COVID-19 severity and waning immunity after up to 4 mRNA vaccine doses in 73 608 patients with cancer and 621 475 matched controls in Singapore: a nationwide cohort study
Importance: Despite patients with cancer being at risk of poor outcomes from COVID-19, there are few published studies for vaccine efficacy in this group, with suboptimal immunogenicity and waning vaccine efficacy described in small studies being a concern. Objective: To assess the incidence rate of...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
| Published: |
2024
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| Online Access: | https://hdl.handle.net/10356/174182 |
| _version_ | 1811676878592802816 |
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| author | Tan, Wei Chong Tan, Janice Yu Jin Lim, Joline Si Jing Tan, Ryan Ying Cong Lee, Ainsley Ryan Yan Bin Leong, Fun Loon Lee, Soo Chin Chai, Louis Yi Ann Tan, Thuan Tong Muhammad Ismail Bin Abdul Malek Ong, Benjamin Lye, David C. Chiew, Calvin J. Chng, Wee Joo Lim, Soon Thye Bharwani, Lavina D. Tan, Iain Bee Huat Sundar, Raghav Tan, Kelvin Bryan |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Tan, Wei Chong Tan, Janice Yu Jin Lim, Joline Si Jing Tan, Ryan Ying Cong Lee, Ainsley Ryan Yan Bin Leong, Fun Loon Lee, Soo Chin Chai, Louis Yi Ann Tan, Thuan Tong Muhammad Ismail Bin Abdul Malek Ong, Benjamin Lye, David C. Chiew, Calvin J. Chng, Wee Joo Lim, Soon Thye Bharwani, Lavina D. Tan, Iain Bee Huat Sundar, Raghav Tan, Kelvin Bryan |
| author_sort | Tan, Wei Chong |
| collection | NTU |
| description | Importance: Despite patients with cancer being at risk of poor outcomes from COVID-19, there are few published studies for vaccine efficacy in this group, with suboptimal immunogenicity and waning vaccine efficacy described in small studies being a concern. Objective: To assess the incidence rate of severe COVID-19 disease outcomes associated with the number of vaccine doses received and the waning of protection over time. Design, Setting, and Participants: A prospective multicenter observational cohort study was carried out over 2 time periods (September 15, 2021, to December 20, 2021 [delta wave], and January 20, 2022, to November 11, 2022 [omicron wave]) predominated by SARS-CoV-2 delta and omicron variants, respectively. Overall, 73608 patients with cancer (23217 active treatment, 50391 cancer survivors) and 621475 controls matched by age, sex, race and ethnicity, and socioeconomic status were included. Exposure: Vaccine doses received, from zero to 4 doses, and time elapsed since last vaccine dose. Outcomes: Competing-risk regression analyses were employed to account for competing risks of death in patients with cancer. Main outcomes were incidence rate ratios (IRRs) of COVID-19 infection, hospitalization, and severe disease (defined as requirement for supplemental oxygen, intensive care, or death). The IRRs stratified by time from last vaccine dose served as indicators of waning of vaccine effectiveness over time. Results: The mean (SD) age of actively treated patients with cancer, cancer survivors, and controls were 62.7 (14.7), 62.9 (12.6), and 61.8 (14.7) years, respectively. Of 73608 patients with cancer, 27170 (36.9%) were men; 60100 (81.6%) were Chinese, 7432 (10.1%) Malay, 4597 (6.2%) Indian, and 1479 (2.0%) were of other races and ethnicities. The IRRs for the 3-dose and 4-dose vs the 2-dose group (reference) for COVID-19 hospitalization and severe disease were significantly lower during both the delta and omicron waves in cancer and control populations. The IRRs for severe disease in the 3-dose group for active treatment, cancer survivors, and controls were 0.14, 0.13, and 0.07 during the delta