Effectiveness of CoronaVac among healthcare workers in the setting of high SARS-CoV-2 Gamma variant transmission in Manaus, Brazil: A test-negative case-control study

Abstract

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant P.1 emerged in the city of Manaus in late 2020 during a large resurgence of coronavirus disease (COVID-19), and has spread throughout Brazil. The effectiveness of vaccines in settings with widespread P.1 transmission has not been reported. Methods We performed a matched test-negative case-control study to estimate the effectiveness of an inactivated vaccine, CoronaVac, in healthcare workers (HCWs) in Manaus, where P.1 accounted for 75% of genotyped SARS-CoV-2 samples at the peak of its epidemic. Information from electronic surveillance databases was used to select cases of RT-PCR-confirmed SARS-CoV-2 infection and matched test-negative controls from 19 January, 2021 to 25 March, 2021. We used conditional logistic regression to estimate the effectiveness in reducing the odds of primary and secondary outcomes of, respectively, symptomatic and any SARS-CoV-2 infection. Findings Among 53,176 HCWs, 46,884 (88%) received at least one dose of CoronaVac and 2,656 (5%) underwent RT-PCR testing from 19 January, 2021 to 25 March, 2021. Of 2,797 RT-PCR tests, 776 (28%) were positive. 393 and 135 case-control pairs with and without, respectively, symptomatic illness were selected for the matched analyses. Vaccination with at least one dose was associated with a 0.50-fold reduction (adjusted vaccine effectiveness, 49.6%; 95% CI, 11.3 - 71.4) in the odds of symptomatic SARS-CoV-2 infection during the period 14 days or more after receiving the first dose. Estimated vaccine effectiveness of at least one dose against any SARS-CoV-2 infection was 35.1% (95% CI, -6.6 - 60.5) in the same time period. Interpretation Administration of at least one dose of CoronaVac showed effectiveness against symptomatic SARS-CoV-2 infection in the setting of epidemic P.1 transmission, underscoring the need to increase vaccination efforts in response to the spread of this variant in Brazil and globally. Funding Pan American Health Organization; Fundação Oswaldo Cruz (Fiocruz); Municipal Health Secretary of Manaus

Covid-19: How the Brazil variant took hold of South America

“…Argentina, Brazil, Chile, Mexico, and Peru have all agreed to purchase at least 30 million doses of the Chinese CanSino, Sinopharm, and Sinovac (CoronaVac) vaccines, and vaccination with Sinovac and Russia’s Sputnik V are underway in at least six Latin American countries. A study of the CoronaVac vaccine in Manaus, where P.1 is dominant, found it to be 50% effective after a single dose 9. Touchton says governments should obtain permission to manufacture more vaccines locally, even if they are less effective.…”

“…A study of the CoronaVac vaccine in Manaus, where P.1 is dominant, found it to be 50% effective after a single dose. 9 Touchton says governments should obtain permission to manufacture more vaccines locally, even if they are less effective.…”

Vaccinating children against SARS-CoV-2

“…It is therefore essential to continue monitoring disease severity across all age groups so vaccination strategies can be adapted rapidly if required. For example, adults seem to retain substantial immunity for at least eight months after vaccination or natural infection,192021 but if ageing immune systems and waning immunity against new variants lead to shorter protection from severe disease, updated vaccines for adults and vaccinating children to reduce transmission may become more desirable. Additionally, emergence of variants with increased severity in children, or in adults with previous immunity, would signal a more urgent need to control both transmission and disease through vaccinating children.…”

CoronaVac: more data for regulators and policy makers

“…Notably, the preliminary results of the CoronaVac phase 3 trial in Brazil showed vaccine efficacy of 50•7% (95% CI 35•9 to 62•0%) against symptomatic disease when SARS-CoV-2 lineage P.2 (the zeta variant) was the predominant circulating lineage, 7 and a test-negative case-control study done during a period of SARS-CoV-2 lineage P.1 (gamma variant) dominance estimated vaccine effectiveness at 36•8% (-54•9 to 74•2). 8 The anti-RBD antibody results presented by Tanriover and colleagues 4 were non-quantitative. Although an immune correlate of protection for COVID-19 remains to be determined, absolute antibody titres at multiple timepoints alongside a benchmark of convalescent serum or WHO serum standard would have allowed the comparison of immunogenicity with other vaccine candidates.…”