Relative effectiveness and durability of booster doses of SARS-CoV-2 vaccines: A systematic review and meta-analysis

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Abstract

Billions of people worldwide have received booster doses of SARS-CoV-2 vaccines. Continuous monitoring of the relative vaccine effectiveness (rVE) and durability of booster vaccination over previous vaccinations is important for developing vaccination strategies during the post-pandemic era. We conducted a systematic review and meta-analysis of trials and observational studies to determine the rVE of the 1st booster over no booster and that of the 2nd booster over the 1st booster. Three trials and 91 observational studies were included in this systematic review. For the 1st booster homologous vaccination, the rVE at a median of 9 weeks after booster vaccination was 66.9% (95% confidence interval: 59.8%, 72.7%), 75.9% (62.6%, 84.5%), 74.1% (66.9%, 79.8%), 86.1% (78.7%, 90.9%) and 84.2% (78.3%, 88.5%) against overall infection, symptomatic infection, hospital admission, severe infection and COVID-19-related death, respectively. The rVE against overall infection was affected by variants of concern and vaccine types and waned by average of 4.3% (3.3%, 5.4%; P-trend<0.01) per week. Heterologous regimens for the 1st booster vaccination demonstrated effectiveness comparable to that of homologous regimens. The rVE of the 2nd booster homologous vaccination at a median of 7 weeks after booster vaccination was 41.9% (31.2%, 51.0%), 53.1% (24.5%, 70.9%), 60.6% (55.3%, 65.3%), 56.4% (45.3%, 65.2%) and 68.2% (51.2%, 79.2%) against the five outcomes above, respectively, with no significant decrease in the rVE of 2nd booster vaccination. In conclusion, both the 1st and 2nd booster homologous vaccinations provided additional protection against mild and severe infections. The rVE of the 1st booster rapidly waned over time. The rVE of the 2nd booster, including heterologous vaccination, its durability and the sources of heterogeneity, however, remains uncertain and more relevant studies are needed.

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Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2025)

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