Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data
BackgroundThe durability of heterologous COVID-19 vaccine effectiveness (VE) has been primarily studied in high-income countries, while evaluation of heterologous vaccine policies in low- and middle-income countries remains limited. ObjectiveWe aimed to evaluate t...
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| Format: | Article |
| Language: | English |
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JMIR Publications
2024-03-01
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| Series: | JMIR Public Health and Surveillance |
| Online Access: | https://publichealth.jmir.org/2024/1/e48255 |
| _version_ | 1797276722896306176 |
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| author | Ponlagrit Kumwichar Chittawan Poonsiri Siobhan Botwright Natchalaikorn Sirichumroonwit Bootsakorn Loharjun Supharerk Thawillarp Nontawit Cheewaruangroj Amorn Chokchaisiripakdee Yot Teerawattananon Virasakdi Chongsuvivatwong |
| author_facet | Ponlagrit Kumwichar Chittawan Poonsiri Siobhan Botwright Natchalaikorn Sirichumroonwit Bootsakorn Loharjun Supharerk Thawillarp Nontawit Cheewaruangroj Amorn Chokchaisiripakdee Yot Teerawattananon Virasakdi Chongsuvivatwong |
| author_sort | Ponlagrit Kumwichar |
| collection | DOAJ |
| description |
BackgroundThe durability of heterologous COVID-19 vaccine effectiveness (VE) has been primarily studied in high-income countries, while evaluation of heterologous vaccine policies in low- and middle-income countries remains limited.
ObjectiveWe aimed to evaluate the duration during which the VE of heterologous COVID-19 vaccine regimens in mitigating serious outcomes, specifically severe COVID-19 and death following hospitalization with COVID-19, remains over 50%.
MethodsWe formed a dynamic cohort by linking records of Thai citizens aged ≥18 years from citizen vital, COVID-19 vaccine, and COVID-19 cases registry databases between May 2021 and July 2022. Encrypted citizen identification numbers were used to merge the data between the databases. This study focuses on 8 common heterologous vaccine sequences: CoronaVac/ChAdOx1, ChAdOx1/BNT162b2, CoronaVac/CoronaVac/ChAdOx1, CoronaVac/ChAdOx1/ChAdOx1, CoronaVac/ChAdOx1/BNT162b2, BBIBP-CorV/BBIBP-CorV/BNT162b2, ChAdOx1/ChAdOx1/BNT162b2, and ChAdOx1/ChAdOx1/mRNA-1273. Nonimmunized individuals were considered for comparisons. The cohort was stratified according to the vaccination status, age, sex, province location, month of vaccination, and outcome. Data analysis employed logistic regression to determine the VE, accounting for potential confounders and durability over time, with data observed over a follow-up period of 7 months.
ResultsThis study includes 52,580,841 individuals, with approximately 17,907,215 and 17,190,975 receiving 2- and 3-dose common heterologous vaccines (not mutually exclusive), respectively. The 2-dose heterologous vaccinations offered approximately 50% VE against severe COVID-19 and death following hospitalization with COVID-19 for 2 months; however, the protection significantly declined over time. The 3-dose heterologous vaccinations sustained over 50% VE against both outcomes for at least 8 months, as determined by logistic regression with durability time-interaction modeling. The vaccine sequence consisting of CoronaVac/CoronaVac/ChAdOx1 demonstrated >80% VE against both outcomes, with no evidence of VE waning. The final monthly measured VE of CoronaVac/CoronaVac/ChAdOx1 against severe COVID-19 and death following hospitalization at 7 months after the last dose was 82% (95% CI 80.3%-84%) and 86.3% (95% CI 83.6%-84%), respectively.
