• Yinon M Bar-On, Yair Goldberg, Micha Mandel, Omri Bodenheimer, Laurence Freedman, Nir Kalkstein, Barak Mizrahi, Sharon Alroy-Preis, Nachman Ash, Ron Milo, and Amit Huppert.
• From the Department of Plant and Environmental Sciences, Weizmann Institute of Science, Rehovot (Y.M.B.-O., R.M.), Technion-Israel Institute of Technology, Haifa (Y.G.), Hebrew University of Jerusalem (M.M.) and Israel Ministry of Health (O.B., S.A.-P., N.A.), Jerusalem, the Biostatistical and Biomathematical Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan (L.F., A.H.), KI Research Institute, Kfar Malal (N.K., B.M.), and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (A.H.) - all in Israel.
• N. Engl. J. Med. 2021 Oct 7; 385 (15): 139314001393-1400.

BackgroundOn July 30, 2021, the administration of a third (booster) dose of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) was approved in Israel for persons who were 60 years of age or older and who had received a second dose of vaccine at least 5 months earlier. Data are needed regarding the effect of the booster dose on the rate of confirmed coronavirus 2019 disease (Covid-19) and the rate of severe illness.MethodsWe extracted data for the period from July 30 through August 31, 2021, from the Israeli Ministry of Health database regarding 1,137,804 persons who were 60 years of age or older and had been fully vaccinated (i.e., had received two doses of BNT162b2) at least 5 months earlier. In the primary analysis, we compared the rate of confirmed Covid-19 and the rate of severe illness between those who had received a booster injection at least 12 days earlier (booster group) and those who had not received a booster injection (nonbooster group). In a secondary analysis, we evaluated the rate of infection 4 to 6 days after the booster dose as compared with the rate at least 12 days after the booster. In all the analyses, we used Poisson regression after adjusting for possible confounding factors.ResultsAt least 12 days after the booster dose, the rate of confirmed infection was lower in the booster group than in the nonbooster group by a factor of 11.3 (95% confidence interval [CI], 10.4 to 12.3); the rate of severe illness was lower by a factor of 19.5 (95% CI, 12.9 to 29.5). In a secondary analysis, the rate of confirmed infection at least 12 days after vaccination was lower than the rate after 4 to 6 days by a factor of 5.4 (95% CI, 4.8 to 6.1).ConclusionsIn this study involving participants who were 60 years of age or older and had received two doses of the BNT162b2 vaccine at least 5 months earlier, we found that the rates of confirmed Covid-19 and severe illness were substantially lower among those who received a booster (third) dose of the BNT162b2 vaccine.Copyright © 2021 Massachusetts Medical Society.

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