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VACCINE EFFECTIVENESS OF TWO-DOSE BNT162B2 AGAINST SYMPTOMATIC AND SEVERE COVID-19 AMONG ADOLESCENTS IN BRAZIL AND SCOTLAND OVER TIME: A TEST-NEGATIVE CASE-CONTROL STUDY
Autor
Florentino, Pilar T. V
Millington, Tristan
Silva, Thiago Cerqueira
Robertson, Chris
Oliveira, Vinicius de Araújo
Júnior, Juracy B S
Alves, Flávia J O
Penna, Gerson O
Katikireddi, Srinivasa Vital
Boaventura, Viviane S
Werneck, Guilherme L
Pearce, Neil
McCowan, Colin
Sullivan, Christopher
Agrawal, Utkarsh
Grange, Zoe
Ritchie, Lewis D
Simpson, Colin R
Sheikh, Aziz
Barreto, Mauricio L
Rudan, Igor
Barral Netto, Manoel
Paixão, Enny S
Millington, Tristan
Silva, Thiago Cerqueira
Robertson, Chris
Oliveira, Vinicius de Araújo
Júnior, Juracy B S
Alves, Flávia J O
Penna, Gerson O
Katikireddi, Srinivasa Vital
Boaventura, Viviane S
Werneck, Guilherme L
Pearce, Neil
McCowan, Colin
Sullivan, Christopher
Agrawal, Utkarsh
Grange, Zoe
Ritchie, Lewis D
Simpson, Colin R
Sheikh, Aziz
Barreto, Mauricio L
Rudan, Igor
Barral Netto, Manoel
Paixão, Enny S
Afiliación
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos em Saúde. Salvador, BA, Brasil / Universidade de São Paulo. Instituto de Ciências Biomédicas. São Paulo, Brasil.
University of Edinburgh. Usher Institute. Edinburgh, UK.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Laboratórios LIB e LEITV. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
Public Health Scotland. Glasgow, Scotland, UK.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos em Saúde. Salvador, BA, Brasil.
Universidade Federal da Bahia. Faculdade de Medicina. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos em Saúde. Salvador, BA, Brasil.
Universidade de Brasília. Centro de Medicina Tropical. Escola de Governo da Fiocruz Brasília. Brasília, DF, Brasil
University of Glasgow. MRC/CSO Social and Public Health Sciences Unit. Glasgow, UK.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Laboratórios LIB e LEITV. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Instituto de Estudos de Saúde Coletiva. Rio de Janeiro, RJ, Brasil.
Faculty of Epidemiology and Population Health. London School of Hygiene & Tropical Medicine. London, UK.
University of St Andrews. School of Medicine St Andrews. Scotland, UK.
Public Health Scotland Glasgow. Scotland, UK.
University of St Andrews. School of Medicine St Andrews. Scotland, UK.
Public Health Scotland Glasgow. Scotland, UK.
University of Aberdeen. Academic Primary Care. Aberdeen, Scotland, UK.
Victoria University of Wellington. Wellington Faculty of Health. School of Health. Wellington, New Zealand.
University of Edinburgh. Usher Institute. Edinburgh, UK.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos em Saúde. Salvador, BA, Brasil.
University of Edinburgh. Usher Institute. Edinburgh, UK.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos em Saúde. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Laboratórios LIB e LEITV. Salvador, BA, Brasil.
Faculty of Epidemiology and Population Health. London School of Hygiene & Tropical Medicine. London, UK.
University of Edinburgh. Usher Institute. Edinburgh, UK.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Laboratórios LIB e LEITV. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
Public Health Scotland. Glasgow, Scotland, UK.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos em Saúde. Salvador, BA, Brasil.
Universidade Federal da Bahia. Faculdade de Medicina. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos em Saúde. Salvador, BA, Brasil.
