Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy (Lai, Yan, Ye, Ma, Qin, X. Li, Wan, C.K.H. Wong, C.L. Cheung, I.C.K. Wong, Chan), Li Ka Shing Faculty of Medicine, The University of Hong Kong; Laboratory of Data Discovery for Health (Lai, Ma, Chui, X. Li, Wan, C.K.H. Wong, C.L. Cheung, I.C.K. Wong, Chan), Hong Kong Science and Technology Park; School of Nursing (Chui) and of Public Health (Chui) and Departments of Medicine (X. Li, P.H. Li, B.M.U. Cheung, Lau) and of Family Medicine and Primary Care, School of Clinical Medicine (Wan, C.K.H. Wong), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Aston Pharmacy School (I.C.K. Wong), Aston University, Birmingham, UK.
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy (Lai, Yan, Ye, Ma, Qin, X. Li, Wan, C.K.H. Wong, C.L. Cheung, I.C.K. Wong, Chan), Li Ka Shing Faculty of Medicine, The University of Hong Kong; Laboratory of Data Discovery for Health (Lai, Ma, Chui, X. Li, Wan, C.K.H. Wong, C.L. Cheung, I.C.K. Wong, Chan), Hong Kong Science and Technology Park; School of Nursing (Chui) and of Public Health (Chui) and Departments of Medicine (X. Li, P.H. Li, B.M.U. Cheung, Lau) and of Family Medicine and Primary Care, School of Clinical Medicine (Wan, C.K.H. Wong), Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Aston Pharmacy School (I.C.K. Wong), Aston University, Birmingham, UK
CMAJ. 2023 Jan 30;195(4):E143-E152. doi: 10.1503/cmaj.221068.
Multimorbidity is a prevalent risk factor for COVID-19-related complications and death. We sought to evaluate the association of homologous booster vaccination using BNT162b2 (Pfizer-BioNTech) or CoronaVac (Sinovac) with COVID-19-related deaths among people with multimorbidity during the initial Omicron wave of the COVID-19 pandemic.
Using routine clinical records from public health care facilities in Hong Kong, we conducted a territory-wide retrospective cohort study comparing people aged 18 years or older with 2 or more chronic conditions who received a homologous booster (third) dose with those who received only 2 doses, between Nov. 11, 2021, and Mar. 31, 2022. The primary outcome was death related to COVID-19.
We included 120 724 BNT162b2 recipients (including 87 289 who received a booster), followed for a median of 34 (interquartile range [IQR] 20-63) days and 127 318 CoronaVac recipients (including 94 977 who received a booster), followed for a median of 38 (IQR 22-77) days. Among BNT162b2 recipients, booster-vaccinated people had fewer COVID-19-related deaths than those who received 2 doses (5 v. 34, incidence rate 1.3 v. 23.4 per million person-days, weighted incidence rate ratio [IRR] 0.05, 95% confidence interval [CI] 0.02-0.16). We observed similar results among recipients of CoronaVac booster vaccination compared with those who received only 2 doses (26 v. 88, incidence rate 5.3 v. 53.1 per million person-days, weighted IRR 0.08, 95% CI 0.05-0.12).
Among people with multimorbidity, booster vaccination with BNT162b2 or CoronaVac was associated with reductions of more than 90% in COVID-19-related mortality rates compared with only 2 doses. These results highlight the crucial role of booster vaccination for protecting vulnerable populations as the COVID-19 pandemic continues to evolve.
多种合并症是 COVID-19 相关并发症和死亡的常见危险因素。我们旨在评估在 COVID-19 大流行的奥密克戎初始波期间，使用 BNT162b2（辉瑞-生物科技）或 CoronaVac（科兴）同源加强针接种与多种合并症人群 COVID-19 相关死亡的关联。
利用来自香港公共医疗保健机构的常规临床记录，我们进行了一项全港范围的回顾性队列研究，比较了 2021 年 11 月 11 日至 2022 年 3 月 31 日期间，接受 2 剂或以上基础剂量后，再接种同源加强针（第 3 剂）与仅接种 2 剂的人群，其主要结局为 COVID-19 相关死亡。
我们纳入了 120724 名 BNT162b2 接种者（其中 87289 人接种了加强针），中位随访时间为 34（四分位间距[IQR]：20-63）天，纳入了 127318 名 CoronaVac 接种者（其中 94977 人接种了加强针），中位随访时间为 38（IQR：22-77）天。在 BNT162b2 接种者中，与接种 2 剂的人群相比，接种加强针的人群 COVID-19 相关死亡人数较少（5 例比 34 例，发病率为每百万人群日 1.3 例比 23.4 例，加权发病率比[IRR]0.05，95%置信区间[CI]0.02-0.16）。我们观察到 CoronaVac 加强针接种者与仅接种 2 剂的人群相比，也有类似的结果（26 例比 88 例，发病率为每百万人群日 5.3 例比 53.1 例，加权 IRR 0.08，95%CI 0.05-0.12）。
在多种合并症患者中，与仅接种 2 剂相比，BNT162b2 或 CoronaVac 的加强针接种与 COVID-19 相关死亡率降低了 90%以上。这些结果强调了加强针接种在 COVID-19 大流行持续演变过程中，为保护弱势群体所发挥的关键作用。
