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Effectiveness of Homologous and Heterologous Covid-19 Boosters against Omicron: TO THE EDITOR - NEJM

Mary Wilson

Well-known member
May 25, 2022

DOI: 10.1056/NEJMc2203165

TO THE EDITOR:

For persons who received a single dose of the Ad26.COV2.S vaccine (Johnson & Johnson–Janssen) against coronavirus disease 2019 (Covid-19), a booster dose of a messenger RNA (mRNA) vaccine at least 2 months after the primary dose is recommended. Recipients of Ad26.COV2.S for both the primary and booster doses may receive a second booster dose of an mRNA Covid-19 vaccine at least 4 months after the first Ad26.COV2.S booster dose.[SUP]1[/SUP] Immunogenicity data from a phase 1–2 clinical trial conducted before B.1.1.529 and the BA sublineages of omicron emerged showed that increases in the titers of binding and neutralizing antibodies with heterologous boosting were similar to or greater than the increases with homologous boosting.[SUP]2[/SUP] In a study involving U.S. veterans, data that were obtained during a period in which omicron was the predominant circulating variant also showed that among Ad26.COV2.S recipients, vaccine effectiveness against omicron infection was higher with heterologous boosting than with homologous boosting[SUP]3[/SUP]; however, data from the general adult population and on vaccine effectiveness over time are lacking. More than 18 million doses of the Ad26.COV2.S vaccine have been administered in the United States alone[SUP]4[/SUP]; therefore, data are needed on boosting strategies that are effective over time.

We performed a test-negative, case–control analysis to assess the effectiveness of four vaccination regimens against symptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a period when omicron was the predominant circulating variant: a single priming dose of Ad26.COV2.S, a single priming dose of Ad26.COV2.S plus a booster dose of Ad26.COV2.S (Ad26.COV2.S/Ad26.COV2.S), a single priming dose of Ad26.COV2.S plus a booster dose of mRNA vaccine (Ad26.COV2.S/mRNA), and two priming doses of an mRNA vaccine plus a booster dose of mRNA vaccine (mRNA/mRNA/mRNA). In the regimens that included an mRNA vaccine, either the BNT162b2 vaccine (Pfizer–BioNTech) or the mRNA-1273 vaccine (Moderna) was used. The methods have been published previously[SUP]5[/SUP] and are described in the Supplementary Appendix, available with the full text of this letter at NEJM.org.

A total of 512,928 rapid and laboratory-based nucleic acid amplification tests (NAATs) were used in the current study; the tests were obtained between January 2 and March 23, 2022, from the Increasing Community Access to Testing (ICATT) platform, which facilitates no-cost, drive-through SARS-CoV-2 testing at pharmacies.[SUP]5 ...

https://www.nejm.org/doi/full/10.1056/NEJMc2203165?query=featured_home[/SUP]
 
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