Universidade de Brasília. Centro de Medicina Tropical. Escola de Governo da Fiocruz Brasília. Brasília, DF, Brasil
University of Glasgow. MRC/CSO Social and Public Health Sciences Unit. Glasgow, UK.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Laboratórios LIB e LEITV. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil / Universidade Federal do Rio de Janeiro. Instituto de Estudos de Saúde Coletiva. Rio de Janeiro, RJ, Brasil.
Faculty of Epidemiology and Population Health. London School of Hygiene & Tropical Medicine. London, UK.
University of St Andrews. School of Medicine St Andrews. Scotland, UK.
Public Health Scotland Glasgow. Scotland, UK.
University of St Andrews. School of Medicine St Andrews. Scotland, UK.
Public Health Scotland Glasgow. Scotland, UK.
University of Aberdeen. Academic Primary Care. Aberdeen, Scotland, UK.
Victoria University of Wellington. Wellington Faculty of Health. School of Health. Wellington, New Zealand.
University of Edinburgh. Usher Institute. Edinburgh, UK.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos em Saúde. Salvador, BA, Brasil.
University of Edinburgh. Usher Institute. Edinburgh, UK.
Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos em Saúde. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Laboratórios LIB e LEITV. Salvador, BA, Brasil.
Faculty of Epidemiology and Population Health. London School of Hygiene & Tropical Medicine. London, UK.
Resumen en ingles
Background: Little is known about vaccine effectiveness over time among adolescents, especially against the SARS-CoV-2 omicron (B.1.1.529) variant. This study assessed the associations between time since two-dose vaccination
with BNT162b2 and the occurrence of symptomatic SARS-CoV-2 infection and severe COVID-19 among adolescents in Brazil and Scotland. Methods: We did test-negative, case-control studies in adolescents aged 12–17 years with COVID-19-related symptoms in Brazil and Scotland. We linked records of SARS-CoV-2 RT-PCR and antigen tests to national vaccination and clinical records. We excluded tests from individuals who did not have symptoms, were vaccinated before the start of the national vaccination programme, received vaccines other than BNT162b2 or a SARS-CoV-2 booster dose of any kind, or had an interval between their first and second dose of fewer than 21 days. Additionally, we excluded negative SARS-CoV-2 tests recorded within 14 days of a previous negative test, negative tests recorded within 7 days after a positive test, any test done within 90 days after a positive test, and tests with missing sex and location information. Cases (SARS-CoV-2 test-positive adolescents) and controls (test-negative adolescents) were drawn from a sample of individuals in whom tests were collected within 10 days of symptom onset. We estimated the adjusted odds ratio and vaccine effectiveness against symptomatic COVID-19 for both countries and against severe COVID-19 (hospitalisation or death) for Brazil across fortnightly periods. Findings: We analysed 503 776 tests from 2 948 538 adolescents in Brazil between Sept 2, 2021, and April 19, 2022, and 127 168 tests from 404 673 adolescents in Scotland between Aug 6, 2021, and April 19, 2022. Vaccine effectiveness peaked at 14–27 days after the second dose in both countries during both waves, and was significantly lower against symptomatic infection during the omicron-dominant period in Brazil (64·7% [95% CI 63·0–66·3]) and in Scotland (82·6% [80·6–84·5]), than it was in the delta-dominant period (80·7% [95% CI 77·8–83·3] in Brazil and 92·8% [85·7–96·4] in Scotland). Vaccine efficacy started to decline from 27 days after the second dose for both countries, reducing to 5·9% (95% CI 2·2–9·4) in Brazil and 50·6% (42·7–57·4) in Scotland at 98 days or more during the omicron-dominant period. In Brazil, protection against severe disease remained above 80% from 28 days after the second dose and was 82·7% (95% CI 68·8–90·4) at 98 days or more after receiving the second dose. Interpretation: We found waning vaccine protection of BNT162b2 against symptomatic COVID-19 infection among adolescents in Brazil and Scotland from 27 days after the second dose. However, protection against severe COVID-19 outcomes remained high at 98 days or more after the second dose in the omicron-dominant period. Booster doses for adolescents need to be considered.
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