Tartof Sara Y, Xie Fagen, Yadav Ruchi, Wernli Karen J, Martin Emily T, Belongia Edward A, Gaglani Manjusha, Zimmerman Richard K, Talbot H Keipp, Thornburg Natalie, Flannery Brendan
Kaiser Permanente Southern California, Department of Research & Evaluation.
Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA.
medRxiv. 2023 Jan 11:2023.01.10.23284397. doi: 10.1101/2023.01.10.23284397.
We estimated combined protection conferred by prior SARS-CoV-2 infection and COVID-19 vaccination against COVID-19-associated acute respiratory illness (ARI).
During SARS-CoV-2 Delta (B.1.617.2) and Omicron (B.1.1.529) variant circulation between October 2021 and April 2022, prospectively enrolled adult patients with outpatient ARI had respiratory and filter paper blood specimens collected for SARS-CoV-2 molecular testing and serology. Dried blood spots were tested for immunoglobulin-G antibodies against SARS-CoV-2 nucleocapsid (NP) and spike protein receptor binding domain antigen using a validated multiplex bead assay. Evidence of prior SARS-CoV-2 infection also included documented or self-reported laboratory-confirmed COVID-19. We used documented COVID-19 vaccination status to estimate vaccine effectiveness (VE) by multivariable logistic regression by prior infection status.
455 (29%) of 1577 participants tested positive for SARS-CoV-2 infection at enrollment; 209 (46%) case-patients and 637 (57%) test-negative patients were NP seropositive, had documented previous laboratory-confirmed COVID-19, or self-reported prior infection. Among previously uninfected patients, three-dose VE was 97% (95% confidence interval [CI], 60%- 99%) against Delta, but not statistically significant against Omicron. Among previously infected patients, three-dose VE was 57% (CI, 20%-76%) against Omicron; VE against Delta could not be estimated.
Three mRNA COVID-19 vaccine doses provided additional protection against SARS-CoV-2 Omicron variant-associated illness among previously infected participants.
我们评估了既往感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）和接种2019冠状病毒病（COVID-19）疫苗对COVID-19相关急性呼吸道疾病（ARI）的联合保护作用。
在2021年10月至2022年4月SARS-CoV-2德尔塔（B.1.617.2）和奥密克戎（B.1.1.529）变异株流行期间，前瞻性纳入门诊ARI成年患者，采集呼吸道和滤纸血标本进行SARS-CoV-2分子检测和血清学检测。使用经过验证的多重微珠分析检测干血斑中针对SARS-CoV-2核衣壳（NP）和刺突蛋白受体结合域抗原的免疫球蛋白G抗体。既往SARS-CoV-2感染的证据还包括记录在案的或自我报告的实验室确诊的COVID-19。我们利用记录在案的COVID-19疫苗接种状况，通过多变量逻辑回归按既往感染状况估计疫苗效力（VE）。
1577名参与者中有455名（29%）在入组时SARS-CoV-2感染检测呈阳性；209名（46%）病例患者和637名（57%）检测阴性患者NP血清学呈阳性、有记录在案的既往实验室确诊的COVID-19或自我报告既往感染。在既往未感染的患者中，三剂疫苗对德尔塔变异株的VE为97%（95%置信区间[CI]，60%-99%），但对奥密克戎变异株无统计学意义。在既往感染的患者中，三剂疫苗对奥密克戎变异株的VE为57%（CI，20%-76%）；无法估计对德尔塔变异株的VE。
三剂mRNA COVID-19疫苗为既往感染的参与者提供了针对SARS-CoV-2奥密克戎变异株相关疾病的额外保护。
