COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Primary Prevention Deng J, Ma Y, Liu Q, et al. Comparison of the Effectiveness and Safety of Heterologous Booster Doses with Homologous Booster Doses for SARS-CoV-2 Vaccines: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Aug 29;19(17):10752. doi: 10.3390/ijerph191710752.
PICO Terms
Ad5-nCoV; CanSino; Convidecia; non-replicating viral vector (I/C) adult (P) adverse reactions; safety (O) anti-RBD IgG; anti-receptor-binding domain IgG (O) any infection (O) booster; third dose (I/C) Comirnaty; Pfizer vaccine; BNT162b2; BioNTech/Fosun Pharma; mRNA (I/C) FINLAY-FR-1A; SOBERANA Plus (I/C) geometric mean titres (O) health care workers (HCW) (P) healthy (P) heterologous, prime-boost (I/C) hospitalization (O) immune mediated inflammatory disorders (P) immunogenicity (O) Johnson & Johnson vaccine; Janssen Pharmaceutical Companies; Ad26.COV2.S; non-replicating viral vector (I/C) kidney transplant patients (P) neutralizing antibodies (O) non-responders (P) NSVI-06-08; CHO Cell; recombinant vaccine; (I/C) reactogenicity (O) seroconversion (O) Sinopharm vaccine; China National Biotec Group Company; Wuhan-WIV04; Beijing-HBO2; BBIBP-CorV; Vero Cells; inactivated virus (I/C) Sinovac vaccine; CoronaVac; inactivated virus (I/C) Soberana Plus; FINLAY-FR-1A; Soberana booster; Instituto Finlay de Vacunas Cuba; protein subunit vaccine (I/C) Spikevax; Moderna vaccine; mRNA-1273 SARS-CoV-2; ModernaTX; mRNA (I/C) symptomatic infection (O) vaccine effectiveness (O) Vaxzevria; AstraZeneca vaccine; ChAd0x1 nCOV-19; non-replicating viral vector; adenovirus; University of Oxford/AstraZeneca; AZD1222 (I/C) ZF2001; Anhui Zhifei Longcom; protein subunit (I/C)

As vaccine resources were distributed unevenly worldwide, sometimes there might have been shortages or delays in vaccine supply; therefore, considering the use of heterogeneous booster doses for Coronavirus disease 2019 (COVID-19) might be an alternative strategy. Therefore, we aimed to review the data available to evaluate and compare the effectiveness and safety of heterologous booster doses with homologous booster doses for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines. We searched relevant studies up to 27 April 2022. Random-effects inverse variance models were used to evaluate the vaccine effectiveness (VE) and its 95% confidence interval (CI) of COVID-19 outcomes and odds ratio (OR) and its CI of safety events. The Newcastle-Ottawa quality assessment scale and Cochrane Collaboration's tool were used to assess the quality of the included cohort studies. A total of 23 studies involving 1,726,506 inoculation cases of homologous booster dose and 5,343,580 inoculation cases of heterologous booster dose was included. The VE of heterologous booster for the prevention of SARS-CoV-2 infection (VEheterologous = 96.10%, VEhomologous = 84.00%), symptomatic COVID-19 (VEheterologous = 56.80%, VEhomologous = 17.30%), and COVID-19-related hospital admissions (VEheterologous = 97.40%, VEhomologous = 93.20%) was higher than homologous booster. Compared with homologous booster group, there was a higher risk of fever (OR = 1.930, 95% CI, 1.199-3.107), myalgia (OR = 1.825, 95% CI, 1.079-3.089), and malaise or fatigue (OR = 1.745, 95% CI, 1.047-2.906) within 7 days after boosting, and a higher risk of malaise or fatigue (OR = 4.140, 95% CI, 1.729-9.916) within 28 days after boosting in heterologous booster group. Compared with homologous booster group, geometric mean neutralizing titers (GMTs) of neutralizing antibody for different SARS-CoV-2 variants and response rate of antibody and gama interferon were higher in heterologous booster group. Our findings suggested that both homologous and heterologous COVID-19 booster doses had great effectiveness, immunogenicity, and acceptable safety, and a heterologous booster dose was more effective, which would help make appropriate public health decisions and reduce public hesitancy in vaccination.

Discipline / Specialty Area Score
Public Health
Infectious Disease
Comments from MORE raters

Infectious Disease rater

This is very relevant information, which confirm previous reports and immunological analysis.

Public Health rater

This is an interesting, well-done systematic review.