ConclusionsIn Thailand, within a 7-month observation period, the 2-dose regimens could not maintain a 50% VE against severe and fatal COVID-19 for over 2 months, but all of the 3-dose regimens did. The CoronaVac/CoronaVac/ChAdOx1 regimen showed the best protective effect against severe and fatal COVID-19. The estimated durability of 50% VE for at least 8 months across all 3-dose heterologous COVID-19 vaccine regimens supports the adoption of heterologous prime-boost vaccination strategies, with a primary series of inactivated virus vaccine and boosting with either a viral vector or an mRNA vaccine, to prevent similar pandemics in low- and middle-income countries. |
| first_indexed | 2024-03-07T15:32:19Z |
| format | Article |
| id | doaj.art-19e4ff87fbc245cc9a24bda3b544cdfa |
| institution | Directory Open Access Journal |
| issn | 2369-2960 |
| language | English |
| last_indexed | 2024-03-07T15:32:19Z |
| publishDate | 2024-03-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Public Health and Surveillance |
| spelling | doaj.art-19e4ff87fbc245cc9a24bda3b544cdfa2024-03-05T15:00:39ZengJMIR PublicationsJMIR Public Health and Surveillance2369-29602024-03-0110e4825510.2196/48255Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration DataPonlagrit Kumwicharhttps://orcid.org/0000-0002-1580-5720Chittawan Poonsirihttps://orcid.org/0000-0003-2143-1662Siobhan Botwrighthttps://orcid.org/0000-0002-8204-2065Natchalaikorn Sirichumroonwithttps://orcid.org/0000-0001-7403-0278Bootsakorn Loharjunhttps://orcid.org/0000-0002-4709-6682Supharerk Thawillarphttps://orcid.org/0000-0001-8793-0670Nontawit Cheewaruangrojhttps://orcid.org/0000-0002-3727-1432Amorn Chokchaisiripakdeehttps://orcid.org/0000-0003-3319-1467Yot Teerawattananonhttps://orcid.org/0000-0003-2217-2930Virasakdi Chongsuvivatwonghttps://orcid.org/0000-0002-9850-4463 BackgroundThe durability of heterologous COVID-19 vaccine effectiveness (VE) has been primarily studied in high-income countries, while evaluation of heterologous vaccine policies in low- and middle-income countries remains limited. ObjectiveWe aimed to evaluate the duration during which the VE of heterologous COVID-19 vaccine regimens in mitigating serious outcomes, specifically severe COVID-19 and death following hospitalization with COVID-19, remains over 50%. MethodsWe formed a dynamic cohort by linking records of Thai citizens aged ≥18 years from citizen vital, COVID-19 vaccine, and COVID-19 cases registry databases between May 2021 and July 2022. Encrypted citizen identification numbers were used to merge the data between the databases. This study focuses on 8 common heterologous vaccine sequences: CoronaVac/ChAdOx1, ChAdOx1/BNT162b2, CoronaVac/CoronaVac/ChAdOx1, CoronaVac/ChAdOx1/ChAdOx1, CoronaVac/ChAdOx1/BNT162b2, BBIBP-CorV/BBIBP-CorV/BNT162b2, ChAdOx1/ChAdOx1/BNT162b2, and ChAdOx1/ChAdOx1/mRNA-1273. Nonimmunized individuals were considered for comparisons. The cohort was stratified according to the vaccination status, age, sex, province location, month of vaccination, and outcome. Data analysis employed logistic regression to determine the VE, accounting for potential confounders and durability over time, with data observed over a follow-up period of 7 months. ResultsThis study includes 52,580,841 individuals, with approximately 17,907,215 and 17,190,975 receiving 2- and 3-dose common heterologous vaccines (not mutually exclusive), respectively. The 2-dose heterologous vaccinations offered approximately 50% VE against severe COVID-19 and death following hospitalization with COVID-19 for 2 months; however, the protection significantly declined over time. The 3-dose heterologous vaccinations sustained over 50% VE against both outcomes for at least 8 months, as determined by logistic regression with durability time-interaction modeling. The vaccine sequence consisting of CoronaVac/CoronaVac/ChAdOx1 demonstrated >80% VE against both outcomes, with no evidence of VE waning. The final monthly measured VE of CoronaVac/CoronaVac/ChAdOx1 against severe COVID-19 and death following hospitalization at 7 months after the last dose was 82% (95% CI 80.3%-84%) and 86.3% (95% CI 83.6%-84%), respectively. ConclusionsIn Thailand, within a 7-month observation period, the 2-dose regimens could not maintain a 50% VE against severe and fatal COVID-19 for over 2 months, but all of the 3-dose regimens did. The CoronaVac/CoronaVac/ChAdOx1 regimen showed the best protective effect against severe and fatal COVID-19. The estimated durability of 50% VE for at least 8 months across all 3-dose heterologous COVID-19 vaccine regimens supports the adoption of heterologous prime-boost vaccination strategies, with a primary series of inactivated virus vaccine and boosting with either a viral vector or an mRNA vaccine, to prevent similar pandemics in low- and middle-income countries.https://publichealth.jmir.org/2024/1/e48255 |
| spellingShingle | Ponlagrit Kumwichar Chittawan Poonsiri Siobhan Botwright Natchalaikorn Sirichumroonwit Bootsakorn Loharjun Supharerk Thawillarp Nontawit Cheewaruangroj Amorn Chokchaisiripakdee Yot Teerawattananon Virasakdi Chongsuvivatwong Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data JMIR Public Health and Surveillance |
| title | Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data |
| title_full | Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data |
| title_fullStr | Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data |
| title_full_unstemmed | Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data |
| title_short | Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data |
| title_sort | durability of the effectiveness of heterologous covid 19 vaccine regimens in thailand retrospective cohort study using national registration data |
| url | https://publichealth.jmir.org/2024/1/e48255 |
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