Department of Epidemiology and Preventive Medicine, School of Public Health, the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, 6139001, Israel.
Israel Ministry of Health, Senior Shield Project, Airport City, Israel.
JAMA Netw Open. 2022 Jul 1;5(7):e2219940. doi: 10.1001/jamanetworkopen.2022.19940.
COVID-19 vaccine might be less immunogenic and effective among residents of long-term care facilities (LTCFs).
To examine the association of BNT162b2 third dose (first booster dose) with overall SARS-CoV-2 infection, COVID-19 hospitalizations, and mortality among LTCF residents during a nationwide surge of the Delta variant in Israel.
DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study conducted nationwide COVID-19 surveillance in LTCFs in Israel between August and October 2021. Participants were residents of LTCFs aged 60 years or older.
Vaccination with the third dose of BNT162b2 vaccine vs receipt of 2 doses at least 5 months earlier, based on self-preference and choice.
The cumulative incidences of reverse transcription-polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection, COVID-19 hospitalizations, and COVID-19-related deaths more than 7 days after vaccination with the third dose were compared between the groups using Kaplan-Meier curves. Hazard ratios (HRs) and 95% CIs were obtained using multivariable Cox regression models.
Among 18 611 residents included in the analysis, 12 715 (68.3%) were female, 463 (2.5%) were from the Arab population, 16 976 (91.2%) were from the general Jewish population, and 618 (3.3%) were from the ultraorthodox Jewish population; the mean (SD) age was 81.1 (9.2) years; 16 082 residents received their first booster dose (third dose) and 2529 were vaccinated with 2 doses at least 5 months earlier. The median (IQR) follow-up durations were 66 (60-70) days among 3-dose recipients and 56 (53-62) days among 2-dose-only recipients; 107 residents had SARS-CoV-2 infection after 7 days following vaccination with the booster dose compared with 185 among the 2-dose only group (cumulative incidence: 0.7% vs 7.5%; adjusted HR, 0.11 [95% CI, 0.07-0.15]). The respective adjusted HRs were 0.07 (95% CI, 0.03-0.14) and 0.10 (95% CI, 0.04-0.24) for the associations of vaccination with the third dose with hospitalization for mild-to-moderate COVID-19 and severe illness. Five COVID-19-related deaths occurred among the third dose vaccinees during the follow-up period compared with 22 among the 2-dose-only vaccinees (cumulative rate: 0.04% vs 0.9%; adjusted HR, 0.04 [95% CI, 0.009-0.16]).
This cohort study found significant inverse associations between vaccination with the third dose of the BNT162b2 vaccine with overall SARS-CoV-2 infection, COVID-19 hospitalizations, severe disease, and COVID-19-related deaths among LTCF residents during a massive surge caused by the Delta variant in Israel.
COVID-19 疫苗在长期护理机构（LTCF）的居民中的免疫原性和有效性可能较低。
在以色列德尔塔变异株全国性激增期间，研究 BNT162b2 第三剂（第一剂加强针）与 LTCF 居民的总体 SARS-CoV-2 感染、COVID-19 住院和死亡率之间的关联。
设计、地点和参与者：本观察性队列研究在以色列全国 LTCF 进行了 COVID-19 监测，时间为 2021 年 8 月至 10 月。参与者为 60 岁或以上的 LTCF 居民。
根据自身偏好和选择，与接种 2 剂至少 5 个月前相比，接种 BNT162b2 疫苗的第三剂。
使用 Kaplan-Meier 曲线比较两组之间接种第三剂后 7 天以上的逆转录-聚合酶链反应（RT-PCR）确认的 SARS-CoV-2 感染、COVID-19 住院和 COVID-19 相关死亡的累积发生率。使用多变量 Cox 回归模型获得危险比（HR）和 95%置信区间。
在纳入分析的 18611 名居民中，12715 名（68.3%）为女性，463 名（2.5%）来自阿拉伯人，16976 名（91.2%）来自普通犹太人群体，618 名（3.3%）来自极端正统犹太人群体；平均（SD）年龄为 81.1（9.2）岁；16082 名居民接受了第一剂加强针（第三剂），2529 名接种了 2 剂至少 5 个月前。3 剂组的中位（IQR）随访时间为 66（60-70）天，2 剂组为 56（53-62）天；与 2 剂组相比，107 名居民在接种加强针后 7 天出现 SARS-CoV-2 感染（累计发病率：0.7%比 7.5%；调整后的 HR，0.11[95%CI，0.07-0.15]）。接种第三剂与轻度至中度 COVID-19 住院和严重疾病的关联的相应调整后 HR 分别为 0.07（95%CI，0.03-0.14）和 0.10（95%CI，0.04-0.24）。在随访期间，第三剂疫苗组有 5 例 COVID-19 相关死亡，而 2 剂疫苗组有 22 例（累计率：0.04%比 0.9%；调整后的 HR，0.04[95%CI，0.009-0.16]）。
这项队列研究发现，在以色列由德尔塔变异株引起的大规模激增期间，接种 BNT162b2 第三剂疫苗与 LTCF 居民的总体 SARS-CoV-2 感染、COVID-19 住院、严重疾病和 COVID-19 相关死亡之间存在显著的负相关关系。
