Lutz Chelsea S, Hartman Rachel M, Vigil Deionna E, Britton Amadea, Burrage Amanda B, Campbell Angela P, Close Ryan M, Desnoyers Christine, Dobson Jennifer, Garcia Starla, Halasa Natasha, Honie Elvira, Kobayashi Miwako, McMorrow Meredith, Mostafa Heba H, Parker Dennie, Pohl Kyle, Prill Mila M, Richards Jennifer, Roessler Kristen C, Sutcliffe Catherine G, Taylor Kim, Swango-Wilson Amy, Va Puthiery, Verani Jennifer R, Singleton Rosalyn J, Hammitt Laura L
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
CDC COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Open Forum Infect Dis. 2023 Mar 27;10(4):ofad172. doi: 10.1093/ofid/ofad172. eCollection 2023 Apr.
Despite the disproportionate morbidity and mortality experienced by American Indian and Alaska Native (AI/AN) persons during the coronavirus disease 2019 (COVID-19) pandemic, few studies have reported vaccine effectiveness (VE) estimates among these communities.
We conducted a test-negative case-control analysis among AI/AN persons aged ≥12 years presenting for care from January 1, 2021, through November 30, 2021, to evaluate the effectiveness of mRNA COVID-19 vaccines against COVID-19-associated outpatient visits and hospitalizations. Cases and controls were patients with ≥1 symptom consistent with COVID-19-like illness; cases were defined as those test-positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and controls were defined as those test-negative for SARS-CoV-2. We used unconditional multivariable logistic regression to estimate VE, defined as 1 minus the adjusted odds ratio for vaccination among cases vs controls.
The analysis included 207 cases and 267 test-negative controls. Forty-four percent of cases and 78% of controls received 2 doses of either BNT162b2 or mRNA-1273 vaccine. VE point estimates for 2 doses of mRNA vaccine were higher for hospitalized participants (94.6%; 95% CI, 88.0-97.6) than outpatient participants (86.5%; 95% CI, 63.0-95.0), but confidence intervals overlapped.
Among AI/AN persons, mRNA COVID-19 vaccines were highly effective in preventing COVID-associated outpatient visits and hospitalizations. Maintaining high vaccine coverage, including booster doses, will reduce the burden of disease in this population.
尽管美国印第安人和阿拉斯加原住民（AI/AN）在2019年冠状病毒病（COVID-19）大流行期间发病率和死亡率过高，但很少有研究报告这些社区的疫苗有效性（VE）估计值。
我们对2021年1月1日至2021年11月30日期间前来就诊的12岁及以上AI/AN人群进行了一项检测阴性病例对照分析，以评估mRNA COVID-19疫苗预防与COVID-19相关的门诊就诊和住院的有效性。病例和对照为有≥1种与COVID-19样疾病相符症状的患者；病例定义为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）检测呈阳性的患者，对照定义为SARS-CoV-2检测呈阴性的患者。我们使用无条件多变量逻辑回归来估计VE，定义为1减去病例与对照中接种疫苗的调整比值比。
分析包括207例病例和267例检测阴性对照。44%的病例和78%的对照接种了2剂BNT162b2或mRNA-1273疫苗。住院参与者2剂mRNA疫苗的VE点估计值（94.6%；95%CI，88.0-97.6）高于门诊参与者（86.5%；95%CI，63.0-95.0），但置信区间重叠。
在AI/AN人群中，mRNA COVID-19疫苗在预防与COVID相关的门诊就诊和住院方面非常有效。维持高疫苗接种率，包括加强剂量，将减轻该人群的疾病负担。
