Sinclair Jane E, Mayfield Helen J, Short Kirsty R, Brown Samuel J, Puranik Rajesh, Mengersen Kerrie, Litt John C B, Lau Colleen L
School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, Brisbane, QLD, Australia.
School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
NPJ Vaccines. 2022 Aug 11;7(1):93. doi: 10.1038/s41541-022-00517-6.
The Pfizer COVID-19 vaccine is associated with increased myocarditis incidence. Constantly evolving evidence regarding incidence and case fatality of COVID-19 and myocarditis related to infection or vaccination, creates challenges for risk-benefit analysis of vaccination. Challenges are complicated further by emerging evidence of waning vaccine effectiveness, and variable effectiveness against variants. Here, we build on previous work on the COVID-19 Risk Calculator (CoRiCal) by integrating Australian and international data to inform a Bayesian network that calculates probabilities of outcomes for the delta variant under different scenarios of Pfizer COVID-19 vaccine coverage, age groups (≥12 years), sex, community transmission intensity and vaccine effectiveness. The model estimates that in a population where 5% were unvaccinated, 5% had one dose, 60% had two doses and 30% had three doses, there was a substantially greater probability of developing (239-5847 times) and dying (1430-384,684 times) from COVID-19-related than vaccine-associated myocarditis (depending on age and sex). For one million people with this vaccine coverage, where transmission intensity was equivalent to 10% chance of infection over 2 months, 68,813 symptomatic COVID-19 cases and 981 deaths would be prevented, with 42 and 16 expected cases of vaccine-associated myocarditis in males and females, respectively. These results justify vaccination in all age groups as vaccine-associated myocarditis is generally mild in the young, and there is unequivocal evidence for reduced mortality from COVID-19 in older individuals. The model may be updated to include emerging best evidence, data pertinent to different countries or vaccines and other outcomes such as long COVID.
辉瑞新冠疫苗与心肌炎发病率增加有关。关于新冠病毒感染及与感染或疫苗接种相关的心肌炎的发病率和病死率的证据不断演变，给疫苗接种的风险效益分析带来了挑战。疫苗效力减弱的新证据以及针对变异毒株的效力差异，使这些挑战更加复杂。在此，我们在之前关于新冠风险计算器（CoRiCal）的工作基础上，整合澳大利亚和国际数据，构建一个贝叶斯网络，以计算在辉瑞新冠疫苗不同接种覆盖率、年龄组（≥12岁）、性别、社区传播强度和疫苗效力的不同情况下，德尔塔变异毒株感染的各种结果的概率。该模型估计，在一个5%未接种疫苗、5%接种一剂、60%接种两剂、30%接种三剂的人群中，因新冠相关疾病而发病（239 - 5847倍）和死亡（1430 - 384,684倍）的可能性远高于疫苗相关心肌炎（取决于年龄和性别）。对于一百万具有这种疫苗接种覆盖率的人群，在传播强度相当于2个月内感染几率为10%的情况下，可预防68,813例有症状的新冠病例和981例死亡，男性和女性中分别预计有42例和16例疫苗相关心肌炎病例。这些结果证明在所有年龄组进行疫苗接种是合理的，因为疫苗相关心肌炎在年轻人中通常症状较轻，而且有明确证据表明老年人因新冠病毒感染导致的死亡率降低。该模型可进行更新，以纳入新出现的最佳证据、与不同国家或疫苗相关的数据以及其他结果，如长期新冠症状。
