Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, USA.
J Am Med Dir Assoc. 2023 Jun;24(6):901-905. doi: 10.1016/j.jamda.2023.02.102. Epub 2023 Mar 2.
To examine incidence of and resident characteristics associated with breakthrough infections (BTIs) and severe illness among residents with 2 messenger RNA (mRNA) vaccinations.
Retrospective cohort study.
Nursing home (NH) residents who completed their primary series of mRNA COVID-19 vaccination by March 31, 2021.
Electronic health records and Minimum Data Set assessments from a multistate NH data consortium were used to identify BTI and severe illness (a composite measure of hospitalization and/or death within 30 days of BTI) occurring prior to November 24, 2021. A t test for differences in means was used to compare covariates for residents with and without BTI. Finally, we estimated incidence rate ratios (IRRs) for BTI with 95% CIs using a modified Poisson regression approach, comparing residents with BTI vs residents without. We adjusted for facility fixed effects in our model.
Our sample included 23,172 residents from 984 NHs who were at least 14 days past their second mRNA vaccine dose. Of those, 1173 (5%) developed an incident COVID-19 BTI (mean follow-up time: 250 days). Among residents with BTI, 8.6% were hospitalized or died within 30 days of BTI diagnosis. Factors associated with severe illness included age ≥85 years (IRR 2.08, 95% CI 1.08-4.02, reference age <65 years), bowel incontinence (IRR 1.73, 95% CI 1.01-2.99), coronary artery disease (IRR 1.96, 95% CI 1.31-2.94), chronic kidney disease (IRR 1.65, 95% CI 1.07-2.54), and schizophrenia (IRR 2.38, 95% CI 1.19-4.75).
Among vaccinated NH residents, BTIs and associated severe illness are rare. Residents aged ≥85 years and with certain comorbidities appear to be the most vulnerable. Given that the pandemic continues and testing policies have relaxed, these data provide prognostic information for NH facilities faced with continued outbreaks.
研究 2 剂 mRNA 疫苗接种后突破性感染（BTI）和居民严重疾病的发生率和与居民特征的关系。
回顾性队列研究。
参加者为 2021 年 3 月 31 日前完成 mRNA COVID-19 疫苗初级系列接种的疗养院居民。
使用多州疗养院数据联盟的电子健康记录和最小数据集评估，来确定 2021 年 11 月 24 日之前发生的 BTI 和严重疾病（住院和/或 BTI 后 30 天内死亡的综合衡量指标）。使用 t 检验比较有和无 BTI 的居民的协变量差异。最后，我们使用修正后的泊松回归方法，比较 BTI 居民和无 BTI 居民，估计 BTI 的发病率比（IRR）和 95%置信区间（CI）。我们在模型中调整了设施固定效应。
我们的样本包括来自 984 个疗养院的 23172 名至少 14 天接受过第二剂 mRNA 疫苗接种的居民。其中，1173 人（5%）发生了新冠病毒 BTI（平均随访时间：250 天）。在发生 BTI 的居民中，8.6%在 BTI 诊断后 30 天内住院或死亡。与严重疾病相关的因素包括年龄≥85 岁（IRR 2.08，95%CI 1.08-4.02，参考年龄<65 岁）、肠失禁（IRR 1.73，95%CI 1.01-2.99）、冠状动脉疾病（IRR 1.96，95%CI 1.31-2.94）、慢性肾脏病（IRR 1.65，95%CI 1.07-2.54）和精神分裂症（IRR 2.38，95%CI 1.19-4.75）。
在接种疫苗的疗养院居民中，BTI 和相关的严重疾病很少见。年龄≥85 岁且有某些合并症的居民似乎最脆弱。鉴于大流行仍在继续，检测政策也有所放宽，这些数据为面临持续爆发的疗养院设施提供了预后信息。
