Covid-19 疫苗对奥密克戎（B.1.1.529）变异株的有效性。
Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant.
机构信息
From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom.
出版信息
N Engl J Med. 2022 Apr 21;386(16):1532-1546. doi: 10.1056/NEJMoa2119451. Epub 2022 Mar 2.
BACKGROUND
A rapid increase in coronavirus disease 2019 (Covid-19) cases due to the omicron (B.1.1.529) variant of severe acute respiratory syndrome coronavirus 2 in highly vaccinated populations has aroused concerns about the effectiveness of current vaccines.
METHODS
We used a test-negative case-control design to estimate vaccine effectiveness against symptomatic disease caused by the omicron and delta (B.1.617.2) variants in England. Vaccine effectiveness was calculated after primary immunization with two doses of BNT162b2 (Pfizer-BioNTech), ChAdOx1 nCoV-19 (AstraZeneca), or mRNA-1273 (Moderna) vaccine and after a booster dose of BNT162b2, ChAdOx1 nCoV-19, or mRNA-1273.
RESULTS
Between November 27, 2021, and January 12, 2022, a total of 886,774 eligible persons infected with the omicron variant, 204,154 eligible persons infected with the delta variant, and 1,572,621 eligible test-negative controls were identified. At all time points investigated and for all combinations of primary course and booster vaccines, vaccine effectiveness against symptomatic disease was higher for the delta variant than for the omicron variant. No effect against the omicron variant was noted from 20 weeks after two ChAdOx1 nCoV-19 doses, whereas vaccine effectiveness after two BNT162b2 doses was 65.5% (95% confidence interval [CI], 63.9 to 67.0) at 2 to 4 weeks, dropping to 8.8% (95% CI, 7.0 to 10.5) at 25 or more weeks. Among ChAdOx1 nCoV-19 primary course recipients, vaccine effectiveness increased to 62.4% (95% CI, 61.8 to 63.0) at 2 to 4 weeks after a BNT162b2 booster before decreasing to 39.6% (95% CI, 38.0 to 41.1) at 10 or more weeks. Among BNT162b2 primary course recipients, vaccine effectiveness increased to 67.2% (95% CI, 66.5 to 67.8) at 2 to 4 weeks after a BNT162b2 booster before declining to 45.7% (95% CI, 44.7 to 46.7) at 10 or more weeks. Vaccine effectiveness after a ChAdOx1 nCoV-19 primary course increased to 70.1% (95% CI, 69.5 to 70.7) at 2 to 4 weeks after an mRNA-1273 booster and decreased to 60.9% (95% CI, 59.7 to 62.1) at 5 to 9 weeks. After a BNT162b2 primary course, the mRNA-1273 booster increased vaccine effectiveness to 73.9% (95% CI, 73.1 to 74.6) at 2 to 4 weeks; vaccine effectiveness fell to 64.4% (95% CI, 62.6 to 66.1) at 5 to 9 weeks.
CONCLUSIONS
Primary immunization with two doses of ChAdOx1 nCoV-19 or BNT162b2 vaccine provided limited protection against symptomatic disease caused by the omicron variant. A BNT162b2 or mRNA-1273 booster after either the ChAdOx1 nCoV-19 or BNT162b2 primary course substantially increased protection, but that protection waned over time. (Funded by the U.K. Health Security Agency.).
背景
由于严重急性呼吸系统综合症冠状病毒 2 的 omicron（B.1.1.529）变体在高接种人群中导致冠状病毒病 2019（Covid-19）病例迅速增加，人们对当前疫苗的有效性产生了担忧。
方法
我们使用了一种阴性病例对照设计来估计在英国，omicron 和 delta（B.1.617.2）变体引起的有症状疾病的疫苗有效性。在接种两剂 BNT162b2（辉瑞-生物科技）、ChAdOx1 nCoV-19（阿斯利康）或 mRNA-1273（莫德纳）疫苗后，以及接种 BNT162b2、ChAdOx1 nCoV-19 或 mRNA-1273 加强针后，计算疫苗有效性。
结果
在 2021 年 11 月 27 日至 2022 年 1 月 12 日期间，共确定了 886774 名符合条件的感染 omicron 变体的人、204154 名符合条件的感染 delta 变体的人以及 1572621 名符合条件的阴性对照测试者。在所有调查的时间点以及所有初级疗程和加强疫苗的组合中，针对 delta 变体的疫苗有效性均高于针对 omicron 变体的疫苗有效性。在接种两剂 ChAdOx1 nCoV-19 后 20 周，针对 omicron 变体的疫苗有效性没有效果，而在接种两剂 BNT162b2 后 2 至 4 周，疫苗有效性为 65.5%（95%置信区间[CI]，63.9 至 67.0），在 25 周或更长时间后降至 8.8%（95%CI，7.0 至 10.5）。在 ChAdOx1 nCoV-19 初级疗程接受者中，在接种 BNT162b2 加强针后 2 至 4 周，疫苗有效性增加到 62.4%（95%CI，61.8 至 63.0），然后在 10 周或更长时间后降至 39.6%（95%CI，38.0 至 41.1）。在 BNT162b2 初级疗程接受者中，在接种 BNT162b2 加强针后 2 至 4 周，疫苗有效性增加到 67.2%（95%CI，66.5 至 67.8），然后在 10 周或更长时间后降至 45.7%（95%CI，44.7 至 46.7）。在接种 ChAdOx1 nCoV-19 初级疗程后，在接种 mRNA-1273 加强针后 2 至 4 周，疫苗有效性增加到 70.1%（95%CI，69.5 至 70.7），在 5 至 9 周后降至 60.9%（95%CI，59.7 至 62.1）。在接种 BNT162b2 初级疗程后，mRNA-1273 加强针将疫苗有效性提高到 73.9%（95%CI，73.1 至 74.6）在 2 至 4 周内；疫苗有效性在 5 至 9 周内降至 64.4%（95%CI，62.6 至 66.1）。
结论
接种两剂 ChAdOx1 nCoV-19 或 BNT162b2 疫苗对 omicron 变体引起的有症状疾病提供了有限的保护。在 ChAdOx1 nCoV-19 或 BNT162b2 初级疗程后接种 BNT162b2 或 mRNA-1273 加强针大大提高了保护，但保护作用随着时间的推移而减弱。（由英国卫生安全局资助）。
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