Virk Abinash, Johnson Matthew G, Roellinger Daniel L, Scott Christopher G, Sampathkumar Priya, Breeher Laura E, Swift Melanie
Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Open Forum Infect Dis. 2023 Mar 27;10(5):ofad161. doi: 10.1093/ofid/ofad161. eCollection 2023 May.
The protective efficacy of prior coronavirus disease 2019 (COVID-19) with or without vaccination remains unknown. This study sought to understand if 2 or more messenger RNA (mRNA) vaccine doses provide additional protection in patients with prior infection, or if infection alone provides comparable protection.
We conducted a retrospective cohort study of the risk of COVID-19 from 16 December 2020 through 15 March 2022, among vaccinated and unvaccinated patients of all ages with and without prior infection. A Simon-Makuch hazard plot illustrated the incidence of COVID-19 between groups. Multivariable Cox proportional hazards regression was used to examine the association of demographics, prior infection, and vaccination status with new infection.
Among 101 941 individuals with at least 1 COVID-19 polymerase chain reaction test prior to 15 March 2022, 72 361 (71.0%) received mRNA vaccination and 5957 (5.8%) were previously infected. The cumulative incidence of COVID-19 was substantially higher throughout the study period for those previously uninfected and unvaccinated, and lowest for those previously infected and vaccinated. After accounting for age, sex, and the interaction between vaccination and prior infection, a reduction in reinfection risk was noted during the Omicron and pre-Omicron phases of 26% (95% confidence interval [CI], 8%-41%; = .0065) to 36% (95% CI, 10%-54%; = .0108), respectively, among previously infected and vaccinated individuals, compared to previously infected subjects without vaccination.
Vaccination was associated with lower risk of COVID-19, including in those with prior infection. Vaccination should be encouraged for all including those with prior infection, especially as new variants emerge and variant-specific booster vaccines become available.
既往感染过2019冠状病毒病（COVID-19）（无论是否接种疫苗）的保护效力尚不清楚。本研究旨在了解两剂或更多剂信使核糖核酸（mRNA）疫苗是否能为既往感染者提供额外保护，或者仅感染是否能提供类似的保护。
我们对2020年12月16日至2022年3月15日期间所有年龄、接种和未接种疫苗、有和无既往感染的患者发生COVID-19的风险进行了一项回顾性队列研究。Simon-Makuch风险图展示了各组之间COVID-19的发病率。多变量Cox比例风险回归用于检验人口统计学、既往感染和疫苗接种状态与新感染之间的关联。
在2022年3月15日之前至少进行过1次COVID-19聚合酶链反应检测的101941人中，72361人（71.0%）接受了mRNA疫苗接种，5957人（5.8%）曾感染过。在整个研究期间，既往未感染且未接种疫苗者的COVID-19累积发病率显著更高，而既往感染且接种疫苗者的发病率最低。在考虑年龄、性别以及疫苗接种和既往感染之间的相互作用后，在奥密克戎和奥密克戎之前阶段，既往感染且接种疫苗的个体与未接种疫苗的既往感染个体相比，再感染风险分别降低了26%（95%置信区间[CI]，8%-41%；P = 0.0065）至36%（95%CI，10%-54%；P = 0.0108）。
接种疫苗与较低的COVID-19风险相关，包括既往感染者。应鼓励所有人接种疫苗，包括既往感染者，尤其是在新变种出现且有针对变种的加强疫苗可用时。
