All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Rev Med Virol. 2024 Jan;34(1):e2515. doi: 10.1002/rmv.2515.
The Omicron variant of severe acute respiratory syndrome coronavirus 2 is a new variant of concern (VOC) and an emerging subvariant that exhibits heightened infectivity, transmissibility, and immune evasion, escalating the incidence of moderate to severe coronavirus disease 2019 (COVID-19). It resists monoclonal antibodies and diminishes vaccine efficacy. Notably, new sublineages have outpaced earlier predominant sublineages. Although the primary vaccination series and initial boosters were robust against previous VOCs, their efficacy waned against Omicron and its subvariants. In this systematic review, we assessed real-world evidence on the immunogenicity, clinical efficacy, and safety of a second booster or fourth COVID-19 vaccine dose against the Omicron VOC and its subvariants. A comprehensive literature search was conducted in Medline/PubMed, Google Scholar, bioRxiv, and medRxiv, and relevant studies published between 2022 and 30 May 2023 were reviewed. We found a total of 40 relevant articles focusing on a second booster dose for COVID-19, including clinical trials and observational studies, involving 3,972,856 patients. The results consistently revealed that an additional second booster dose restored and prolonged waning immunity, activating both humoral and cellular responses against Omicron and its subvariants. A second booster treatment correlated with enduring protection against COVID-19, notably preventing substantial symptomatic disease and mortality associated with severe Omicron infection. Both monovalent messenger RNA (mRNA) and nonmRNA vaccines demonstrated similar efficacy and safety, with bivalent mRNA vaccines exhibiting broader protection against emerging subvariants of Omicron. The safety profiles of second booster were favourable with only mild systemic and local symptoms reported in some recipients. In conclusion, this systematic review underscores the additional COVID-19 vaccine boosters, particularly with bivalent or multivalent mRNA vaccines, for countering the highly infectious emerging subvariants of Omicron.
奥密克戎变异株是一种新的关切变异株（VOC），也是一种新兴的亚变异株，具有更高的传染性、传播性和免疫逃逸能力，导致 2019 年冠状病毒病（COVID-19）的发病率中度至重度增加。它能抵抗单克隆抗体并降低疫苗的功效。值得注意的是，新的亚谱系已经超过了早期的主要亚谱系。虽然初级疫苗接种系列和最初的加强针对以前的 VOC 非常有效，但它们对奥密克戎及其亚变体的效果减弱。在这项系统评价中，我们评估了针对奥密克戎 VOC 及其亚变体的第二次加强针或第四次 COVID-19 疫苗剂量的免疫原性、临床疗效和安全性的真实世界证据。在 Medline/PubMed、Google Scholar、bioRxiv 和 medRxiv 中进行了全面的文献搜索，并审查了 2022 年 5 月 30 日之前发表的相关研究。我们共发现了 40 篇关于 COVID-19 第二次加强针的相关文章，包括临床试验和观察性研究，涉及 3972856 名患者。结果一致表明，额外的第二次加强针恢复并延长了免疫功能的下降，激活了针对奥密克戎及其亚变体的体液和细胞反应。第二次加强针治疗与对 COVID-19 的持久保护相关，特别是可以预防与严重奥密克戎感染相关的大量有症状疾病和死亡率。单价信使 RNA（mRNA）和非 mRNA 疫苗均显示出相似的疗效和安全性，而双价 mRNA 疫苗对奥密克戎新兴亚变体具有更广泛的保护作用。第二次加强针的安全性良好，仅在一些接受者中报告了轻微的全身和局部症状。总之，这项系统评价强调了针对高传染性新兴奥密克戎亚变体的额外 COVID-19 疫苗加强针，特别是使用双价或多价 mRNA 疫苗。
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