Association of a Third Dose of BNT162b2 Vaccine with Incidence of SARS-CoV-2 Infection among Health Care Workers in Israel

Avishay Spitzer; Yoel Angel; Or Marudi; David Zeltser; Esther Saiag; Hanoch Goldshmidt; Ilana Goldiner; Moshe Stark; Ora Halutz; Ronni Gamzu; Marina Slobodkin; Nadav Amrami; Eugene Feigin; Meital Elbaz; Moran Furman; Yotam Bronstein; Amanda Chikly; Anna Eshkol; Victoria Furer; Talia Mayer; Suzy Meijer; Ariel Melloul; Michal Mizrahi; Michal Yakubovsky; Dana Rosenberg; Ari Safir; Liron Spitzer; Eyal Taleb; Ori Elkayam; Adi Silberman; Tali Eviatar; Ofir Elalouf; Tal Levinson; Katia Pozyuchenko; Ayelet Itzhaki-Alfia; Eli Sprecher; Ronen Ben-Ami; Oryan Henig

doi:10.1001/jama.2021.23641

Association of a Third Dose of BNT162b2 Vaccine with Incidence of SARS-CoV-2 Infection among Health Care Workers in Israel

Avishay Spitzer, Yoel Angel, Or Marudi, David Zeltser, Esther Saiag, Hanoch Goldshmidt, Ilana Goldiner, Moshe Stark, Ora Halutz, Ronni Gamzu, Marina Slobodkin, Nadav Amrami, Eugene Feigin, Meital Elbaz, Moran Furman, Yotam Bronstein, Amanda Chikly, Anna Eshkol, Victoria Furer, Talia MayerSuzy Meijer, Ariel Melloul, Michal Mizrahi, Michal Yakubovsky, Dana Rosenberg, Ari Safir, Liron Spitzer, Eyal Taleb, Ori Elkayam, Adi Silberman, Tali Eviatar, Ofir Elalouf, Tal Levinson, Katia Pozyuchenko, Ayelet Itzhaki-Alfia, Eli Sprecher, Ronen Ben-Ami, Oryan Henig

Research output: Contribution to journal › Article › peer-review

80 Scopus citations

Abstract

Importance: Administration of a BNT162b2 booster dose (Pfizer-BioNTech) to fully vaccinated individuals aged 60 years and older was significantly associated with lower risk of SARS-CoV-2 infection and severe illness. Data are lacking on the effectiveness of booster doses for younger individuals and health care workers. Objective: To estimate the association of a BNT162b2 booster dose with SARS-CoV-2 infections among health care workers who were previously vaccinated with a 2-dose series of BNT162b2. Design, Setting, and Participants: This was a prospective cohort study conducted at a tertiary medical center in Tel Aviv, Israel. The study cohort included 1928 immunocompetent health care workers who were previously vaccinated with a 2-dose series of BNT162b2, and had enrolled between August 8 and 19, 2021, with final follow-up reported through September 20, 2021. Screening for SARS-CoV-2 infection was performed every 14 days. Anti-spike protein receptor binding domain IgG titers were determined at baseline and 1 month after enrollment. Cox regression with time-dependent analysis was used to estimate hazard ratios of SARS-CoV-2 infection between booster-immunized status and 2-dose vaccinated (booster-nonimmunized) status. Exposures: Vaccination with a booster dose of BNT162b2 vaccine. Main Outcomes and Measures: The primary outcome was SARS-CoV-2 infection, as confirmed by reverse transcriptase-polymerase chain reaction. Results: Among 1928 participants, the median age was 44 years (IQR, 36-52 years) and 1381 were women (71.6%). Participants completed the 2-dose vaccination series a median of 210 days (IQR, 205-213 days) before study enrollment. A total of 1650 participants (85.6%) received the booster dose. During a median follow-up of 39 days (IQR, 35-41 days), SARS-CoV-2 infection occurred in 44 participants (incidence rate, 60.2 per 100000 person-days); 31 (70.5%) were symptomatic. Five SARS-CoV-2 infections occurred in booster-immunized participants and 39 in booster-nonimmunized participants (incidence rate, 12.8 vs 116 per 100000 person-days, respectively). In a time-dependent Cox regression analysis, the adjusted hazard ratio of SARS-CoV-2 infection for booster-immunized vs booster-nonimmunized participants was 0.07 (95% CI, 0.02-0.20). Conclusions and Relevance: Among health care workers at a single center in Israel who were previously vaccinated with a 2-dose series of BNT162b2, administration of a booster dose compared with not receiving one was associated with a significantly lower rate of SARS-CoV-2 infection over a median of 39 days of follow-up. Ongoing surveillance is required to assess durability of the findings..

