Lieutenant Colonel Charles S Kettles VA Medical Center, Ann Arbor, MI, USA
Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.
BMJ. 2023 May 23;381:e074521. doi: 10.1136/bmj-2022-074521.
To determine the association between covid-19 vaccination types and doses with adverse outcomes of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during the periods of delta (B.1.617.2) and omicron (B.1.1.529) variant predominance.
Retrospective cohort.
US Veterans Affairs healthcare system.
Adults (≥18 years) who are affiliated to Veterans Affairs with a first documented SARS-CoV-2 infection during the periods of delta (1 July-30 November 2021) or omicron (1 January-30 June 2022) variant predominance. The combined cohorts had a mean age of 59.4 (standard deviation 16.3) and 87% were male.
Covid-19 vaccination with mRNA vaccines (BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna)) and adenovirus vector vaccine (Ad26.COV2.S (Janssen/Johnson & Johnson)).
Stay in hospital, intensive care unit admission, use of ventilation, and mortality measured 30 days after a positive test result for SARS-CoV-2.
In the delta period, 95 336 patients had infections with 47.6% having at least one vaccine dose, compared with 184 653 patients in the omicron period, with 72.6% vaccinated. After adjustment for patient demographic and clinical characteristics, in the delta period, two doses of the mRNA vaccines were associated with lower odds of hospital admission (adjusted odds ratio 0.41 (95% confidence interval 0.39 to 0.43)), intensive care unit admission (0.33 (0.31 to 0.36)), ventilation (0.27 (0.24 to 0.30)), and death (0.21 (0.19 to 0.23)), compared with no vaccination. In the omicron period, receipt of two mRNA doses were associated with lower odds of hospital admission (0.60 (0.57 to 0.63)), intensive care unit admission (0.57 (0.53 to 0.62)), ventilation (0.59 (0.51 to 0.67)), and death (0.43 (0.39 to 0.48)). Additionally, a third mRNA dose was associated with lower odds of all outcomes compared with two doses: hospital admission (0.65 (0.63 to 0.69)), intensive care unit admission (0.65 (0.59 to 0.70)), ventilation (0.70 (0.61 to 0.80)), and death (0.51 (0.46 to 0.57)). The Ad26.COV2.S vaccination was associated with better outcomes relative to no vaccination, but higher odds of hospital stay and intensive care unit admission than with two mRNA doses. BNT162b2 was generally associated with worse outcomes than mRNA-1273 (adjusted odds ratios between 0.97 and 1.42).
In veterans with recent healthcare use and high occurrence of multimorbidity, vaccination was robustly associated with lower odds of 30 day morbidity and mortality compared with no vaccination among patients infected with covid-19. The vaccination type and number of doses had a significant association with outcomes.
确定在 delta（B.1.617.2）和 omicron（B.1.1.529）变体为主导期间，covid-19 疫苗类型和剂量与严重急性呼吸综合征冠状病毒-2（SARS-CoV-2）感染不良结局之间的关联。
回顾性队列。
美国退伍军人事务部医疗保健系统。
在 delta（2021 年 7 月 1 日至 11 月 30 日）或 omicron（2022 年 1 月 1 日至 6 月 30 日）变体为主导期间首次记录 SARS-CoV-2 感染的退伍军人事务部患者（≥18 岁）。合并队列的平均年龄为 59.4（标准差 16.3），87%为男性。
接种 mRNA 疫苗（BNT162b2（辉瑞-生物科技）和 mRNA-1273（莫德纳））和腺病毒载体疫苗（Ad26.COV2.S（杨森/强生））。
在 SARS-CoV-2 检测结果阳性后 30 天，住院、入住重症监护病房、使用呼吸机和死亡的情况。
在 delta 期，95336 例患者感染，其中 47.6%至少接种了一剂疫苗，而在 omicron 期，184653 例患者接种了 72.6%的疫苗。在调整了患者的人口统计学和临床特征后，在 delta 期，与未接种疫苗相比，接种两剂 mRNA 疫苗与住院（调整后的优势比 0.41（95%置信区间 0.39 至 0.43））、入住重症监护病房（0.33（0.31 至 0.36））、通气（0.27（0.24 至 0.30））和死亡（0.21（0.19 至 0.23））的可能性降低有关。在 omicron 期，接种两剂 mRNA 疫苗与住院（0.60（0.57 至 0.63））、入住重症监护病房（0.57（0.53 至 0.62））、通气（0.59（0.51 至 0.67））和死亡（0.43（0.39 至 0.48））的可能性降低有关。此外，与两剂相比，接种第三剂 mRNA 疫苗与所有结局的可能性降低有关：住院（0.65（0.63 至 0.69））、入住重症监护病房（0.65（0.59 至 0.70））、通气（0.70（0.61 至 0.80））和死亡（0.51（0.46 至 0.57））。Ad26.COV2.S 疫苗接种与未接种疫苗相比，结果较好，但与两剂 mRNA 疫苗相比，住院和入住重症监护病房的几率较高。与 mRNA-1273 相比，BNT162b2 通常与较差的结局相关（调整后的优势比在 0.97 至 1.42 之间）。
在最近有医疗保健需求和高发病率的退伍军人中，与未接种疫苗相比，covid-19 感染患者接种疫苗与 30 天发病率和死亡率降低显著相关。疫苗类型和接种剂量与结局有显著关联。
