Department of Public Health Sciences, Biological Sciences Division, University of Chicago, Chicago, Illinois.
Department of Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois.
JAMA Netw Open. 2022 Dec 1;5(12):e2249002. doi: 10.1001/jamanetworkopen.2022.49002.
It is important to understand the association between staff vaccination rates and adverse COVID-19 outcomes in nursing homes.
To assess the extent to which staff vaccination was associated with preventing COVID-19 cases and deaths among residents and staff in nursing homes.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study used data on COVID-19 outcomes in Medicare- and Medicaid-certified nursing homes in the US between May 30, 2021, and January 30, 2022. Participants included the residents of 15 042 US nursing homes that reported COVID-19 data to the Centers for Disease Control and Prevention and passed Centers for Medicare & Medicaid Services data quality checks in the National Healthcare Safety Network.
Weekly staff vaccination rates.
Main outcomes are weekly COVID-19 cases and deaths among residents and weekly COVID-19 cases among staff. The treatment variable is the primary 2-dose staff vaccination rate in each facility each week.
In the primary analysis of 15 042 nursing homes before the Omicron variant wave (May 30 to December 5, 2021) using fixed effects of facility and week, increasing weekly staff vaccination rates by 10 percentage points was associated with 0.13 (95% CI, -0.20 to -0.10) fewer weekly COVID-19 cases per 1000 residents, 0.02 (95% CI, -0.03 to -0.01) fewer weekly COVID-19 deaths per 1000 residents, and 0.03 (95% CI, -0.04 to -0.02) fewer weekly COVID-19 staff cases. In the secondary analysis of the Omicron wave (December 5, 2021, to January 30, 2022), increasing staff vaccination rates were not associated with lower rates of adverse COVID-19 outcomes in nursing homes.
The findings of this cohort study suggest that before the Omicron variant wave, increasing staff vaccination rates was associated with lower incidence of COVID-19 cases and deaths among residents and staff in US nursing homes. However, as newer, more infectious and transmissible variants of the virus emerged, the original 2-dose regimen of the COVID-19 vaccine as recommended in December 2020 was no longer associated with lower rates of adverse COVID-19 outcomes in nursing homes. Policy makers may want to consider longer-term policy options to increase the uptake of booster doses among staff in nursing homes.
了解员工疫苗接种率与疗养院中 COVID-19 不良结局之间的关联非常重要。
评估员工疫苗接种率与预防疗养院居民和员工 COVID-19 病例和死亡之间的关联程度。
设计、地点和参与者：这项纵向队列研究使用了美国医疗保险和医疗补助认证的疗养院中 COVID-19 结果的数据，数据采集时间为 2021 年 5 月 30 日至 2022 年 1 月 30 日。参与者包括向疾病控制与预防中心报告 COVID-19 数据并通过医疗保险和医疗补助服务中心国家医疗保健安全网络数据质量检查的 15422 家美国疗养院的居民。
每周员工疫苗接种率。
主要结果是居民每周 COVID-19 病例和死亡人数以及员工每周 COVID-19 病例数。治疗变量是每个设施每周的主要 2 剂员工疫苗接种率。
在没有奥密克戎变异株波的初步分析中（2021 年 5 月 30 日至 12 月 5 日），使用设施和周的固定效应，每周员工疫苗接种率提高 10 个百分点与每 1000 名居民中减少 0.13（95%CI，-0.20 至-0.10）例每周 COVID-19 病例、每 1000 名居民中减少 0.02（95%CI，-0.03 至-0.01）例每周 COVID-19 死亡人数以及每 1000 名居民中减少 0.03（95%CI，-0.04 至-0.02）例每周 COVID-19 员工病例相关。在奥密克戎波的二次分析中（2021 年 12 月 5 日至 2022 年 1 月 30 日），提高员工疫苗接种率与疗养院中 COVID-19 不良结局发生率降低无关。
这项队列研究的结果表明，在奥密克戎变异株波之前，提高员工疫苗接种率与美国疗养院居民和员工 COVID-19 病例和死亡人数的减少有关。然而，随着病毒出现更新、更具传染性和传染性的变异株，2020 年 12 月推荐的 COVID-19 疫苗 2 剂方案不再与疗养院 COVID-19 不良结局发生率降低相关。政策制定者可能希望考虑长期政策选择，以提高疗养院工作人员对加强针的接种率。
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