Vaccine effectiveness against transmission of alpha, delta and omicron SARS-COV-2-infection, Belgian contact tracing, 2021–2022

•We investigated SARS-CoV-2 Variant-specific transmission during high-risk exposure.•Vaccination and prior infection reduced Alpha, Delta and Omicron transmission.•Escape from vaccine-induced and infection-acquired immunity was highest for Omicron.•Protection against Omicron by primary-vaccination had little effect on susceptibility.•Lower infectiousness after vaccination waned slowly and was less affected by variants. Vaccine effectiveness against transmission (VET) of SARS-CoV-2-infection can be estimated from secondary attack rates observed during contact tracing. We estimated VET, the vaccine-effect on infectiousness of the index case and susceptibility of the high-risk exposure contact (HREC). We fitted RT-PCR-test results from HREC to immunity status (vaccine schedule, prior infection, time since last immunity-conferring event), age, sex, calendar week of sampling, household, background positivity rate and dominant VOC using a multilevel Bayesian regression-model. We included Belgian data collected between January 2021 and January 2022. For primary BNT162b2-vaccination we estimated initial VET at 96% (95%CI 95–97) against Alpha, 87% (95%CI 84–88) against Delta and 31% (95%CI 25–37) against Omicron. Initial VET of booster-vaccination (mRNA primary and booster-vaccination) was 87% (95%CI 86–89) against Delta and 68% (95%CI 65–70) against Omicron. The VET-estimate against Delta and Omicron decreased to 71% (95%CI 64–78) and 55% (95%CI 46–62) respectively, 150–200 days after booster-vaccination. Hybrid immunity, defined as vaccination and documented prior infection, was associated with durable and higher or comparable (by number of antigen exposures) protection against transmission. While we observed VOC-specific immune-escape, especially by Omicron, and waning over time since immunization, vaccination remained associated with a reduced risk of SARS-CoV-2-transmission.