Public Health Secretariat, Department of Health, Generalitat de Catalunya, Barcelona, Spain.
Direcció assistencial d'Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Generalitat de Catalunya, Barcelona, Spain.
BMJ. 2021 Aug 18;374:n1868. doi: 10.1136/bmj.n1868.
To determine associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 among nursing home residents, nursing home staff, and healthcare workers.
Prospective cohort study.
Nursing homes and linked electronic medical record, test, and mortality data in Catalonia on 27 December 2020.
28 456 nursing home residents, 26 170 nursing home staff, and 61 791 healthcare workers.
Participants were followed until the earliest outcome (confirmed SARS-CoV-2 infection, hospital admission or death with covid-19) or 26 May 2021. Vaccination status was introduced as a time varying exposure, with a 14 day run-in after the first dose. Mixed effects Cox models were fitted to estimate hazard ratios with index month as a fixed effect and adjusted for confounders including sociodemographics, comorbidity, and previous medicine use.
Among the nursing home residents, SARS-CoV-2 infection was found in 2482, 411 were admitted to hospital with covid-19, and 450 died with covid-19 during the study period. In parallel, 1828 nursing home staff and 2968 healthcare workers were found to have SARS-CoV-2 infection, but fewer than five were admitted or died with covid-19. The adjusted hazard ratio for SARS-CoV-2 infection after two doses of vaccine was 0.09 (95% confidence interval 0.08 to 0.11) for nursing home residents, 0.20 (0.17 to 0.24) for nursing home staff, and 0.13 (0.11 to 0.16) for healthcare workers. Adjusted hazard ratios for hospital admission and mortality after two doses of vaccine were 0.05 (0.04 to 0.07) and 0.03 (0.02 to 0.04), respectively, for nursing home residents. Nursing home staff and healthcare workers recorded insufficient events for mortality analysis.
Vaccination was associated with 80-91% reduction in SARS-CoV-2 infection in all three cohorts and greater reductions in hospital admissions and mortality among nursing home residents for up to five months. More data are needed on longer term effects of covid-19 vaccines.
确定 2020 年 12 月 27 日在加泰罗尼亚的养老院居民、养老院工作人员和医护人员中，BNT162b2 疫苗接种与 SARS-CoV-2 感染以及因 COVID-19 住院和死亡的关联。
前瞻性队列研究。
养老院以及相关的电子病历、检测和死亡率数据。
28456 名养老院居民、26170 名养老院工作人员和 61791 名医护人员。
参与者随访至最早出现的结局（确诊的 SARS-CoV-2 感染、因 COVID-19 住院或死亡）或 2021 年 5 月 26 日。疫苗接种状态被设定为一个时间变化的暴露因素，在第一剂后有 14 天的潜伏期。采用混合效应 Cox 模型，以指数月份为固定效应，调整混杂因素，包括社会人口统计学、合并症和以前的药物使用。
在养老院居民中，研究期间有 2482 人确诊 SARS-CoV-2 感染，411 人因 COVID-19 住院，450 人因 COVID-19 死亡。与此同时，1828 名养老院工作人员和 2968 名医护人员被发现感染了 SARS-CoV-2，但因 COVID-19 住院或死亡的人数少于 5 人。接种两剂疫苗后，SARS-CoV-2 感染的调整后的危险比为 0.09（95%置信区间 0.08 至 0.11），养老院居民为 0.20（0.17 至 0.24），医护人员为 0.13（0.11 至 0.16）。接种两剂疫苗后，因 COVID-19 住院和死亡的调整后的危险比分别为 0.05（0.04 至 0.07）和 0.03（0.02 至 0.04）。
在所有三个队列中，疫苗接种与 SARS-CoV-2 感染的减少 80-91%相关，并且在接种疫苗后五个月内，养老院居民的住院和死亡率下降幅度更大。还需要更多的数据来了解 COVID-19 疫苗的长期效果。