Original language	English
Pages (from-to)	341-349
Number of pages	9
Journal	JAMA - Journal of the American Medical Association
Volume	327
Issue number	4
DOIs	https://doi.org/10.1001/jama.2021.23641
State	Published - 25 Jan 2022
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2022 American Medical Association. All rights reserved.

Funding

receiving grants from Pfizer outside the submitted work. Dr Goldshmidt reported receiving reagents for the serology tests from Siemens during the conduct of the study. Dr Ben-Ami reported receiving personal fees from Pfizer, Gilead, Teva, and Merck outside the submitted work. No other disclosures were reported. Funding/Support: The study was funded by the Tel Aviv Sourasky Medical Center. Anti–S1-RBD serology laboratory assays were funded and provided by Siemens. Dr A. Spitzer is partially supported by the Israeli Council for Higher Education via the Weizmann Data Science Research Center, and by a research grant from the estate of Tully and Michele Plesser.

Funders	Funder number
Weizmann Data Science Research Center
Pfizer
Council for Higher Education
Tel Aviv Sourasky Medical Center

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1001/jama.2021.23641

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Spitzer, A., Angel, Y., Marudi, O., Zeltser, D., Saiag, E., Goldshmidt, H., Goldiner, I., Stark, M., Halutz, O., Gamzu, R., Slobodkin, M., Amrami, N., Feigin, E., Elbaz, M., Furman, M., Bronstein, Y., Chikly, A., Eshkol, A., Furer, V., ... Henig, O. (2022). Association of a Third Dose of BNT162b2 Vaccine with Incidence of SARS-CoV-2 Infection among Health Care Workers in Israel. JAMA - Journal of the American Medical Association, 327(4), 341-349. https://doi.org/10.1001/jama.2021.23641

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title = "Association of a Third Dose of BNT162b2 Vaccine with Incidence of SARS-CoV-2 Infection among Health Care Workers in Israel",

abstract = "Importance: Administration of a BNT162b2 booster dose (Pfizer-BioNTech) to fully vaccinated individuals aged 60 years and older was significantly associated with lower risk of SARS-CoV-2 infection and severe illness. Data are lacking on the effectiveness of booster doses for younger individuals and health care workers. Objective: To estimate the association of a BNT162b2 booster dose with SARS-CoV-2 infections among health care workers who were previously vaccinated with a 2-dose series of BNT162b2. Design, Setting, and Participants: This was a prospective cohort study conducted at a tertiary medical center in Tel Aviv, Israel. The study cohort included 1928 immunocompetent health care workers who were previously vaccinated with a 2-dose series of BNT162b2, and had enrolled between August 8 and 19, 2021, with final follow-up reported through September 20, 2021. Screening for SARS-CoV-2 infection was performed every 14 days. Anti-spike protein receptor binding domain IgG titers were determined at baseline and 1 month after enrollment. Cox regression with time-dependent analysis was used to estimate hazard ratios of SARS-CoV-2 infection between booster-immunized status and 2-dose vaccinated (booster-nonimmunized) status. Exposures: Vaccination with a booster dose of BNT162b2 vaccine. Main Outcomes and Measures: The primary outcome was SARS-CoV-2 infection, as confirmed by reverse transcriptase-polymerase chain reaction. Results: Among 1928 participants, the median age was 44 years (IQR, 36-52 years) and 1381 were women (71.6%). Participants completed the 2-dose vaccination series a median of 210 days (IQR, 205-213 days) before study enrollment. A total of 1650 participants (85.6%) received the booster dose. During a median follow-up of 39 days (IQR, 35-41 days), SARS-CoV-2 infection occurred in 44 participants (incidence rate, 60.2 per 100000 person-days); 31 (70.5%) were symptomatic. Five SARS-CoV-2 infections occurred in booster-immunized participants and 39 in booster-nonimmunized participants (incidence rate, 12.8 vs 116 per 100000 person-days, respectively). In a time-dependent Cox regression analysis, the adjusted hazard ratio of SARS-CoV-2 infection for booster-immunized vs booster-nonimmunized participants was 0.07 (95% CI, 0.02-0.20). Conclusions and Relevance: Among health care workers at a single center in Israel who were previously vaccinated with a 2-dose series of BNT162b2, administration of a booster dose compared with not receiving one was associated with a significantly lower rate of SARS-CoV-2 infection over a median of 39 days of follow-up. Ongoing surveillance is required to assess durability of the findings..",

