在奥密克戎亚型BA.2/BA.2.12.1和BA.4/BA.5流行期间，单价mRNA新冠疫苗加强剂量对儿童、青少年和成人有症状的严重急性呼吸综合征冠状病毒2感染的有效性。
Effectiveness of Booster Doses of Monovalent mRNA COVID-19 Vaccine Against Symptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children, Adolescents, and Adults During Omicron Subvariant BA.2/BA.2.12.1 and BA.4/BA.5 Predominant Periods.
作者信息
Ciesla Allison Avrich, Wiegand Ryan E, Smith Zachary R, Britton Amadea, Fleming-Dutra Katherine E, Miller Joseph, Accorsi Emma K, Verani Jennifer R, Shang Nong, Derado Gordana, Pilishvili Tamara, Link-Gelles Ruth
机构信息
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Eagle Health Analytics, San Antonio, Texas, USA.
出版信息
Open Forum Infect Dis. 2023 Apr 13;10(5):ofad187. doi: 10.1093/ofid/ofad187. eCollection 2023 May.
BACKGROUND
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BA.2/BA.2.12.1 and BA.4/BA.5 subvariants have mutations associated with increased capacity to evade immunity when compared with prior variants. We evaluated mRNA monovalent booster dose effectiveness among persons ≥5 years old during BA.2/BA.2.12.1 and BA.4/BA.5 predominance.
METHODS
A test-negative, case-control analysis included data from 12 148 pharmacy SARS-CoV-2 testing sites nationwide for persons aged ≥5 years with ≥1 coronavirus disease-2019 (COVID-19)-like symptoms and a SARS-CoV-2 nucleic acid amplification test from April 2 to August 31, 2022. Relative vaccine effectiveness (rVE) was estimated comparing 3 doses of COVID-19 mRNA monovalent vaccine to 2 doses; for tests among persons ≥50 years, rVE estimates also compared 4 doses to 3 doses (≥4 months since third dose).
RESULTS
A total of 760 986 test-positive cases and 817 876 test-negative controls were included. Among individuals ≥12 years, rVE of 3 versus 2 doses ranged by age group from 45% to 74% at 1-month post vaccination and waned to 0% by 5-7 months post vaccination during the BA.4/BA.5 period.Adults aged ≥50 years (fourth dose eligible) who received 4 doses were less likely to have symptomatic SARS-CoV-2 infection compared with those with 3 doses; this rVE remained >0% through at least 3 months since last dose. For those aged ≥65 years, rVE of 4 versus 3 doses 1-month post vaccination was higher during BA.2/BA.2.12.1 (rVE = 49%; 95% confidence interval [CI], 43%-53%) than BA.4/BA.5 (rVE = 40%; 95% CI, 36%-44%). In 50- to 64-year-olds, rVE estimates were similar.
CONCLUSIONS
Monovalent mRNA booster doses provided additional protection against symptomatic SARS-CoV-2 infection during BA.2/BA.2.12.1 and BA.4/BA.5 subvariant circulation, but protection waned over time.
背景
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的BA.2/BA.2.12.1和BA.4/BA.5亚变体与之前的变体相比，具有与免疫逃逸能力增强相关的突变。我们评估了在BA.2/BA.2.12.1和BA.4/BA.5占主导期间，5岁及以上人群中mRNA单价加强针的有效性。
方法
一项检测阴性的病例对照分析纳入了来自全国12148个药房SARS-CoV-2检测点的数据，这些数据来自年龄≥5岁、有≥1种类似2019冠状病毒病（COVID-19）症状且在2022年4月2日至8月31日期间进行了SARS-CoV-2核酸扩增检测的人群。通过比较3剂COVID-19 mRNA单价疫苗与2剂疫苗来估计相对疫苗效力（rVE）；对于50岁及以上人群的检测，rVE估计还比较了4剂与3剂（第三剂接种后≥4个月）。
结果
共纳入760986例检测阳性病例和817876例检测阴性对照。在12岁及以上个体中，接种3剂与2剂相比的rVE在接种后1个月时按年龄组范围为45%至74%，在BA.4/BA.5期间接种后5至7个月时降至0%。与接种3剂的成年人相比，年龄≥50岁（符合接种第四剂条件）且接种4剂的成年人出现有症状SARS-CoV-2感染的可能性较小；自最后一剂接种后至少3个月内，这种rVE仍>0%。对于年龄≥65岁的人群，接种后1个月时接种4剂与3剂相比的rVE在BA.2/BA.2.12.1期间（rVE = 49%；95%置信区间[CI]，43%-53%）高于BA.4/BA.5期间（rVE = 40%；95%CI，36%-44%）。在50至64岁人群中，rVE估计值相似。
结论
在BA.2/BA.2.12.1和BA.4/BA.5亚变体流行期间，单价mRNA加强针为有症状的SARS-CoV-2感染提供了额外保护，但保护作用会随时间减弱。
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