Vaccine effectiveness of heterologous CoronaVac plus BNT162b2 in Brazil

Thiago Cerqueira-Silva, Srinivasa Vittal Katikireddi, Vinicius de Araujo Oliveira, Renzo Flores-Ortiz, Juracy Bertoldo Júnior, Enny S Paixão, Chris Robertson, Gerson O Penna, Guilherme L Werneck, Maurício L. Barreto, Neil Pearce, Aziz Sheikh, Manoel Barral-Netto, Viviane S Boaventura

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There is considerable interest in the waning of effectiveness of coronavirus disease 2019 (COVID-19) vaccines and vaccine effectiveness (VE) of booster doses. Using linked national Brazilian databases, we undertook a test-negative design study involving almost 14 million people (~16 million tests) to estimate VE of CoronaVac over time and VE of BNT162b2 booster vaccination against RT-PCR-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe COVID-19 outcomes (hospitalization or death). Compared with unvaccinated individuals, CoronaVac VE at 14-30 d after the second dose was 55.0% (95% confidence interval (CI): 54.3-55.7) against confirmed infection and 82.1% (95% CI: 81.4-82.8) against severe outcomes. VE decreased to 34.7% (95% CI: 33.1-36.2) against infection and 72.5% (95% CI: 70.9-74.0) against severe outcomes over 180 d after the second dose. A BNT162b2 booster, 6 months after the second dose of CoronaVac, improved VE against infection to 92.7% (95% CI: 91.0-94.0) and VE against severe outcomes to 97.3% (95% CI: 96.1-98.1) 14-30 d after the booster. Compared with younger age groups, individuals 80 years of age or older had lower protection after the second dose but similar protection after the booster. Our findings support a BNT162b2 booster vaccine dose after two doses of CoronaVac, particularly for the elderly.
Original languageEnglish
Pages (from-to)838-843
Number of pages6
JournalNature Medicine
Issue number4
Early online date9 Feb 2022
Publication statusPublished - 30 Apr 2022


  • coronavirus disease 2019
  • COVID 19
  • vaccines
  • vaccination
  • mRNA vaccines
  • SARS CoV-2


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