparticle–formulated, nucleoside-modified RNA vaccine that encodes a prefusion stabilized, membrane-anchored SARS-CoV-2 full-length spike protein. The primary end points were efficacy of the vaccine against laboratory-confirmed Covid-19 and safety. Results A total of 43,548 participants underwent randomization, of whom 43,448 received injections: 21,720 with BNT162b2 and 21,728 with placebo. There were 8 cases of Covid-19 with onset at least 7 days after the second dose among participants assigned to receive BNT162b2 and 162 cases among those assigned to placebo; BNT162b2 was 95% effective in preventing Covid-19 (95% credible interval, 90.3 to 97.6). Similar vaccine efficacy (generally 90 to 100%) was observed across subgroups defined by age, sex, race, ethnicity, baseline body-mass index, and the presence of coexisting conditions. Among 10 cases of severe Covid-19 with onset after the first dose, 9 occurred in placebo recipients and 1 in a BNT162b2 recipient. The safety profile of BNT162b2 was characterized by short-term, mild-to-moderate pain at the injection site, fatigue, and headache. The incidence of serious adverse events was low and was similar in the vaccine and placebo groups. Conclusions A two-dose regimen of BNT162b2 conferred 95% protection against Covid-19 in persons 16 years of age or older. Safety over a median of 2 months was similar to that of other viral vaccines. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04368728.)
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                Author and article information

                Contributors
                Kai Yu:
                ORCID: http://orcid.org/0000-0001-5089-0281
                wzxkjk@126.com
                Feng Sun: sunfeng@bjmu.edu.cn
                Journal
                Journal ID (nlm-ta): BMC Med
                Journal ID (iso-abbrev): BMC Med
                Title: BMC Medicine
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1741-7015
                Publication date (Electronic): 23 May 2022
                Publication date PMC-release: 23 May 2022
                Publication date Collection: 2022
                Volume: 20
                Electronic Location Identifier: 200
                Affiliations
                [1 ]GRID grid.464428.8, ISNI 0000 0004 1758 3169, Department of Science and Education, , Peking University Binhai Hospital, ; Tianjin, China
                [2 ]GRID grid.194645.b, ISNI 0000000121742757, Department of Pharmacology and Pharmacy, , The University of Hong Kong, ; Hong Kong, China
                [3 ]GRID grid.464467.3, Tianjin Centers for Disease Control and Prevention, ; Tianjin, China
                [4 ]GRID grid.11135.37, ISNI 0000 0001 2256 9319, Department of Epidemiology and Biostatistics, School of Public Health, , Peking University Health Science Centre, ; Beijing, China
                Author information
                http://orcid.org/0000-0001-5089-0281
                Article
                Publisher ID: 2397
                DOI: 10.1186/s12916-022-02397-y
                PMC ID: 9126103
                PubMed ID: 35606843
                SO-VID: 50422355-7d58-4291-90f6-9ab40b51ff17
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 27 September 2021
                Date accepted : 9 May 2022
                Funding
                Funded by: National Key R&D Program of China
                Award ID: 2021YFC2301601
                Award Recipient :
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Medicine
                Keywords: sars-cov-2,covid-19,variants of concern,systematic review,vaccine effectiveness
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: sars-cov-2, covid-19, variants of concern, systematic review, vaccine effectiveness

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