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Hybrid, infection‑ and vaccination‑induced protection against laboratory‑ confirmed SARS‑CoV‑2 infection in a European multi‑centre prospective cohort of healthcare workers, 2021–2024

2025-12-29Artigo científico Acesso aberto
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dc.contributor.authorRojas‑Castro, Madelyn
dc.contributor.authorMulchandani, Ranya
dc.contributor.authorBrolin, Kim
dc.contributor.authorMakarić, Zvjezdan Lovrić
dc.contributor.authorUusküla, Anneli
dc.contributor.authorBergin, Colm
dc.contributor.authorFleming, Catherine
dc.contributor.authorBonfanti, Paolo
dc.contributor.authorMurri, Rita
dc.contributor.authorZvirbulis, Viesturs
dc.contributor.authorZavadska, Dace
dc.contributor.authorSzuldrzynski, Konstanty
dc.contributor.authorGaio, Vânia
dc.contributor.authorPopescu, Corneliu Petru
dc.contributor.authorCraiu, Mihai
dc.contributor.authorHrișcă, Raluca‑Maria
dc.contributor.authorCisneros, Maria
dc.contributor.authorLatorre‑Millán, Miriam
dc.contributor.authorPetrović, Goranka
dc.contributor.authorLohur, Liss
dc.contributor.authorMcGrath, Jonathan
dc.contributor.authorFerguson, Lauren
dc.contributor.authorSpolti, Anna
dc.contributor.authorDonati, Katleen De Gaetano
dc.contributor.authorAbolina, Ilze
dc.contributor.authorGravele, Dagne
dc.contributor.authorMachado, Ausenda
dc.contributor.authorFlorescu, Simin Aysel
dc.contributor.authorLazar, Mihaela
dc.contributor.authorSubirats, Pilar
dc.contributor.authorClusa, Laura
dc.contributor.authorSarajlić, Gordan
dc.contributor.authorSui, Jacklyn
dc.contributor.authorKenny, Claire
dc.contributor.authorSantangelo, Rosaria
dc.contributor.authorKrievins, Dainis
dc.contributor.authorBarzdina, Elsa Anna
dc.contributor.authorHenriques, Camila Valadas
dc.contributor.authorKosa, Alma Gabriela
dc.contributor.authorPohrib, Săftica‑Mariana
dc.contributor.authorMiron, Victor Daniel
dc.contributor.authorMuñoz‑Almagro, Carmen
dc.contributor.authorMilagro, Anna Maria
dc.contributor.authorBacci, Sabrina
dc.contributor.authorSavulescu, Camelia
dc.contributor.authorVEBIS HCW VE study group
dc.date.accessioned2026-01-14T15:20:54Z
dc.date.available2026-01-14T15:20:54Z
dc.date.issued2025-12-29
dc.description.abstractBackground: Healthcare workers (HCWs) face high occupational exposure to SARS-CoV-2 and are a priority group for vaccination. Both natural infection and vaccination-individually or combined as hybrid immunity-confer protection against SARS-CoV-2 infection. This study aimed to evaluate the protection conferred by hybrid, infection-induced, and booster vaccine-induced immunity against laboratory-confirmed SARS-CoV-2 infections in HCWs during the circulation of three pandemic and one post-pandemic Omicron sublineages. Methods: We conducted a prospective cohort study of HCWs from 18 hospitals across nine European countries. Participants underwent RT-PCR testing at enrolment and during weekly or fortnightly follow-ups. The study period was divided based on dominant Omicron sublineage circulation: BA.1/2 (Dec 16, 2021-Jun 1, 2022), BA.4/5/BQ.1 (Jun 2-Dec 31, 2022), BA.2/XBB (Jan 1-May 2, 2023), and post-pandemic XBB.1.5/BA.2.86 (Sep 1, 2023-May 21, 2024). Participants were classified into four groups: hybrid (prior infection and recent booster vaccination 7-179 days), infection-induced (prior infection, no recent vaccination), vaccine-induced immunity (recent booster vaccination, no prior infection), and a reference group (no prior infection, no recent booster vaccination). Adjusted hazard ratios (aHRs) for infection were estimated using Cox regression, adjusting for hospital, age, sex, chronic condition, and patient-facing role. Results: A total of 3 133 HCWs were included: 2572 (82%) female, 1734 (55%) aged 40-59, and 563 (29%) with ≥ 1 chronic condition. Hybrid immunity showed significant protection during BA.1/2 (aHR = 0.37, 95%CI 0.21-0.63), BA.4/5/BQ.1 (aHR = 0.36, 95%CI 0.22-0.58), and XBB.1.5/BA.2.86 (aHR = 0.53, 95%CI 0.37-0.74) periods. Infection-induced immunity was protective across all periods, most during BA.1/2 (aHR = 0.26, 95%CI 0.12-0.53), and least during BA.2/XBB (aHR = 0.66, 95%CI 0.36-1.22). Vaccine-induced immunity alone offered limited protection during BA.1/2 (aHR = 0.72, 95%CI 0.49-1.06) and BA.4/5/BQ.1 (aHR = 0.77, 95%CI 0.50-1.19), with wide confidence intervals suggesting low statistical significance. Conclusions: Hybrid and infection-induced immunity groups were more protected against infection caused by earlier Omicron sub-lineages and more protected than vaccination alone, which had no significant protective effect. These findings highlight the need for adaptive public health strategies, including timely vaccine updates and understanding of prior SARS-CoV-2 infection to inform COVID-19 vaccination policies for HCWs in the post-pandemic era.eng
dc.description.sponsorshipThis study was funded by the European Centre for Disease Prevention and Control through “Vaccine Effectiveness, Burden and Impact Studies” (VEBIS) Lot 2 “Assessment of COVID-19 and influenza vaccine effectiveness among healthcare workers” framework contract ECDC/2021/017.
dc.identifier.citationBMC Med. 2025 Dec 29;23(1):697. doi: 10.1186/s12916-025-04503-2
dc.identifier.doi10.1186/s12916-025-04503-2
dc.identifier.eissn1741-7015
dc.identifier.pmid41466249
dc.identifier.urihttp://hdl.handle.net/10400.18/10693
dc.language.isoeng
dc.peerreviewedyes
dc.publisherBioMed Central
dc.relation.hasversionhttps://link.springer.com/article/10.1186/s12916-025-04503-2
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectHybrid Immunity
dc.subjectHealthcare Workers
dc.subjectProspective Cohort Study
dc.subjectCOVID-19 Vaccination
dc.subjectOmicron Variant
dc.subjectEurope
dc.subjectEstado de Saúde e de Doença
dc.subjectDeterminantes de Saúde
dc.subjectInfecções Respiratórias
dc.titleHybrid, infection‑ and vaccination‑induced protection against laboratory‑ confirmed SARS‑CoV‑2 infection in a European multi‑centre prospective cohort of healthcare workers, 2021–2024eng
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue1
oaire.citation.startPage697
oaire.citation.titleBMC Medicine
oaire.citation.volume23
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85

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