Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity_ reinfections versus breakthrough infections _ medRxiv.pdf

5/18/22, 10:20 PM

Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections | medRxiv

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Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections Sivan Gazit, Roei Shlezinger, Galit Perez, Roni Lotan, Asaf Peretz, Amir Ben-Tov, Dani Cohen, Khitam Muhsen, Gabriel Chodick, Tal Patalon doi: https://doi.org/10.1101/2021.08.24.21262415

This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.  485

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Abstract Background Reports of waning vaccine-induced immunity against COVID-19 have begun to surface. With that, the comparable long-term protection conferred by previous infection with SARS-CoV-2 remains unclear. Methods We conducted a retrospective observational study comparing three groups: (1)SARS-CoV-2naïve individuals who received a two-dose regimen of the BioNTech/Pfizer mRNA BNT162b2 vaccine, (2)previously infected individuals who have not been vaccinated, and (3)previously infected and single dose vaccinated individuals. Three multivariate logistic regression models were applied. In all models we evaluated four outcomes: SARS-CoV-2 infection, symptomatic disease, COVID-19-related hospitalization and death. The follow-up period of June 1 to August 14, 2021, when the Delta variant was dominant in Israel. Results SARS-CoV-2-naïve vaccinees had a 13.06-fold (95% CI, 8.08 to 21.11) increased risk for breakthrough infection with the Delta variant compared to those previously infected, when the first event (infection or vaccination) occurred during January and February of 2021. The increased risk was significant (P<0.001) for symptomatic disease as well. When allowing the infection to occur at any time before vaccination (from March 2020 to February 2021), evidence of waning natural immunity was https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1

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Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections | medRxiv

demonstrated, though SARS-CoV-2 naïve vaccinees had a 5.96-fold (95% CI, 4.85 to 7.33) increased risk for breakthrough infection and a 7.13-fold (95% CI, 5.51 to 9.21) increased risk for symptomatic disease. SARS-CoV-2-naïve vaccinees were also at a greater risk for COVID-19-related-hospitalizations compared to those that were previously infected. Conclusions This study demonstrated that natural immunity confers longer lasting and stronger protection against infection, symptomatic disease and hospitalization caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 two-dose vaccine-induced immunity. Individuals who were both previously infected with SARS-CoV-2 and given a single dose of the vaccine gained additional protection against the Delta variant. Competing Interest Statement

The authors have declared no competing interest. Funding Statement

There was no external funding for the project. Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the MHS (Maccabi Healthcare Services) Institutional Review Board (IRB). Due to the retrospective design of the study, informed consent was waived by the IRB, and all identifying details of the participants were removed before computational analysis. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1

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Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections | medRxiv

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes

Footnotes The authors declare they have no conflict of interest. Funding: There was no external funding for the project. Paper in collection COVID-19 SARS-CoV-2 preprints from medRxiv and bioRxiv

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The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.  Back to top

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Posted August 25, 2021.

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COVID-19 SARS-CoV-2 preprints from medRxiv and bioRxiv Subject Area Infectious Diseases (except HIV/AIDS)

Subject Areas All Articles Addiction Medicine Allergy and Immunology Anesthesia Cardiovascular Medicine Dentistry and Oral Medicine Dermatology https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1

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Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections | medRxiv

Emergency Medicine Endocrinology (including Diabetes Mellitus and Metabolic Disease) Epidemiology Forensic Medicine Gastroenterology Genetic and Genomic Medicine Geriatric Medicine Health Economics Health Informatics Health Policy Health Systems and Quality Improvement Hematology HIV/AIDS Infectious Diseases (except HIV/AIDS) Intensive Care and Critical Care Medicine Medical Education Medical Ethics Nephrology Neurology Nursing Nutrition Obstetrics and Gynecology Occupational and Environmental Health Oncology Ophthalmology Orthopedics Otolaryngology Pain Medicine Palliative Medicine Pathology Pediatrics Pharmacology and Therapeutics Primary Care Research Psychiatry and Clinical Psychology Public and Global Health Radiology and Imaging Rehabilitation Medicine and Physical Therapy https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1

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Comparing SARS-CoV-2 natural immunity to vaccine-induced immunity: reinfections versus breakthrough infections | medRxiv

Respiratory Medicine Rheumatology Sexual and Reproductive Health Sports Medicine Surgery Toxicology Transplantation Urology

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