Vaccine · 2026
Hybrid immunity provides stronger protection against SARS-CoV-2 infection than vaccination alone: Evidence from a population-based active monitoring study.
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Fantin Romain, Das Sanchita, Loria Viviana, Calderón Alejandro, Aparicio Amada, Youn Jung-Ho, Lee Okako, Barahona-Ordonez Jose, Porras Carolina, Herrero Rolando, Hildesheim Allan, RESPIRA Study Group
Аннотация
BACKGROUND: Hybrid immunity, defined as vaccination plus prior infection, induces higher antibody levels than vaccination alone, but there is limited evidence on whether this enhanced immunological response translates into greater real-world protection against SARS-CoV-2 infection, particularly in population-based active-monitoring cohorts.
METHODS: We used data from RESPIRA, a population-based longitudinal cohort in Costa Rica that enrolled participants between November 2020 and October 2021 and followed them monthly for two years with guided saliva self-collection. We compared PCR testing results from saliva specimens collected from individuals with hybrid immunity (PCR-confirmed infection before enrollment plus two vaccine doses; N = 1157 specimens) to those from participants with two vaccine doses and no evidence of prior infection (N = 1712 specimens). All selected samples were collected between June 2021 and May 2022. The two groups were compared using GEE models adjusted for demographic, specimen-related and epidemiologic factors.
RESULTS: Hybrid immunity was associated with substantially lower risk of SARS-CoV-2 infection measured by PCR in saliva samples compared with vaccination alone (adjusted OR = 0.61 [0.43-0.84]). Findings were consistent when using self-reported COVID-19 diagnosis as the outcome.
CONCLUSIONS: Hybrid immunity conferred stronger protection against SARS-CoV-2 infection than two vaccine doses alone.
METHODS: We used data from RESPIRA, a population-based longitudinal cohort in Costa Rica that enrolled participants between November 2020 and October 2021 and followed them monthly for two years with guided saliva self-collection. We compared PCR testing results from saliva specimens collected from individuals with hybrid immunity (PCR-confirmed infection before enrollment plus two vaccine doses; N = 1157 specimens) to those from participants with two vaccine doses and no evidence of prior infection (N = 1712 specimens). All selected samples were collected between June 2021 and May 2022. The two groups were compared using GEE models adjusted for demographic, specimen-related and epidemiologic factors.
RESULTS: Hybrid immunity was associated with substantially lower risk of SARS-CoV-2 infection measured by PCR in saliva samples compared with vaccination alone (adjusted OR = 0.61 [0.43-0.84]). Findings were consistent when using self-reported COVID-19 diagnosis as the outcome.
CONCLUSIONS: Hybrid immunity conferred stronger protection against SARS-CoV-2 infection than two vaccine doses alone.