wave and 0.29, 0.19, and 0.21 during omicron wave, respectively. The IRRs for severe disease in the 4-dose group during the omicron wave were even lower at 0.13, 0.10 and 0.10, respectively. No waning of vaccine effectiveness against hospitalization and severe disease was seen beyond 5 months after a third dose, nor up to 5 months (the end of this study's follow-up) after a fourth dose. Conclusion: This cohort study provides evidence of the clinical effectiveness of mRNA-based vaccines against COVID-19 in patients with cancer. Longevity of immunity in preventing severe COVID-19 outcomes in actively treated patients with cancer, cancer survivors, and matched controls was observed at least 5 months after the third or fourth dose. |
| first_indexed | 2024-10-01T02:28:28Z |
| format | Journal Article |
| id | ntu-10356/174182 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T02:28:28Z |
| publishDate | 2024 |
| record_format | dspace |
| spelling | ntu-10356/1741822024-03-24T15:38:28Z COVID-19 severity and waning immunity after up to 4 mRNA vaccine doses in 73 608 patients with cancer and 621 475 matched controls in Singapore: a nationwide cohort study Tan, Wei Chong Tan, Janice Yu Jin Lim, Joline Si Jing Tan, Ryan Ying Cong Lee, Ainsley Ryan Yan Bin Leong, Fun Loon Lee, Soo Chin Chai, Louis Yi Ann Tan, Thuan Tong Muhammad Ismail Bin Abdul Malek Ong, Benjamin Lye, David C. Chiew, Calvin J. Chng, Wee Joo Lim, Soon Thye Bharwani, Lavina D. Tan, Iain Bee Huat Sundar, Raghav Tan, Kelvin Bryan Lee Kong Chian School of Medicine (LKCMedicine) Singapore General Hospital National Centre for Infectious Diseases Tan Tock Seng Hospital Medicine, Health and Life Sciences SARS-CoV-2 vaccine Immune response Importance: Despite patients with cancer being at risk of poor outcomes from COVID-19, there are few published studies for vaccine efficacy in this group, with suboptimal immunogenicity and waning vaccine efficacy described in small studies being a concern. Objective: To assess the incidence rate of severe COVID-19 disease outcomes associated with the number of vaccine doses received and the waning of protection over time. Design, Setting, and Participants: A prospective multicenter observational cohort study was carried out over 2 time periods (September 15, 2021, to December 20, 2021 [delta wave], and January 20, 2022, to November 11, 2022 [omicron wave]) predominated by SARS-CoV-2 delta and omicron variants, respectively. Overall, 73608 patients with cancer (23217 active treatment, 50391 cancer survivors) and 621475 controls matched by age, sex, race and ethnicity, and socioeconomic status were included. Exposure: Vaccine doses received, from zero to 4 doses, and time elapsed since last vaccine dose. Outcomes: Competing-risk regression analyses were employed to account for competing risks of death in patients with cancer. Main outcomes were incidence rate ratios (IRRs) of COVID-19 infection, hospitalization, and severe disease (defined as requirement for supplemental oxygen, intensive care, or death). The IRRs stratified by time from last vaccine dose served as indicators of waning of vaccine effectiveness over time. Results: The mean (SD) age of actively treated patients with cancer, cancer survivors, and controls were 62.7 (14.7), 62.9 (12.6), and 61.8 (14.7) years, respectively. Of 73608 patients with cancer, 27170 (36.9%) were men; 60100 (81.6%) were Chinese, 7432 (10.1%) Malay, 4597 (6.2%) Indian, and 1479 (2.0%) were of other races and ethnicities. The IRRs for the 3-dose and 4-dose vs the 2-dose group (reference) for COVID-19 hospitalization and severe disease were significantly lower during both the delta and omicron waves in cancer and control