既往感染和疫苗接种对奥密克戎感染症状的影响。
Effects of Previous Infection and Vaccination on Symptomatic Omicron Infections.
机构信息
From the Infectious Disease Epidemiology Group and the World Health Organization Collaborating Center for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Education City (H.N.A., H.C., L.J.A.-R.), the Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences (H.H.A.), the Biomedical Research Center (H.M.Y., H.A.A.-K., M.K.S., P.C., G.K.N.), and the Departments of Biomedical Science (H.M.Y., H.A.A.-K., M.K.S., G.K.N.) and Public Health (H.F.A.-R., L.J.A.-R.), College of Health Sciences, QU Health, Qatar University, the Department of Pathology, Sidra Medicine (P.T., M.R.H.), Hamad Medical Corporation (P.C., Z.A.-K., E.A.-K., A.J., A.H.K., A.N.L., R.M.S., A.A.B., A.A.-K.), Primary Health Care Corporation (M.G.A.-K.), and the Ministry of Public Health (H.E.A.-R., M.H.A.-T., R.B.) - all in Doha, Qatar; the Departments of Population Health Sciences (H.N.A., H.C., A.A.B., L.J.A.-R.) and Medicine (A.A.B.), Weill Cornell Medicine, Cornell University, New York; and the Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, United Kingdom (P.C.).
出版信息
N Engl J Med. 2022 Jul 7;387(1):21-34. doi: 10.1056/NEJMoa2203965. Epub 2022 Jun 15.
BACKGROUND
The protection conferred by natural immunity, vaccination, and both against symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with the BA.1 or BA.2 sublineages of the omicron (B.1.1.529) variant is unclear.
METHODS
We conducted a national, matched, test-negative, case-control study in Qatar from December 23, 2021, through February 21, 2022, to evaluate the effectiveness of vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna), natural immunity due to previous infection with variants other than omicron, and hybrid immunity (previous infection and vaccination) against symptomatic omicron infection and against severe, critical, or fatal coronavirus disease 2019 (Covid-19).
RESULTS
The effectiveness of previous infection alone against symptomatic BA.2 infection was 46.1% (95% confidence interval [CI], 39.5 to 51.9). The effectiveness of vaccination with two doses of BNT162b2 and no previous infection was negligible (-1.1%; 95% CI, -7.1 to 4.6), but nearly all persons had received their second dose more than 6 months earlier. The effectiveness of three doses of BNT162b2 and no previous infection was 52.2% (95% CI, 48.1 to 55.9). The effectiveness of previous infection and two doses of BNT162b2 was 55.1% (95% CI, 50.9 to 58.9), and the effectiveness of previous infection and three doses of BNT162b2 was 77.3% (95% CI, 72.4 to 81.4). Previous infection alone, BNT162b2 vaccination alone, and hybrid immunity all showed strong effectiveness (>70%) against severe, critical, or fatal Covid-19 due to BA.2 infection. Similar results were observed in analyses of effectiveness against BA.1 infection and of vaccination with mRNA-1273.
CONCLUSIONS
No discernable differences in protection against symptomatic BA.1 and BA.2 infection were seen with previous infection, vaccination, and hybrid immunity. Vaccination enhanced protection among persons who had had a previous infection. Hybrid immunity resulting from previous infection and recent booster vaccination conferred the strongest protection. (Funded by Weill Cornell Medicine-Qatar and others.).
背景
自然免疫、疫苗接种以及两者共同作用对有症状的严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染，包括奥密克戎（B.1.1.529）变异株的 BA.1 或 BA.2 亚系的保护作用尚不清楚。
方法
我们在 2021 年 12 月 23 日至 2022 年 2 月 21 日期间在卡塔尔进行了一项全国性、匹配的、阴性对照、病例对照研究，以评估 BNT162b2（辉瑞-生物技术公司）或 mRNA-1273（莫德纳）疫苗接种、先前感染除奥密克戎以外的其他变体产生的自然免疫，以及先前感染和近期加强免疫接种产生的混合免疫对有症状的奥密克戎感染和严重、危急或致命的 2019 冠状病毒病（COVID-19）的有效性。
结果
仅先前感染对有症状的 BA.2 感染的有效性为 46.1%（95%置信区间[CI]，39.5 至 51.9）。两剂 BNT162b2 疫苗接种而无先前感染的有效性可忽略不计（-1.1%；95%CI，-7.1 至 4.6），但几乎所有人都在 6 个月前接种了第二剂。三剂 BNT162b2 疫苗接种而无先前感染的有效性为 52.2%（95%CI，48.1 至 55.9）。先前感染和两剂 BNT162b2 疫苗接种的有效性为 55.1%（95%CI，50.9 至 58.9），而先前感染和三剂 BNT162b2 疫苗接种的有效性为 77.3%（95%CI，72.4 至 81.4）。仅先前感染、BNT162b2 疫苗接种和混合免疫对 BA.2 感染引起的严重、危急或致命 COVID-19 均显示出高度有效性（>70%）。在分析 BA.1 感染的有效性和 mRNA-1273 疫苗接种的有效性时也观察到了类似的结果。
结论
先前感染、疫苗接种和混合免疫在预防有症状的 BA.1 和 BA.2 感染方面没有明显差异。疫苗接种增强了有先前感染史人群的保护作用。先前感染和近期加强免疫接种产生的混合免疫提供了最强的保护。（由威尔康奈尔医学院-卡塔尔和其他机构资助）。
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