Risk Malcolm, Shen Chen, Hayek Salim S, Holevinski Lynn, Schiopu Elena, Freed Gary, Akin Cem, Zhao Lili
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA.
Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Clin Infect Dis. 2022 Aug 24;75(1):e623-e629. doi: 10.1093/cid/ciac106.
There is a lack of data regarding how the Delta variant of coronavirus disease 2019 (COVID-19) has impacted the effectiveness of the BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna), and Ad26.COV2.S (Johnson & Johnson-Janssen) vaccines at preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 hospitalization.
We compared the effectiveness of the three vaccines during the pre- and post-Delta variant period (before and after 1 July 2021) in a large cohort of vaccinated and unvaccinated patients in the Michigan Medicine healthcare system. We assessed vaccine effectiveness (VE) using 2 analyses: an inverse propensity weighted (IPW) Kaplan-Meier (KM) analysis based on time from vaccination, and a Cox model based on calendar time with vaccination as a time-varying covariate.
Compared to Ad26.COV2.S recipients, the risk of hospitalization for COVID-19 in the post-Delta variant period was lower for BNT162b2 recipients (hazard ratio [HR] = 0.37; 95% confidence interval [CI]: [.14-.98]; P = .05) and mRNA-1273 recipients (HR = 0.21; 95% CI: [.07-.64]; P = .006). Recipients of the mRNA-1273 vaccine had a lower risk of SARS-CoV-2 infection than Ad26.COV2.S recipients (HR = 0.6; 95% CI: [.43-.83]; P = .003) and BNT162b2 recipients (HR = 0.64; 95% CI: [.54-.76]; P < .001). After 1 July, efficacy against SARS-CoV-2 infection declined for Ad26.COV2.S recipients (VE = 76% before; VE = 49% after; P = .02), BNT162b2 recipients (VE = 87% before; VE = 52% after; P < .001), and mRNA-1273 recipients (VE = 92% before; VE = 70% after; P < .001). Waning immunity and the Delta variant contributed independently and significantly to this decline.
Although there is a substantial decline in effectiveness, the approved COVID-19 vaccines remain effective against infection and hospitalization due to the Delta variant. The mRNA-based vaccines are more effective than the Ad26.COV2.S vaccine.
关于2019冠状病毒病（COVID-19）的德尔塔变种如何影响BNT162b2（辉瑞-生物科技公司）、mRNA-1273（莫德纳公司）和Ad26.COV2.S（强生-杨森公司）疫苗预防严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染和COVID-19住院的有效性，目前缺乏相关数据。
我们比较了密歇根大学医疗系统中大量接种和未接种疫苗患者在德尔塔变种出现之前和之后（2021年7月1日之前和之后）这三种疫苗的有效性。我们使用两种分析方法评估疫苗有效性（VE）：一种基于接种时间的逆倾向加权（IPW）Kaplan-Meier（KM）分析，另一种基于日历时间且将接种作为随时间变化协变量的Cox模型。
与接种Ad26.COV2.S疫苗的人相比，在德尔塔变种出现之后，接种BNT162b2疫苗的人患COVID-19住院的风险较低（风险比[HR]=0.37；95%置信区间[CI]：[0.14 - 0.98]；P = 0.05），接种mRNA-1273疫苗的人也是如此（HR = 0.21；95% CI：[0.07 - 0.64]；P = 0.006）。接种mRNA-1273疫苗的人感染SARS-CoV-2的风险低于接种Ad26.COV2.S疫苗的人（HR = 0.6；95% CI：[0.43 - 0.83]；P = 0.003）和接种BNT162b2疫苗的人（HR = 0.64；95% CI：[0.54 - 0.76]；P < 0.001）。7月1日之后，Ad26.COV2.S疫苗接种者对SARS-CoV-2感染的效力下降（之前的VE = 76%；之后的VE = 49%；P = 0.02），BNT162b2疫苗接种者也是如此（之前的VE = 87%；之后的VE = 52%；P < 0.001），mRNA-1273疫苗接种者同样如此（之前的VE = 92%；之后的VE = 70%；P < 0.001）。免疫力下降和德尔塔变种各自独立且显著地导致了这种下降。
尽管有效性大幅下降，但已获批的COVID-19疫苗对德尔塔变种导致的感染和住院仍然有效。基于mRNA的疫苗比Ad26.COV2.S疫苗更有效。
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