author = "Avishay Spitzer and Yoel Angel and Or Marudi and David Zeltser and Esther Saiag and Hanoch Goldshmidt and Ilana Goldiner and Moshe Stark and Ora Halutz and Ronni Gamzu and Marina Slobodkin and Nadav Amrami and Eugene Feigin and Meital Elbaz and Moran Furman and Yotam Bronstein and Amanda Chikly and Anna Eshkol and Victoria Furer and Talia Mayer and Suzy Meijer and Ariel Melloul and Michal Mizrahi and Michal Yakubovsky and Dana Rosenberg and Ari Safir and Liron Spitzer and Eyal Taleb and Ori Elkayam and Adi Silberman and Tali Eviatar and Ofir Elalouf and Tal Levinson and Katia Pozyuchenko and Ayelet Itzhaki-Alfia and Eli Sprecher and Ronen Ben-Ami and Oryan Henig",

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doi = "10.1001/jama.2021.23641",

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Spitzer, A, Angel, Y, Marudi, O, Zeltser, D, Saiag, E, Goldshmidt, H, Goldiner, I, Stark, M, Halutz, O, Gamzu, R, Slobodkin, M, Amrami, N, Feigin, E, Elbaz, M, Furman, M, Bronstein, Y, Chikly, A, Eshkol, A, Furer, V, Mayer, T, Meijer, S, Melloul, A, Mizrahi, M, Yakubovsky, M, Rosenberg, D, Safir, A, Spitzer, L, Taleb, E, Elkayam, O, Silberman, A, Eviatar, T, Elalouf, O, Levinson, T, Pozyuchenko, K, Itzhaki-Alfia, A, Sprecher, E, Ben-Ami, R & Henig, O 2022, 'Association of a Third Dose of BNT162b2 Vaccine with Incidence of SARS-CoV-2 Infection among Health Care Workers in Israel', JAMA - Journal of the American Medical Association, vol. 327, no. 4, pp. 341-349. https://doi.org/10.1001/jama.2021.23641

TY - JOUR

T1 - Association of a Third Dose of BNT162b2 Vaccine with Incidence of SARS-CoV-2 Infection among Health Care Workers in Israel

