• Ariel Hammerman, Ruslan Sergienko, Michael Friger, Tanya Beckenstein, Alon Peretz, Doron Netzer, Shlomit Yaron, and Ronen Arbel.
• From the Division of Community Medical Services, Clalit Health Services, Tel Aviv (A.H., T.B., A.P., D.N., S.Y., R.A.), the Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba (R.S., M.F.), and the Maximizing Health Outcomes Research Lab, Sapir College, Sderot (R.A.) - all in Israel.
• N. Engl. J. Med. 2022 Mar 31; 386 (13): 1221-1229.

BackgroundThe risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) decreases substantially among patients who have recovered from coronavirus disease 2019 (Covid-19). However, it is unknown how long protective immunity lasts. Current guidelines recommend vaccination of recovered patients even though data regarding vaccine effectiveness in such cases are still limited.MethodsIn this retrospective cohort study, we reviewed electronic medical records from a large health care organization in Israel to assess reinfection rates in patients who had recovered from SARS-CoV-2 infection before any vaccination against Covid-19. We compared reinfection rates among patients who had subsequently received the BNT162b2 vaccine (Pfizer-BioNTech) and those who had not been vaccinated between March 1 and November 26, 2021. We used a Cox proportional-hazards regression model with time-dependent covariates to estimate the association between vaccination and reinfection after adjustment for demographic factors and coexisting illnesses. Vaccine effectiveness was estimated as 1 minus the hazard ratio. In a secondary analysis, we evaluated the vaccine effectiveness of one dose as compared with two doses.ResultsA total of 149,032 patients who had recovered from SARS-CoV-2 infection met the eligibility criteria. Of these patients, 83,356 (56%) received subsequent vaccination during the 270-day study period. Reinfection occurred in 354 of the vaccinated patients (2.46 cases per 100,000 persons per day) and in 2168 of 65,676 unvaccinated patients (10.21 cases per 100,000 persons per day). Vaccine effectiveness was estimated at 82% (95% confidence interval [CI], 80 to 84) among patients who were 16 to 64 years of age and 60% (95% CI, 36 to 76) among those 65 years of age or older. No significant difference in vaccine effectiveness was found for one dose as compared with two doses.ConclusionsAmong patients who had recovered from Covid-19, the receipt of at least one dose of the BNT162b2 vaccine was associated with a significantly lower risk of recurrent infection.Copyright © 2022 Massachusetts Medical Society.

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