39 COVID-19 deaths among the fourth vaccine dose recipients in Israel

72% relative risk reduction, but very modest absolute risk reduction was observed for 4 vs 3 doses of COVID-19 vaccine (administered 4 months ago or earlier) in Israel.

SARS-CoV-2 infection was detected among 4058 residents who received the fourth dose of the vaccine vs 4370 among residents who received 3 doses, yielding cumulative incidences of 17.6% vs 24.9%. There were 217 hospitalizations for COVID-19 of mild-to-moderate severity among the 4-dose recipients compared with 493 among the 3-dose recipients, yielding cumulative incidences of 0.9% and 2.8%, respectively. The corresponding numbers of COVID-19 hospitalizations for severe illness were 108 and 259, and the respective cumulative incidences were 0.5% and 1.5%. There were 39 COVID-19 related deaths among the fourth dose recipients vs 85 deaths among the 3-dose recipients, yielding a cumulative mortality of 0.2% vs 0.5%.

The estimated effectiveness of the fourth dose against the Omicron variant found in this current study was lower than that found for the third dose against the Delta variant (89% against infection and 92%-96% against COVID-19 hospitalization and deaths), likely owing to the high immune escape of the Omicron variant.

Later Korean study found that effectiveness of the fourth dose against severe infection and death was 67.7% in the first 60 days. 


Muhsen K, Maimon N, Mizrahi AY, Boltyansky B, Bodenheimer O, Diamant ZH, Gaon L, Cohen D, Dagan R. Association of Receipt of the Fourth BNT162b2 Dose With Omicron Infection and COVID-19 Hospitalizations Among Residents of Long-term Care Facilities. JAMA Internal Medicine. 2022 Jun 23.

Park SK, Choe YJ, Jang EJ, Kim RK, Lim DS, Yi S, Lee S, Kwon GY, Shin JY, Choi SY, Jeong MJ. Effectiveness of fourth dose of COVID-19 mRNA vaccine in elderly population during Omicron BA. 2 and BA. 5 circulation: nationwide cohort study in Korea (K-COVE). In Open Forum Infectious Diseases 2023 Mar 1 (p. ofad109). Oxford University Press.


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