The effectiveness of the first dose COVID-19 booster vs. full vaccination to prevent SARS-CoV-2 infection and severe COVID-19 clinical event: a meta-analysis and systematic review of longitudinal studies

Junjie Xu; Xinquan Lan; Liangyuan Zhang; Xiangjun Zhang; Jiaqi Zhang; Moxin Song; Jiaye Liu

doi:10.3389/fpubh.2023.1165611

The effectiveness of the first dose COVID-19 booster vs. full vaccination to prevent SARS-CoV-2 infection and severe COVID-19 clinical event: a meta-analysis and systematic review of longitudinal studies

Front Public Health. 2023 Jun 1:11:1165611. doi: 10.3389/fpubh.2023.1165611. eCollection 2023.

Authors

Junjie Xu^#^{1

2}, Xinquan Lan^#^{1

2}, Liangyuan Zhang^#^{1

2}, Xiangjun Zhang³, Jiaqi Zhang^{1

2}, Moxin Song^{1

2}, Jiaye Liu⁴

Affiliations

¹ Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, China.
² Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China.
³ Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States.
⁴ School of Public Health, Shenzhen University Medical School, Shenzhen, China.

^# Contributed equally.

Abstract

Background: The effectiveness of full Coronavirus Disease 2019 (COVID-19) vaccination against COVID-19 wanes over time. This study aimed to synthesize the clinical effectiveness of the first dose of COVID-19 booster by comparing it to the full vaccination.

Methods: Studies in PubMed, Web of Science, Embase, and clinical trials databases were searched from 1 January 2021 to 10 September 2022. Studies were eligible if they comprised general adult participants who were not ever or currently infected with SARS-CoV-2, did not have impaired immunity or immunosuppression, and did not have severe diseases. The seroconversion rate of antibodies to S and S subunits and antibody titers of SARS-CoV-2, frequency, phenotype of specific T and B cells, and clinical events involving confirmed infection, admission to the intensive care unit (ICU), and death were compared between the first booster dose of COVID-19 vaccination group and full vaccination group. The DerSimonian and Laird random effects models were used to estimate the pooled risk ratios (RRs) and corresponding 95% confidence intervals (CIs) for the outcomes of clinical interest. While a qualitative description was mainly used to compare the immunogenicity between the first booster dose of COVID-19 vaccination group and full vaccination group. Sensitivity analysis was used to deal with heterogenicity.

Results: Of the 10,173 records identified, 10 studies were included for analysis. The first dose COVID-19 booster vaccine could induce higher seroconversion rates of antibodies against various SAS-CoV-2 fragments, higher neutralization antibody titers against various SARS-CoV-2 variants, and robust cellular immune response compared to the full vaccination. The risk of SARS-CoV-2 infection, the risk of admission to the ICU, and the risk of death were all higher in the non-booster group than those in the booster group, with RRs of 9.45 (95% CI 3.22-27.79; total evaluated population 12,422,454 vs. 8,441,368; I² = 100%), 14.75 (95% CI 4.07-53.46; total evaluated population 12,048,224 vs. 7,291,644; I² = 91%), and 13.63 (95% CI 4.72-39.36; total evaluated population 12,385,960 vs. 8,297,037; I² = 85%), respectively.

Conclusion: A homogenous or heterogeneous booster COVID-19 vaccination could elicit strong humoral and cellular immune responses to SARS-CoV-2. Furthermore, it could significantly reduce the risk of SARS-CoV-2 infection and severe COVID-19 clinical events on top of two doses. Future studies are needed to investigate the long-term clinical effectiveness of the first booster dose of the COVID-19 vaccine and compare the effectiveness between homogenous and heterogeneous booster COVID-19 vaccination.

Systematic review registration: https://inplasy.com/inplasy-2022-11-0114/, identifier: INPLASY2022110114.

Keywords: COVID-19; SARS-CoV-2; booster; effectiveness; meta-analysis; vaccine.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 Vaccines
COVID-19* / prevention & control
Humans
Longitudinal Studies
SARS-CoV-2

Substances

COVID-19 Vaccines

Supplementary concepts

SARS-CoV-2 variants

Grants and funding

This study was supported by the Shenzhen Science and Technology Innovation Committee Projects (No. JCYJ20220818102817038) and the Scientific Research Foundation of Peking University Shenzhen Hospital (No. KYQD2022216).