Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia.
Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia.
JAMA Netw Open. 2022 Aug 1;5(8):e2226046. doi: 10.1001/jamanetworkopen.2022.26046.
Evidence for the timing of booster vaccination after completion of BNT162b2 and CoronaVac primary vaccination is crucial to guide policy recommendations.
To compare the odds of symptomatic SARS-CoV-2 infection and COVID-19-related outcomes after heterologous and homologous boosting of CoronaVac at 3-month intervals and homologous boosting of BNT162b2 at 6-month intervals, with BNT162b2 primary series (2 doses) as the reference group.
DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study used national data for Malaysia. Participants included all individuals aged 18 years and older who received a complete primary series of CoronaVac or BNT162b2 vaccine and were eligible for a booster dose between November 21, 2021, and December 28, 2021. Data were analyzed from November 21, 2021, to January 7, 2022.
Receipt of a booster vs no booster and categorized into primary series BNT162b2 (2 doses of BNT162b2), primary series CoronaVac (2 doses of CoronaVac), 3 doses of BNT162b2, primary series CoronaVac plus a BNT162b2 booster, and 3 doses of CoronaVac.
The primary outcome was symptomatic SARS-CoV-2 infection. The secondary outcomes were COVID-19-related intensive care unit admission and death. All outcomes were observed from the day an individual was considered fully boosted (≥14 days after booster dose).
Our cohort included 13 840 240 individuals (mean [SD] age, 39.9 [15.5] years; 7 040 298 [50.9%] men; 4 451 180 individuals [32.2%] with ≥1 comorbidities), of whom 5 081 641 individuals (36.7%) had received a booster dose. Using the primary series BNT162b2 recipients as reference, the adjusted odds against symptomatic SAR-CoV-2 infection were lower for individuals who received the primary series CoronaVac plus a BNT162b2 (adjusted odds ratio [aOR], 0.06 [95% CI, 0.05-0.06]), 3 doses of CoronaVac (aOR, 0.08 [95% CI, 0.06-0.10]), or 3 doses of BNT162b2 (aOR, 0.01 [95% CI, 0.00-0.01]). Receipt of heterologous booster (primary series of CoronaVac plus a BNT162b2 booster) was associated with lower odds of SARS-CoV-2 infection (aOR, 0.17 [95% CI, 0.17-0.18]) compared with homologous booster (3 doses of CoronaVac) for individuals aged 60 years and older (aOR, 0.19 [95% CI, 0.19-0.20]).
In this cohort study, for individuals who received the CoronaVac primary series and a booster dose of BNT162b2 or CoronaVac at 3 months, the observed odds of symptomatic SARS-CoV-2 infection were similar to individuals who received the BNT162b2 primary series plus a third dose of BNT162b2 at 6 months. Heterologous booster is recommended for individuals aged 60 years or older who received the CoronaVac primary series, given the lower observed odds against symptomatic SARS-CoV-2 infection among those who received a BNT1612b2 booster.
完成 BNT162b2 和 CoronaVac 基础免疫接种后加强针接种的时间的证据对于指导政策建议至关重要。
比较 CoronaVac 每隔 3 个月进行异源和同源加强免疫接种，以及 BNT162b2 每隔 6 个月进行同源加强免疫接种与 BNT162b2 基础系列（2 剂）相比，对有症状的 SARS-CoV-2 感染和与 COVID-19 相关结局的几率。
设计、地点和参与者：这项基于人群的回顾性队列研究使用了马来西亚的全国数据。参与者包括所有年龄在 18 岁及以上、接受过 CoronaVac 或 BNT162b2 疫苗完整基础系列接种且有资格在 2021 年 11 月 21 日至 2021 年 12 月 28 日之间接种加强针的人群。数据从 2021 年 11 月 21 日分析至 2022 年 1 月 7 日。
接种加强针与未接种加强针，分为基础系列 BNT162b2（2 剂 BNT162b2）、基础系列 CoronaVac（2 剂 CoronaVac）、3 剂 BNT162b2、基础系列 CoronaVac 加 1 剂 BNT162b2 加强针和 3 剂 CoronaVac。
主要结果是有症状的 SARS-CoV-2 感染。次要结果是与 COVID-19 相关的重症监护室入院和死亡。所有结果均从个体被认为完全加强（加强针接种后≥14 天）之日起观察。
我们的队列包括 13840240 人（平均[标准差]年龄 39.9[15.5]岁；7040298 人[50.9%]为男性；4451180 人[32.2%]患有≥1 种合并症），其中 5081641 人（36.7%）接种了加强针。以接受 BNT162b2 基础系列的个体作为参考，接受基础系列 CoronaVac 加 BNT162b2 加强针、3 剂 CoronaVac 或 3 剂 BNT162b2 的个体发生有症状 SAR-CoV-2 感染的调整后比值比（adjusted odds ratio，aOR）分别较低（aOR，0.06[95%CI，0.05-0.06]）、0.08[95%CI，0.06-0.10]）和 0.01[95%CI，0.00-0.01]）。与同源加强免疫（3 剂 CoronaVac）相比，接受异源加强免疫（基础系列 CoronaVac 加 BNT162b2 加强针）的个体（60 岁及以上人群的 aOR，0.17[95%CI，0.17-0.18]）发生 SARS-CoV-2 感染的几率较低。
在这项队列研究中，对于接受 CoronaVac 基础系列和 BNT162b2 或 CoronaVac 加强针接种 3 个月的个体，观察到的有症状 SARS-CoV-2 感染几率与接受 BNT162b2 基础系列加 BNT162b2 加强针接种 6 个月的个体相似。对于接种了 CoronaVac 基础系列的 60 岁及以上人群，建议进行异源加强免疫接种，因为与接受 BNT1612b2 加强针的人群相比，观察到的有症状 SARS-CoV-2 感染几率较低。
