Index Entries

Anneli Uusküla, Heti Pisarev, Anna Tisler, Tatjana Meister, Kadri Suija, Kristi Huik, Aare Abroi, Ruth Kalda, Raivo Kolde, and Krista Fischer
November 21, 2023
Scientific Reports
University of Tartu (Estonia)

aHR = adjusted hazard ratio 

"Abstract: A large proportion of the world’s population has some form of immunity against SARS-CoV-2, through either infection (‘natural’), vaccination or both (‘hybrid’). This retrospective cohort study used data on SARS-CoV-2, vaccination, and hospitalization from national health system from February 2020 to June 2022 and Cox regression modelling to compare those with natural immunity to those with no (Cohort1, n = 94,982), hybrid (Cohort2, n = 47,342), and vaccine (Cohort3, n = 254,920) immunity. In Cohort 1, those with natural immunity were at lower risk for infection during the Delta (aHR 0.17, 95%CI 0.15–0.18) and higher risk (aHR 1.24, 95%CI 1.18–1.32) during the Omicron period than those with no immunity. Natural immunity conferred substantial protection against COVID-19-hospitalization. Cohort 2—in comparison to natural immunity hybrid immunity offered strong protection during the Delta (aHR 0.61, 95%CI 0.46–0.80) but not the Omicron (aHR 1.05, 95%CI 0.93–1.1) period. COVID-19-hospitalization was extremely rare among individuals with hybrid immunity. In Cohort 3, individuals with vaccine-induced immunity were at higher risk than those with natural immunity for infection (Delta aHR 4.90, 95%CI 4.48–5.36; Omicron 1.13, 95%CI 1.06–1.21) and hospitalization (Delta aHR 7.19, 95%CI 4.02–12.84). These results show that risk of infection and severe COVID-19 are driven by personal immunity history and the variant of SARS-CoV-2 causing infection."

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