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Effect of the incremental protection of previous infection against Omicron infection among individuals with a hybrid of infection- and vaccine-induced immunity: a population-based cohort study in Canada


Objectives — We examined the incremental protection and durability of infection-acquired immunity against Omicron infection in individuals with hybrid immunity in Ontario, Canada.

Methods — We followed up six million Individuals with at least one RT-PCR test before November 21, 2021 until an Omicron infection. Protection via infection-acquired immunity was assessed by comparing Omicron infection risk between previously infected individuals and those without documented infection under different vaccination scenarios and stratified by time since last infection or vaccination.

Results — A prior infection was associated with 68% (95%CI 61–73) and 43% (95%CI 27–56) increased protection against Omicron infection in individuals with two and three doses, respectively. Among individuals with two-dose vaccination, the incremental protection of infection-induced immunity decreased from 79% (95%CI 75-81) within 3 months after vaccination or infection to 27% (95%CI 14-37) at 9-11 months. In individuals with three-dose vaccination, it decreased from 57% (95%CI 50-63) within 3 months to 37% (95%CI 19-51) at 3-5 months after vaccination or infection.

Conclusion — Previous SARS-CovV-2 infections provide added cross-variant immunity to vaccination. Given the limited durability of infection-acquired protection in individuals with hybrid immunity, its influence on shield-effects at population level and reinfection risks at individual level may be limited.



Wu S, Li Y, Mishra S, Bodner K, Baral S, Kwong JC, Wei X. Int J Infect Dis. 2023; 127:69-76. Epub 2022 Nov 28.

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