AU - Spitzer, Avishay

AU - Angel, Yoel

AU - Marudi, Or

AU - Zeltser, David

AU - Saiag, Esther

AU - Goldshmidt, Hanoch

AU - Goldiner, Ilana

AU - Stark, Moshe

AU - Halutz, Ora

AU - Gamzu, Ronni

AU - Slobodkin, Marina

AU - Amrami, Nadav

AU - Feigin, Eugene

AU - Elbaz, Meital

AU - Furman, Moran

AU - Bronstein, Yotam

AU - Chikly, Amanda

AU - Eshkol, Anna

AU - Furer, Victoria

AU - Mayer, Talia

AU - Meijer, Suzy

AU - Melloul, Ariel

AU - Mizrahi, Michal

AU - Yakubovsky, Michal

AU - Rosenberg, Dana

AU - Safir, Ari

AU - Spitzer, Liron

AU - Taleb, Eyal

AU - Elkayam, Ori

AU - Silberman, Adi

AU - Eviatar, Tali

AU - Elalouf, Ofir

AU - Levinson, Tal

AU - Pozyuchenko, Katia

AU - Itzhaki-Alfia, Ayelet

AU - Sprecher, Eli

AU - Ben-Ami, Ronen

AU - Henig, Oryan

PY - 2022/1/25

Y1 - 2022/1/25

N2 - Importance: Administration of a BNT162b2 booster dose (Pfizer-BioNTech) to fully vaccinated individuals aged 60 years and older was significantly associated with lower risk of SARS-CoV-2 infection and severe illness. Data are lacking on the effectiveness of booster doses for younger individuals and health care workers. Objective: To estimate the association of a BNT162b2 booster dose with SARS-CoV-2 infections among health care workers who were previously vaccinated with a 2-dose series of BNT162b2. Design, Setting, and Participants: This was a prospective cohort study conducted at a tertiary medical center in Tel Aviv, Israel. The study cohort included 1928 immunocompetent health care workers who were previously vaccinated with a 2-dose series of BNT162b2, and had enrolled between August 8 and 19, 2021, with final follow-up reported through September 20, 2021. Screening for SARS-CoV-2 infection was performed every 14 days. Anti-spike protein receptor binding domain IgG titers were determined at baseline and 1 month after enrollment. Cox regression with time-dependent analysis was used to estimate hazard ratios of SARS-CoV-2 infection between booster-immunized status and 2-dose vaccinated (booster-nonimmunized) status. Exposures: Vaccination with a booster dose of BNT162b2 vaccine. Main Outcomes and Measures: The primary outcome was SARS-CoV-2 infection, as confirmed by reverse transcriptase-polymerase chain reaction. Results: Among 1928 participants, the median age was 44 years (IQR, 36-52 years) and 1381 were women (71.6%). Participants completed the 2-dose vaccination series a median of 210 days (IQR, 205-213 days) before study enrollment. A total of 1650 participants (85.6%) received the booster dose. During a median follow-up of 39 days (IQR, 35-41 days), SARS-CoV-2 infection occurred in 44 participants (incidence rate, 60.2 per 100000 person-days); 31 (70.5%) were symptomatic. Five SARS-CoV-2 infections occurred in booster-immunized participants and 39 in booster-nonimmunized participants (incidence rate, 12.8 vs 116 per 100000 person-days, respectively). In a time-dependent Cox regression analysis, the adjusted hazard ratio of SARS-CoV-2 infection for booster-immunized vs booster-nonimmunized participants was 0.07 (95% CI, 0.02-0.20). Conclusions and Relevance: Among health care workers at a single center in Israel who were previously vaccinated with a 2-dose series of BNT162b2, administration of a booster dose compared with not receiving one was associated with a significantly lower rate of SARS-CoV-2 infection over a median of 39 days of follow-up. Ongoing surveillance is required to assess durability of the findings..

AB - Importance: Administration of a BNT162b2 booster dose (Pfizer-BioNTech) to fully vaccinated individuals aged 60 years and older was significantly associated with lower risk of SARS-CoV-2 infection and severe illness. Data are lacking on the effectiveness of booster doses for younger individuals and health care workers. Objective: To estimate the association of a BNT162b2 booster dose with SARS-CoV-2 infections among health care workers who were previously vaccinated with a 2-dose series of BNT162b2. Design, Setting, and Participants: This was a prospective cohort study conducted at a tertiary medical center in Tel Aviv, Israel. The study cohort included 1928 immunocompetent health care workers who were previously vaccinated with a 2-dose series of BNT162b2, and had enrolled between August 8 and 19, 2021, with final follow-up reported through September 20, 2021. Screening for SARS-CoV-2 infection was performed every 14 days. Anti-spike protein receptor binding domain IgG titers were determined at baseline and 1 month after enrollment. Cox regression with time-dependent analysis was used to estimate hazard ratios of SARS-CoV-2 infection between booster-immunized status and 2-dose vaccinated (booster-nonimmunized) status. Exposures: Vaccination with a booster dose of BNT162b2 vaccine. Main Outcomes and Measures: The primary outcome was SARS-CoV-2 infection, as confirmed by reverse transcriptase-polymerase chain reaction. Results: Among 1928 participants, the median age was 44 years (IQR, 36-52 years) and 1381 were women (71.6%). Participants completed the 2-dose vaccination series a median of 210 days (IQR, 205-213 days) before study enrollment. A total of 1650 participants (85.6%) received the booster dose. During a median follow-up of 39 days (IQR, 35-41 days), SARS-CoV-2 infection occurred in 44 participants (incidence rate, 60.2 per 100000 person-days); 31 (70.5%) were symptomatic. Five SARS-CoV-2 infections occurred in booster-immunized participants and 39 in booster-nonimmunized participants (incidence rate, 12.8 vs 116 per 100000 person-days, respectively). In a time-dependent Cox regression analysis, the adjusted hazard ratio of SARS-CoV-2 infection for booster-immunized vs booster-nonimmunized participants was 0.07 (95% CI, 0.02-0.20). Conclusions and Relevance: Among health care workers at a single center in Israel who were previously vaccinated with a 2-dose series of BNT162b2, administration of a booster dose compared with not receiving one was associated with a significantly lower rate of SARS-CoV-2 infection over a median of 39 days of follow-up. Ongoing surveillance is required to assess durability of the findings..

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Association of a Third Dose of BNT162b2 Vaccine with Incidence of SARS-CoV-2 Infection among Health Care Workers in Israel

Abstract

Bibliographical note

Funding

UN SDGs

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