加拿大安大略省护理院和退休之家居民对奥密克戎感染的防护。
Protection from Omicron Infection in Residents of Nursing and Retirement Homes in Ontario, Canada.
机构信息
McMaster Immunology Research Center, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
出版信息
J Am Med Dir Assoc. 2023 May;24(5):753-758. doi: 10.1016/j.jamda.2023.02.105. Epub 2023 Mar 28.
OBJECTIVES
To identify factors that contribute to protection from infection with the Omicron variant of SARS-CoV-2 in older adults in nursing and retirement homes.
DESIGN
Longitudinal cohort study with retrospective analysis of infection risk.
SETTING AND PARTICIPANTS
997 residents of nursing and retirement homes from Ontario, Canada, in the COVID in LTC study.
METHODS
Residents with 3 messenger RNA (mRNA) dose vaccinations were included in the study. SARS-CoV-2 infection was determined by positive nasopharyngeal polymerase chain reaction test and/or circulating antinucleocapsid IgG antibodies. Cumulative probability of Omicron infection after recent COVID-19 was assessed by log-rank test of Kaplan-Meier curves. Cox regression was used to assess risk of Omicron infection by age, sex, mRNA vaccine combination, whether individuals received a fourth dose, as well as recent COVID-19.
RESULTS
In total, 171 residents (17.2%) had a presumed Omicron variant SARS-CoV-2 infection between December 15, 2021 (local start of the first Omicron wave) and May 3, 2022. Risk of Omicron infection was not different by age [hazard ratio (95% confidence interval) 1.01 (0.99‒1.02)], or in women compared with men [0.97 (0.70‒1.34)], but infection risk decreased 47% with 3 vaccine doses of mRNA-1273 (Moderna) compared with BNT162b2 (Pfizer) [0.53 (0.31-0.90)], 81% with any fourth mRNA vaccine dose [0.19 (0.12‒0.30)], and 48% with SARS-CoV-2 infection in the 3 months prior to beginning of the Omicron wave [0.52, (0.27‒0.99)].
CONCLUSIONS AND IMPLICATIONS
Vaccine type (ie, mRNA-1273/Spikevax vs BNT162b2/Cominarty), any fourth vaccine dose, and hybrid immunity from recent COVID-19, were protective against infection with the Omicron variant. These data emphasize the importance of vaccine type, and number of vaccine doses, in maintenance of protective immunity and reduction of risk of Omicron variant breakthrough infection. These findings promote continued public health efforts to support vaccination programs and monitor vaccine immunogenicity in older adults.
目的
确定导致老年护理院和退休社区中的成年人免受 SARS-CoV-2 奥密克戎变异株感染的因素。
设计
回顾性分析感染风险的纵向队列研究。
地点和参与者
来自加拿大安大略省的 COVID 长期护理研究中的 997 名护理院和退休社区居民。
方法
对接受 3 剂 mRNA 疫苗接种的居民进行了研究。通过鼻咽聚合酶链反应检测呈阳性和/或循环抗核衣壳 IgG 抗体来确定 SARS-CoV-2 感染。通过对数秩检验 Kaplan-Meier 曲线评估最近 COVID-19 后奥密克戎感染的累积概率。Cox 回归用于评估年龄、性别、mRNA 疫苗组合、个体是否接受第四剂、最近 COVID-19 对奥密克戎感染的风险。
结果
在 2021 年 12 月 15 日（第一波奥密克戎开始）至 2022 年 5 月 3 日期间，共有 171 名居民（17.2%）被推定患有奥密克戎变异 SARS-CoV-2 感染。奥密克戎感染的风险不因年龄而异[风险比（95%置信区间）为 1.01（0.99-1.02）]，也不因女性与男性而异[0.97（0.70-1.34）]，但与接受 BNT162b2（辉瑞）相比，接受 3 剂 mRNA-1273（莫德纳）疫苗的感染风险降低 47%[0.53（0.31-0.90）]，接受任何第四剂 mRNA 疫苗的感染风险降低 81%[0.19（0.12-0.30）]，在奥密克戎波开始前 3 个月内发生 SARS-CoV-2 感染的感染风险降低 48%[0.52（0.27-0.99）]。
结论和意义
疫苗类型（即 mRNA-1273/Spikevax 与 BNT162b2/Cominarty）、任何第四剂疫苗以及最近 COVID-19 的混合免疫均对奥密克戎变异株感染具有保护作用。这些数据强调了疫苗类型和疫苗接种次数在维持保护性免疫和降低奥密克戎变异突破感染风险方面的重要性。这些发现促进了继续开展公共卫生工作，以支持疫苗接种计划并监测老年人的疫苗免疫原性。
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