COVID-19 vaccines provide better protection against related pneumonia than previous symptomatic infection

•COVID-19 vaccines effects and previous symptomatic pneumonia illness were analyzed.•Data from 46,998 laboratory-confirmed cases of COVID-19 were analyzed.•Vaccinated participants had a decreased risk of COVID-19-related pneumonia.•The association of previous illness was not significant.•Despite having previous symptomatic infection, it is relevant to offer vaccination. To compare, in a real-world scenario, the protective effect of vaccination and previous laboratory-confirmed symptomatic infection on the risk of COVID-19 pneumonia. A retrospective study was conducted and 46,998 adults with laboratory-confirmed COVID-19 were enrolled. Risk ratios (RRs) and 95% confidence intervals (CIs) were used to evaluate the effect of the evaluated exposures on the risk of pneumonia. In multiple analysis and after adjusting by reinfection status, vaccinated participants were at reduced risk of developing pneumonia (RR = 0.974, 95% CI 0.965–0.983). The association of having had a previous infection was not significant (RR = 1.001, 95% CI 0.969–1.034). Our results suggest, and if later replicated, that COVID-19 vaccines provide better protection against pneumonia than previous symptomatic infections. Therefore, offering vaccination to all eligible subjects despite past COVID-19 infections might be relevant to reducing the pandemic-related burden.