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NEJM: The infection rate has dropped by 2 times, and the severe disease rate has dropped by 3 times!

 Last Update: 2022-05-17
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On January 2, 2022 , Israel began administering the fourth dose of the BNT162b2 vaccine to people 60 years of age or older .

On January 2,

In late December 2021 , the prevalence of confirmed infections in Israel increased dramatically with the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) B.

study population

A total of 1,252,331 people met the inclusion criteria (Figure 1)

Figure 1.

Table 1.

As shown in Table 1, the unadjusted confirmed infection rates of the four-needle group, the three-needle group, and the internal control group were 177 cases/100,000 person-days, 361 cases/100,000 person-days, and 388 cases/100,000 person-days, respectively; The adjusted incidence of severe Covid-19 was 1.

The results of quasi- Poisson regression analysis

Table 2.

Table 3.

Figure 2.

Figure 2.
Adjusted ratios of confirmed infections and severe illness
.

The adjusted confirmed infection rate of the four-needle group was lower than that of the two control groups
.
The adjusted rate was 2.
0 times lower (95% CI, 1.
9-2.
1) in the population at the fourth week (22 to 28 days) after receiving the fourth injection than in the three-injection group and 1.
8 times lower than in the internal control group (95% CI, 1.
7-1.
9) )
.
The adjusted confirmed infection rate (rounded) for the fourth week after the fourth dose was 171 per 100,000 days (95% CI, 165 to 177), compared with 340 per 100,000 days (95% CI, 165 to 177) in the three-dose group.
%CI, 337 to 343), and the internal control group was 308 cases per 100,000 person-days (95%CI, 299 to 317)
.
In an adjusted ratio-difference analysis, the four-dose group reduced confirmed infections by 170 cases per 100,000 person-days (95% CI, 162-176) compared with the three-dose group at week 4, which was 137 fewer than the internal control group.
Cases/100,000-days (95% CI, 125 to 148)
.
From the fifth week (days 29 to 35), the rate of confirmed infections began to decline
.
The adjusted infection rate at week eight after the fourth needle was very similar to the control group: the ratio of the three-needle group to the four-needle group was 1.
1 (95% CI, 1.
0-1.
2), and the ratio of the internal control group to the four-needle group was only 1.
0 ( 95%CI, 0.
9-1.
1)
.
The adjusted confirmed infection rate of the four-needle group was lower than that of the two control groups
.
The adjusted rate was 2.
0 times lower (95% CI, 1.
9-2.
1) in the population at the fourth week (22 to 28 days) after receiving the fourth injection than in the three-injection group and 1.
8 times lower than in the internal control group (95% CI, 1.
7-1.
9) )
.
The adjusted confirmed infection rate (rounded) for the fourth week after the fourth dose was 171 per 100,000 days (95% CI, 165 to 177), compared with 340 per 100,000 days (95% CI, 165 to 177) in the three-dose group.
%CI, 337 to 343), and the internal control group was 308 cases per 100,000 person-days (95%CI, 299 to 317)
.
The four-dose group reduced confirmed infections by 170 compared with the three-dose group at week four in an adjusted rate-difference analysis

For severe Covid-19, the ratio of the control group to the four-needle group was greater and the duration was longer
.
For those four weeks after receiving the fourth injection, the adjusted rate of severe illness was 3.
5 times lower (95% CI, 2.
7-4.
6) than the three-needle group and 2.
3 times lower (95% CI, 1.
7-3.
3) than the internal control group
.
In the fourth week, the adjusted severe rate of the four-needle group, the three-needle group, and the internal control group were 1.
6 cases/100,000 person-days (95% CI, 1.
2-2.
0), 5.
5 cases/100,000 person-days (95% CI, 1.
2-2.
0), respectively.
%CI, 5.
2-5.
9), 3.
6 cases/100,000 person-days (95%CI, 3.
0-4.
5)
.
The adjusted rate difference in the four-needle group was 3.
9 (95% CI, 3.
4 - 4.
5) and 2.
1 fewer (95% CI, 1.
4 - 3.
0) cases per 100,000 days in the three-dose and internal control groups, respectively
.
In the weeks after receiving the fourth dose, the severe rate of the four-needle group continued to be lower than that of the control group, and there was no obvious sign of weakening in the sixth week after receiving the fourth dose ( Figure 2 )
.
For those four weeks after receiving the fourth injection, the adjusted rate of severe illness was 3.
5 times lower (95% CI, 2.
7-4.
6) than the three-needle group and 2.
3 times lower (95% CI, 1.
7-3.
3) than the internal control group
.
In the fourth week, the adjusted severe rate of the four-needle group, the three-needle group, and the internal control group were 1.
6 cases/100,000 person-days (95% CI, 1.
2-2.
0), 5.
5 cases/100,000 person-days (95% CI, 1.
2-2.
0), respectively.
%CI, 5.
2-5.
9), 3.
6 cases/100,000 person-days (95%CI, 3.
0-4.
5)
.
The adjusted rate difference in the four-needle group was 3.
9 (95% CI, 3.
4 - 4.
5) and 2.
1 fewer (95% CI, 1.
4 - 3.
0) cases per 100,000 days in the three-dose and internal control groups, respectively
.
For several weeks after receiving the fourth dose, the severe rate of the four-needle group continued to be lower than that of the control group, and there was no obvious sign of weakening in the sixth week after receiving the fourth dose ( Figure 2 )
.
Figure 2 Figure 2

The omicron variant is genetically different from the progenitor strain of SARS-CoV-2 for which the BNT162b2 vaccine was tailored
.
The results presented here demonstrate that a fourth dose of the vaccine provides additional short-term protection against infection and severe disease caused by the omicron variant compared to the three doses given at least 4 months earlier
.
The incidence of confirmed infections was 2-fold lower and the rate of severe illness was 3-fold lower at the fourth week after receiving the fourth dose of the vaccine compared to the eligible population who did not receive the fourth dose
.
The rate of SARS-CoV-2 infection and severe Covid-19 severity after the fourth dose of BNT162b2 vaccine was lower than after only three doses
.
For confirmed infections, the fourth dose appeared to provide only short-term protection and modest absolute benefit, but protection against severe disease did not diminish over the study period
.

Original source:

Bar-On YM, Goldberg Y, Mandel M, Bodenheimer O, Amir O, Freedman L, Alroy-Preis S, Ash N, Huppert A, Milo R.
Protection by a Fourth Dose of BNT162b2 against Omicron in Israel.
N Engl J Med .
2022 Apr 5.
doi: 10.
1056/NEJMoa2201570.
Epub ahead of print.
PMID: 35381126.

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