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How effective is vaccination against COVID-19 after recovery from prior SARS-CoV-2 infection?
In this cohort study of more than 95 000 Rhode Island residents from March 2020 to December 2021, including residents and employees of long-term congregate care (LTCC) facilities, completion of the primary vaccination series after recovery from COVID-19 was associated with 49% protection from reinfection among LTCC residents, 47% protection among LTCC employees, and 62% protection in the general population during periods when wild type, Alpha, and Delta strains of SARS-CoV-2 were predominant.
These findings suggest that among people who have recovered from COVID-19, subsequent completion of the primary vaccination series reduced the risk of reinfection by approximately half.
The benefit of vaccination for preventing reinfection among individuals who have been previously infected with SARS-CoV-2 is largely unknown.
To obtain population-based estimates of the probability of SARS-CoV-2 reinfection and the effectiveness associated with vaccination after recovery from COVID-19.
Design, Setting, and Participants
This cohort study used Rhode Island statewide surveillance data from March 1, 2020, to December 9, 2021, on COVID-19 vaccinations, laboratory-confirmed cases, hospitalizations, and fatalities to conduct a population-based, retrospective study during periods when wild type, Alpha, and Delta strains of SARS-CoV-2 were predominant. Participants included Rhode Island residents aged 12 years and older who were previously diagnosed with COVID-19 and unvaccinated at the time of first infection, stratified into 3 subpopulations: long-term congregate care (LTCC) residents, LTCC employees, and the general population (ie, individuals not associated with congregate settings). Data were analyzed from October 2021 to January 2022.
Completion of the primary vaccination series, defined as 14 days after the second dose of an mRNA vaccine or 1 dose of vector virus vaccine.
Main Outcomes and Measures
The main outcome was SARS-CoV-2 reinfection, defined as a laboratory-confirmed positive result on a polymerase chain reaction (PCR) or antigen test at least 90 days after the first laboratory-confirmed positive result on a PCR or antigen test.
Overall, 3124 LTCC residents (median [IQR] age, 81 [71-89]; 1675 [53.6%] females), 2877 LTCC employees (median [IQR] age, 41 [30-53]; 2186 [76.0%] females), and 94 516 members of the general population (median [IQR] age, 35 [24-52] years; 45 030 [47.6%] females) met eligibility criteria. Probability of reinfection at 9 months for those who remained unvaccinated after recovery from prior COVID-19 was 13.0% (95% CI, 12.0%-14.0%) among LTCC residents, 10.0% (95% CI, 8.8%-11.5%) among LTCC employees, and 1.9% (95% CI, 1.8%-2.0%) among the general population. Completion of the primary vaccination series after infection was associated with 49% (95% CI, 27%-65%) protection among LTCC residents, 47% (95% CI, 19%-65%) protection among LTCC employees, and 62% (95% CI, 56%-68%) protection in the general population against reinfection, adjusting for potential sociodemographic and clinical confounders and temporal variation in infection rates.
Conclusions and Relevance
These findings suggest that risk of SARS-CoV-2 reinfection after recovery from COVID-19 was relatively high among individuals who remained unvaccinated. Vaccination after recovery from COVID-19 was associated with reducing risk of reinfection by approximately half.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: June 9, 2022.
Published: July 27, 2022. doi:10.1001/jamanetworkopen.2022.23917
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Lewis N et al. JAMA Network Open.
Corresponding Author: Joseph W. Hogan, ScD, Department of Biostatistics, Brown University School of Public Health, Box G-S121-7, 121 S Main St, Providence RI 02912 (firstname.lastname@example.org).
Author Contributions: Mr Lewis and Dr Hogan had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Lewis, Chambers, Chu, De Vito, Chan, McDonald, Hogan.
Acquisition, analysis, or interpretation of data: Lewis, Chambers, Chu, Fortnam, Gargano, Chan, Hogan.
Drafting of the manuscript: Lewis, Chambers, Chu, Fortnam, Hogan.
Critical revision of the manuscript for important intellectual content: Chambers, Chu, De Vito, Gargano, Chan, McDonald, Hogan.
Statistical analysis: Lewis, Chu, Fortnam, De Vito, Hogan.
Obtained funding: Hogan.
Administrative, technical, or material support: Chambers, Chu, Fortnam, Gargano, Chan, McDonald.
Supervision: De Vito, Chan, McDonald, Hogan.
Conflict of Interest Disclosures: None reported.
Funding/Support: This work was funded by the Rhode Island Department of Health. Dr Chambers is supported by the National Institutes of Health (grant No. T32DA013911 and R25MH083620). The Rhode Island Department of Health was responsible for collecting the data.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: Ellen Amore, MS (Center for Health Data and Analysis, Rhode Island Department of Health), assisted with use of vaccination data from the Rhode Island Child and Adult Immunization Registry in this analysis. She was not compensated for this work outside of her normal salary.
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