Eficacia de vacunas de ARNm versus vacunas inactivadas en la prevención de infecciones por COVID-19: revisión sistemática

Abstract

Introduction: The COVID-19 pandemic was one of the most significant global public health challenges, driving the accelerated development of multiple vaccine platforms, such as messenger Ribonucleic Acid (mRNA) vaccines and inactivated vaccines, which demonstrated substantial clinical benefits; however, differences in efficacy, safety, and applicability across epidemiological contexts remain evident. Objective: To compare the efficacy and safety of mRNA vaccines and inactivated vaccines in preventing COVID- 19 infection, hospitalization, and mortality among pediatric and adult populations. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Randomized controlled trials and observational studies published between December 2020 and September 2024 were identified through searches in PubMed, Scopus, and Web of Science. Studies lacking direct comparisons, quantifiable outcomes, or involving nonhuman populations were excluded. Methodological quality and risk of bias were assessed using validated assessment tools. Results: Of the total of 1,024 records identified, 20 studies were included, involving approximately 60,000 participants. The mRNA vaccines, mainly BNT162b2 and mRNA-1273, demonstrated higher efficacy against symptomatic infection, with values close to 95%, whereas inactivated vaccines achieved between 50% and 66%. Both vaccine platforms significantly reduced hospitalization and mortality rates. The mRNA vaccines were associated with a higher frequency of mild-to-moderate reactogenicity, whereas inactivated vaccines exhibited greater tolerability. Conclusions: mRNA vaccines provide superior protection against symptomatic and severe COVID-19. However, inactivated vaccines remain safe and valuable alternatives in healthcare systems with operational limitations. Keywords: COVID-19 vaccines, mRNA vaccines, inactivated vaccines, SARS-CoV-2, vaccine efficacy