退伍军人中新冠疫苗效力随时间的比较
Comparative COVID-19 Vaccine Effectiveness Over Time in Veterans.
作者信息
Mayr Florian B, Talisa Victor B, Shaikh Obaid S, Omer Saad B, Butt Adeel A, Yende Sachin
机构信息
Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
Yale Institute of Global Health, Yale School of Medicine, New Haven, Connecticut, USA.
出版信息
Open Forum Infect Dis. 2022 Jun 24;9(7):ofac311. doi: 10.1093/ofid/ofac311. eCollection 2022 Jul.
BACKGROUND
Comparative effectiveness of coronavirus disease 2019 (COVID-19) vaccines across patient subgroups is poorly understood and essential to precisely targeting vaccination strategies.
METHODS
We used the US Department of Veterans Affairs COVID-19 Shared Data Resource to identify veterans who utilize VA health care and had no documented severe acute respiratory syndrome coronavirus 2 infection before December 11, 2020. Using a test-negative case-control design (TND), we used conditional logistic regression with adjustment for covariates to estimate vaccine effectiveness (VE) over time for veterans who received 2 doses of mRNA vaccines or 1 dose of Ad26.Cov2.S.
RESULTS
We identified 4.8 million veterans with a mean age of 64 years, of whom 58% had ≥1 chronic disease. Vaccine effectiveness for symptomatic infections, hospitalizations, and ICU admission or death declined over time and varied by the type of vaccine ( < 0.01). VE estimates against symptomatic infection during months 1 and 7 for mRNA-1273 compared with BNT162b2 were 89.7% (95% CI, 84.4%-93.0%) and 57.3% (95% CI, 48.4%-64.7%) vs 81.6% (95% CI, 75.9%-85.9%) and 22.5% (95% CI, 7.2%-35.2%) for individuals age <65 years and 78.4% (95% CI, 71.1%-83.9%) and 36.2% (95% CI, 27.7%-43.6%) vs 66.3% (95% CI, 55.7%-74.4%) and -23.3% (95% CI, -40.5% to -8.2%) in subjects age ≥65 years; against hospitalization 92.0% (95% CI, 76.1%-97.3%) and 83.1% (95% CI, 66.8%-91.4%) vs 85.6% (95% CI, 72.6%-92.4%) and 57.0% (95% CI, 31.2%-73.2%) in subjects age <65 years and 66.1% (95% CI, 45.3%-79.0%) and 64.7% (95% CI, 55.2%-72.3%) vs 61.0% (95% CI, 41.3%-74.2%) and 1.7% (95% CI, -22.0% to 20.8%) in those age ≥65 years; against ICU admission or death 89.2% (95% CI, 49.5%-97.7%) and 84.4% (95% CI, 59.0%-94.1%) vs 87.6% (95% CI, 61.0%-96.1%) and 66.4% (95% CI, 7.7%-87.8%) in subjects age <65 years and 75.4% (95% CI, 51.7%-87.5%) and 73.8 (95% CI, 62.9%-81.5%) vs 67.4% (95% CI, 32.6%-84.3%) and 29.3% (95% CI, 2.3%-48.9%) in subjects age ≥65 years, respectively ( < .01 for all comparisons). Similarly, mRNA-1273 was more effective than BNT162b2 in veterans with >1 chronic disease.
CONCLUSIONS
mRNA-1273 was more effective than BNT162b2 in older veterans and those with chronic diseases.
背景
2019冠状病毒病（COVID-19）疫苗在不同患者亚组中的相对有效性尚不清楚，而这对于精准制定疫苗接种策略至关重要。
方法
我们利用美国退伍军人事务部的COVID-19共享数据资源，识别使用退伍军人事务部医疗服务且在2020年12月11日前无严重急性呼吸综合征冠状病毒2感染记录的退伍军人。采用检测阴性病例对照设计（TND），我们使用条件逻辑回归并对协变量进行调整，以估计接受2剂mRNA疫苗或1剂Ad26.Cov2.S的退伍军人随时间推移的疫苗有效性（VE）。
结果
我们识别出480万名退伍军人，平均年龄为64岁，其中58%患有≥1种慢性病。针对有症状感染、住院以及重症监护病房（ICU）入院或死亡的疫苗有效性随时间下降，且因疫苗类型而异（P < 0.01）。在第1个月和第7个月，年龄<65岁的个体中，与BNT162b2相比，mRNA-1273针对有症状感染的VE估计值分别为89.7%（95%CI，84.4%-93.0%）和57.3%（95%CI，48.4%-64.7%），而BNT162b2为81.6%（95%CI，75.9%-85.9%）和22.5%（95%CI，7.2%-35.2%）；年龄≥65岁的个体中，mRNA-1273为78.4%（95%CI，71.1%-83.9%）和36.2%（95%CI，27.7%-43.6%），BNT162b2为66.3%（95%CI，55.7%-74.4%）和 -23.3%（95%CI，-40.5%至-8.2%）；针对住院，年龄<65岁的个体中，mRNA-1273为92.0%（95%CI，76.1%-97.3%）和83.1%（95%CI，66.8%-91.4%），BNT162b2为85.6%（95%CI，72.6%-92.4%）和57.0%（95%CI，31.2%-73.2%）；年龄≥65岁的个体中，mRNA-1273为66.1%（95%CI，45.3%-79.0%）和64.7%（95%CI，55.2%-72.3%），BNT162b2为61.0%（95%CI，41.3%-74.2%）和1.7%（95%CI，-22.0%至20.8%）；针对ICU入院或死亡，年龄<65岁的个体中，mRNA-1273为89.2%（95%CI，49.5%-97.7%）和84.4%（95%CI，59.0%-94.1%），BNT162b2为87.6%（95%CI，61.0%-96.1%）和66.4%（95%CI，7.7%-87.8%）；年龄≥65岁的个体中，mRNA-1273为75.4%（95%CI，51.7%-87.5%）和73.8（95%CI，62.9%-81.5%），BNT162b2为67.4%（95%CI，32.6%-84.3%）和29.3%（95%CI，2.3%-48.9%）（所有比较P < 0.01）。同样，在患有>1种慢性病的退伍军人中，mRNA-1273比BNT162b2更有效。
结论
在老年退伍军人和患有慢性病的退伍军人中，mRNA-1273比BNT162b2更有效。
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