populations. The IRRs for severe disease in the 3-dose group for active treatment, cancer survivors, and controls were 0.14, 0.13, and 0.07 during the delta wave and 0.29, 0.19, and 0.21 during omicron wave, respectively. The IRRs for severe disease in the 4-dose group during the omicron wave were even lower at 0.13, 0.10 and 0.10, respectively. No waning of vaccine effectiveness against hospitalization and severe disease was seen beyond 5 months after a third dose, nor up to 5 months (the end of this study's follow-up) after a fourth dose. Conclusion: This cohort study provides evidence of the clinical effectiveness of mRNA-based vaccines against COVID-19 in patients with cancer. Longevity of immunity in preventing severe COVID-19 outcomes in actively treated patients with cancer, cancer survivors, and matched controls was observed at least 5 months after the third or fourth dose. Published version 2024-03-19T01:29:47Z 2024-03-19T01:29:47Z 2023 Journal Article Tan, W. C., Tan, J. Y. J., Lim, J. S. J., Tan, R. Y. C., Lee, A. R. Y. B., Leong, F. L., Lee, S. C., Chai, L. Y. A., Tan, T. T., Muhammad Ismail Bin Abdul Malek, Ong, B., Lye, D. C., Chiew, C. J., Chng, W. J., Lim, S. T., Bharwani, L. D., Tan, I. B. H., Sundar, R. & Tan, K. B. (2023). COVID-19 severity and waning immunity after up to 4 mRNA vaccine doses in 73 608 patients with cancer and 621 475 matched controls in Singapore: a nationwide cohort study. JAMA Oncology, 9(9), 1221-1229. https://dx.doi.org/10.1001/jamaoncol.2023.2271 2374-2437 https://hdl.handle.net/10356/174182 10.1001/jamaoncol.2023.2271 37440245 2-s2.0-85170106941 9 9 1221 1229 en JAMA Oncology © 2023 Tan WC et al.JAMA Oncology. Open Access: This is an open access article distributed under the terms of the CC-BY License. application/pdf |
| spellingShingle | Medicine, Health and Life Sciences SARS-CoV-2 vaccine Immune response Tan, Wei Chong Tan, Janice Yu Jin Lim, Joline Si Jing Tan, Ryan Ying Cong Lee, Ainsley Ryan Yan Bin Leong, Fun Loon Lee, Soo Chin Chai, Louis Yi Ann Tan, Thuan Tong Muhammad Ismail Bin Abdul Malek Ong, Benjamin Lye, David C. Chiew, Calvin J. Chng, Wee Joo Lim, Soon Thye Bharwani, Lavina D. Tan, Iain Bee Huat Sundar, Raghav Tan, Kelvin Bryan COVID-19 severity and waning immunity after up to 4 mRNA vaccine doses in 73 608 patients with cancer and 621 475 matched controls in Singapore: a nationwide cohort study |
| title | COVID-19 severity and waning immunity after up to 4 mRNA vaccine doses in 73 608 patients with cancer and 621 475 matched controls in Singapore: a nationwide cohort study |
| title_full | COVID-19 severity and waning immunity after up to 4 mRNA vaccine doses in 73 608 patients with cancer and 621 475 matched controls in Singapore: a nationwide cohort study |
| title_fullStr | COVID-19 severity and waning immunity after up to 4 mRNA vaccine doses in 73 608 patients with cancer and 621 475 matched controls in Singapore: a nationwide cohort study |
| title_full_unstemmed | COVID-19 severity and waning immunity after up to 4 mRNA vaccine doses in 73 608 patients with cancer and 621 475 matched controls in Singapore: a nationwide cohort study |
| title_short | COVID-19 severity and waning immunity after up to 4 mRNA vaccine doses in 73 608 patients with cancer and 621 475 matched controls in Singapore: a nationwide cohort study |
| title_sort | covid 19 severity and waning immunity after up to 4 mrna vaccine doses in 73 608 patients with cancer and 621 475 matched controls in singapore a nationwide cohort study |
| topic | Medicine, Health and Life Sciences SARS-CoV-2 vaccine Immune response |
| url | https://hdl.handle.net/10356/174182 |
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