接种 COVID-19 疫苗与接种后时间和德尔塔变异株流行对有症状 SARS-CoV-2 感染的关联。

Association of COVID-19 Vaccination With Symptomatic SARS-CoV-2 Infection by Time Since Vaccination and Delta Variant Predominance.

机构信息

Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia.

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.

出版信息

JAMA. 2022 Mar 15;327(11):1032-1041. doi: 10.1001/jama.2022.2068.

DOI:10.1001/jama.2022.2068

PMID:35157002

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8845038/

Abstract

IMPORTANCE

Monitoring COVID-19 vaccine performance over time since vaccination and against emerging variants informs control measures and vaccine policies.

OBJECTIVE

To estimate the associations between symptomatic SARS-CoV-2 infection and receipt of BNT162b2, mRNA-1273, and Ad26.COV2.S by day since vaccination before and during Delta variant predominance (pre-Delta period: March 13-May 29, 2021; Delta period: July 18-October 17, 2021).

DESIGN, SETTING, AND PARTICIPANTS: Test-negative, case-control design with data from 6884 US COVID-19 testing sites in the pharmacy-based Increasing Community Access to Testing platform. This study included 1 634 271 laboratory-based SARS-CoV-2 nucleic acid amplification tests (NAATs) from adults 20 years and older and 180 112 NAATs from adolescents 12 to 19 years old with COVID-19-like illness from March 13 to October 17, 2021.

EXPOSURES

COVID-19 vaccination (1 Ad26.COV2.S dose or 2 mRNA doses) 14 or more days prior.

MAIN OUTCOMES AND MEASURES

Association between symptomatic infection and prior vaccination measured using the odds ratio (OR) from spline-based multivariable logistic regression.

RESULTS

The analysis included 390 762 test-positive cases (21.5%) and 1 423 621 test-negative controls (78.5%) (59.9% were 20-44 years old; 9.9% were 12-19 years old; 58.9% were female; 71.8% were White). Among adults 20 years and older, the BNT162b2 mean OR for days 14 to 60 after a second dose (initial OR) was lower during the pre-Delta period (0.10 [95% CI, 0.09-0.11]) than during the Delta period (0.16 [95% CI, 0.16-0.17]) and increased with time since vaccination (per-month change in OR, pre-Delta: 0.04 [95% CI, 0.02-0.05]; Delta: 0.03 [95% CI, 0.02-0.03]). The initial mRNA-1273 OR was 0.05 (95% CI, 0.04-0.05) during the pre-Delta period, 0.10 (95% CI, 0.10-0.11) during the Delta period, and increased with time (per-month change in OR, pre-Delta: 0.02 [95% CI, 0.005-0.03]; Delta: 0.03 [95% CI, 0.03-0.04]). The Ad26.COV2.S initial OR was 0.42 (95% CI, 0.37-0.47) during the pre-Delta period and 0.62 (95% CI, 0.58-0.65) during the Delta period and did not significantly increase with time since vaccination. Among adolescents, the BNT162b2 initial OR during the Delta period was 0.06 (95% CI, 0.05-0.06) among 12- to 15-year-olds, increasing by 0.02 (95% CI, 0.01-0.03) per month, and 0.10 (95% CI, 0.09-0.11) among 16- to 19-year-olds, increasing by 0.04 (95% CI, 0.03-0.06) per month.

CONCLUSIONS AND RELEVANCE

Among adults, the OR for the association between symptomatic SARS-CoV-2 infection and COVID-19 vaccination (as an estimate of vaccine effectiveness) was higher during Delta variant predominance, suggesting lower protection. For mRNA vaccination, the steady increase in OR by month since vaccination was consistent with attenuation of estimated effectiveness over time; attenuation related to time was greater than that related to variant.

摘要

重要性：自接种疫苗以来以及针对新兴变异体，监测 COVID-19 疫苗的性能可以为控制措施和疫苗政策提供信息。

目的：评估在 Delta 变体占主导地位之前和期间（预 Delta 期：2021 年 3 月 13 日至 5 月 29 日；Delta 期：2021 年 7 月 18 日至 10 月 17 日），接种 BNT162b2、mRNA-1273 和 Ad26.COV2.S 后每天与有症状的 SARS-CoV-2 感染之间的关联。

设计、地点和参与者：利用来自基于药店的增加社区检测平台的 6884 个美国 COVID-19 检测点的数据，采用测试阴性、病例对照设计。本研究包括 2021 年 3 月 13 日至 10 月 17 日期间，年龄在 20 岁及以上的成年人 1634271 次基于实验室的 SARS-CoV-2 核酸扩增检测（NAAT）和 12 至 19 岁青少年的 180112 次 COVID-19 样疾病的 NAAT。

暴露：14 天或以上之前接种过 1 剂 Ad26.COV2.S 或 2 剂 mRNA。

主要结果和措施：使用基于样条的多变量逻辑回归的比值比（OR）来衡量症状感染与之前接种疫苗之间的关联。

结果：分析包括 390762 例阳性病例（21.5%）和 1423621 例阴性对照（78.5%）（59.9%为 20-44 岁；9.9%为 12-19 岁；58.9%为女性；71.8%为白人）。在 20 岁及以上的成年人中，第二剂后 14 至 60 天的 BNT162b2 平均初始 OR（初始 OR）在预 Delta 期（0.10 [95%CI，0.09-0.11]）低于 Delta 期（0.16 [95%CI，0.16-0.17]），并随时间推移而增加（每月变化 OR，预 Delta：0.04 [95%CI，0.02-0.05]；Delta：0.03 [95%CI，0.02-0.03]）。mRNA-1273 的初始 OR 在预 Delta 期为 0.05（95%CI，0.04-0.05），在 Delta 期为 0.10（95%CI，0.10-0.11），并随时间推移而增加（每月变化 OR，预 Delta：0.02 [95%CI，0.005-0.03]；Delta：0.03 [95%CI，0.03-0.04]）。Ad26.COV2.S 的初始 OR 在预 Delta 期为 0.42（95%CI，0.37-0.47），在 Delta 期为 0.62（95%CI，0.58-0.65），且随时间推移而无明显增加。在青少年中，Delta 期 12 至 15 岁的 BNT162b2 初始 OR 为 0.06（95%CI，0.05-0.06），每月增加 0.02（95%CI，0.01-0.03），16 至 19 岁的初始 OR 为 0.10（95%CI，0.09-0.11），每月增加 0.04（95%CI，0.03-0.06）。

结论和相关性：在成年人中，有症状的 SARS-CoV-2 感染与 COVID-19 疫苗接种（作为疫苗有效性的估计）之间的关联的 OR 在 Delta 变体占主导地位时更高，表明保护作用较低。对于 mRNA 疫苗接种，OR 随时间推移而逐月增加与有效性随时间衰减一致；与时间相关的衰减大于与变体相关的衰减。