Dödligt virus från Kina orsakar panik (SARS-CoV-2, COVID-19)

The review of evidence on natural immunity and possibilities for transmission from previously infected to susceptible contacts found that:

• Evidence from studies specifically designed to assess the impact of previous infection on the risk of transmission is currently lacking. Infection with SARS-CoV-2 does not provide sterilising immunity for all individuals and some who are reinfected might still be able to transmit SARS-CoV-2 infection to susceptible contacts.
• There is evidence that reinfection remains a rare event. Results from cohort studies confirm that the protective effect of previous SARS-CoV-2 infection ranges from 81% to 100% from Day 14 following initial infection, for a follow-up period of five to seven months. Protection against reinfection is lower in individuals aged 65 years and older.
• These studies were carried out before the emergence of SARS-CoV-2 variants of concern (VOCs) and therefore there is limited preliminary evidence that immunity induced against previously circulating SARS-CoV-2 variants may not have the same potency or duration against the VOCs identified to date (in particular the B.1.351 and P.1 variants.)
• As the number of individuals acquiring natural immunity increases, the total number of infections is expected to decrease significantly, leading to decreased transmission overall, unless the genetic changes in the circulating variants induce significant immune escape.

The review of evidence on immunity and possibilities for transmission from infected, previously-vaccinated individuals to susceptible contacts found that:

• Direct evidence of the impact of vaccination on the risk of transmission is only available from one study, a large register-based household transmission study from Scotland. This study suggests that vaccination of a household member reduces the risk of infection in susceptible household members by at least 30%.
• There is evidence that vaccination significantly reduces viral load and symptomatic/asymptomatic infections in vaccinated individuals, which could translate into reduced transmission, although the vaccine efficacy varies by vaccine product and target group. In light of this fact, the total number of infections is expected to decrease significantly as vaccination coverage increases, provided that there is a match between the vaccine strains and the circulating virus strains. This will lead to decreased transmission overall.
• Follow-up periods for vaccinated persons are not yet sufficiently long enough to draw conclusions on the duration of protection against infection long-term. Antibody titres in vaccinated individuals peak at 3−4 weeks following vaccination.
• Many of the vaccine efficacy studies were carried out before the emergence of SARS-CoV-2 VOCs. In studies that address the variants, there is limited preliminary evidence of reduced vaccine efficacy, in particular for B.1.351 and possibly also for P.1.

Follow-up of cohorts with previous SARS-CoV-2 infection and vaccination is needed to better assess the magnitude and duration of protection from reinfection leading to asymptomatic/symptomatic disease, and the effect of protection against further transmission to contacts.

A small trial with 2,000 people in South Africa found that the AstraZeneca vaccine provided "minimal protection" against mild and moderate COVID-19 disease from the B.1.351 coronavirus variant, first identified in South Africa. This variant is causing the majority of infections within the country.

None of the people in the trial died, became severely ill or had to be hospitalized. Efficacy against severe COVID-19 arising from the B.1.351 variant was not assessed in the study because the participants were at lower risk, researchers at the University of the Witwatersrand in Johannesburg said in their analysis. The study has not yet been peer-reviewed.

The World Health Organization has recommended the use of the AstraZeneca vaccine even if variants are present in a country, according to interim recommendations published on February 10.

"Countries should conduct a benefit-risk assessment according to the local epidemiological situation including the extent of circulating virus variants," the interim recommendations state.

The WHO's recommendations state that indirect evidence is compatible with protection against severe COVID-19, and ongoing clinical trials and evaluations would be needed to demonstrate this.