新冠病毒疫苗对城市学术医疗中心医护人员中新冠病毒病例发生率及接种后毒株序列的影响：一项前瞻性队列研究
COVID-19 vaccine impact on rates of SARS-CoV-2 cases and post vaccination strain sequences among healthcare workers at an urban academic medical center: a prospective cohort study.
作者信息
Bouton Tara C, Lodi Sara, Turcinovic Jacquelyn, Weber Sarah E, Quinn Emily, Korn Cathy, Steiner Jacqueline, Schechter-Perkins Elissa M, Duffy Elizabeth, Ragan Elizabeth J, Taylor Bradford P, Schaeffer Beau, Miller Nancy, Davidoff Ravin, Hanage William P, Connor John, Pierre Cassandra, Jacobson Karen R
出版信息
medRxiv. 2021 Apr 27:2021.03.30.21254655. doi: 10.1101/2021.03.30.21254655.
BACKGROUND
COVID-19 vaccine trials and post-implementation data suggest vaccination decreases SARS-CoV-2 infections. We examine COVID-19 vaccination's impact on SARS-CoV-2 case rates and viral diversity among healthcare workers (HCW) during a high community prevalence period.
METHODS
A prospective cohort study from Boston Medical Center (BMC)'s HCW vaccination program, where staff received two doses of BNT162b2 or mRNA-1273. We included PCR-confirmed SARS-CoV-2 cases among HCWs from December 09, 2020 to February 23, 2021. Weekly SARS-CoV-2 rates per 100,000 person-day overall and by time from first injection (1-14 and >14 days) were compared with surrounding community rates. Viral genomes were sequenced from SARS CoV-2 positive samples.
RESULTS
SARS-CoV-2 cases occurred in 1.4% (96/7109) of HCWs given at least a first dose and 0.3% (17/5913) of HCWs given both vaccine doses. Adjusted SARS-CoV-2 infection rate ratios were 0.73 (95% CI 0.53-1.00) 1-14 days and 0.18 (0.10-0.32) >14 days from first dose. HCW SARS-CoV-2 cases >14 days from initial dose compared to within 14 days were more often older (46 versus 38 years, p=0.007), Latinx (10% versus 8%, p=0.03), and asymptomatic (48% versus 11%, p=0.0002). SARS-CoV-2 rates among HCWs fell below those of the surrounding community, with a 18% versus 11% weekly decrease respectively (p=0.14). Comparison of 48 SARS-CoV-2 genomes sequenced from post-first dose cases did not indicate selection pressure towards known spike-antibody escape mutations.
CONCLUSIONS
Our results indicate a positive impact of COVID-19 vaccines on SARS-CoV-2 case rates. Post-vaccination isolates did not show unusual genetic diversity or selection for mutations of concern.
MAIN POINT
Cases of SARS-CoV-2 among health care workers dropped rapidly with COVID-19 vaccination. Sequencing 48 breakthrough infections (overwhelmingly in 14 days after 1st dose) showed no clear sign of any differences in spike protein compared with time-matched, unvaccinated control sequences.
背景
新冠病毒疾病（COVID-19）疫苗试验及实施后的数据表明，接种疫苗可减少严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染。我们研究了在社区患病率较高的时期，COVID-19疫苗接种对医护人员中SARS-CoV-2发病率及病毒多样性的影响。
方法
这是一项对波士顿医疗中心（BMC）医护人员疫苗接种项目进行的前瞻性队列研究，该项目中的工作人员接种了两剂BNT162b2或mRNA-1273疫苗。我们纳入了2020年12月9日至2021年2月23日期间医护人员中经聚合酶链反应（PCR）确诊的SARS-CoV-2病例。将每10万人日的每周SARS-CoV-2发病率整体及按首次注射后的时间（1 - 14天及>14天）与周边社区发病率进行比较。对SARS-CoV-2阳性样本进行病毒基因组测序。
结果
至少接种了第一剂疫苗的医护人员中，1.4%（96/7109）发生了SARS-CoV-2感染，接种了两剂疫苗的医护人员中这一比例为0.3%（17/5913）。调整后的SARS-CoV-2感染率比值在首次注射后1 - 14天为0.73（95%置信区间0.53 - 1.00），>14天为0.18（0.10 - 0.32）。与首次注射后14天内感染的医护人员相比，首次注射>14天后感染SARS-CoV-2的医护人员年龄更大（46岁对38岁，p = 0.007），拉丁裔比例更高（10%对8%，p = 0.03），且无症状感染者比例更高（48%对11%，p = 0.0002）。医护人员中的SARS-CoV-2发病率低于周边社区，每周下降幅度分别为18%和11%（p = 0.14）。对48例首次注射疫苗后病例的SARS-CoV-2基因组测序结果未显示出对已知刺突蛋白抗体逃逸突变的选择压力。
结论
我们的结果表明COVID-19疫苗对SARS-CoV-2发病率有积极影响。接种疫苗后的分离株未显示出异常的遗传多样性或对相关突变的选择。
要点
随着COVID-19疫苗接种，医护人员中的SARS-CoV-2病例迅速下降。对48例突破性感染（绝大多数在首次注射后14天内）进行测序显示，与时间匹配的未接种疫苗对照序列相比，刺突蛋白无明显差异迹象。
Zotero 插件