Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
Influenza Other Respir Viruses. 2023 May;17(5):e13143. doi: 10.1111/irv.13143.
We estimated combined protection conferred by prior SARS-CoV-2 infection and COVID-19 vaccination against COVID-19-associated acute respiratory illness (ARI).
During SARS-CoV-2 Delta (B.1.617.2) and Omicron (B.1.1.529) variant circulation between October 2021 and April 2022, prospectively enrolled adult patients with outpatient ARI had respiratory and filter paper blood specimens collected for SARS-CoV-2 molecular testing and serology. Dried blood spots were tested for immunoglobulin-G antibodies against SARS-CoV-2 nucleocapsid (NP) and spike protein receptor binding domain antigen using a validated multiplex bead assay. Evidence of prior SARS-CoV-2 infection also included documented or self-reported laboratory-confirmed COVID-19. We used documented COVID-19 vaccination status to estimate vaccine effectiveness (VE) by multivariable logistic regression by prior infection status.
Four hundred fifty-five (29%) of 1577 participants tested positive for SARS-CoV-2 infection at enrollment; 209 (46%) case-patients and 637 (57%) test-negative patients were NP seropositive, had documented previous laboratory-confirmed COVID-19, or self-reported prior infection. Among previously uninfected patients, three-dose VE was 97% (95% confidence interval [CI], 60%-99%) against Delta, but not statistically significant against Omicron. Among previously infected patients, three-dose VE was 57% (CI, 20%-76%) against Omicron; VE against Delta could not be estimated.
Three mRNA COVID-19 vaccine doses provided additional protection against SARS-CoV-2 Omicron variant-associated illness among previously infected participants.
我们评估了既往感染 SARS-CoV-2 和接种 COVID-19 疫苗对 COVID-19 相关急性呼吸道疾病（ARI）的联合保护作用。
在 2021 年 10 月至 2022 年 4 月期间 SARS-CoV-2 德尔塔（B.1.617.2）和奥密克戎（B.1.1.529）变异株流行期间，前瞻性招募了患有门诊 ARI 的成年患者，采集呼吸道和滤纸片血标本进行 SARS-CoV-2 分子检测和血清学检测。使用经过验证的多重珠粒分析，对干燥血斑中针对 SARS-CoV-2 核衣壳（NP）和刺突蛋白受体结合域抗原的免疫球蛋白 G 抗体进行检测。既往 SARS-CoV-2 感染的证据还包括记录在案或自我报告的实验室确诊 COVID-19。我们使用记录在案的 COVID-19 疫苗接种状态，通过多变量逻辑回归，根据既往感染状态来估计疫苗有效性（VE）。
在 1577 名入组患者中，455 名（29%）患者在入组时 SARS-CoV-2 感染检测呈阳性；209 名（46%）病例患者和 637 名（57%）阴性对照患者的 NP 血清学呈阳性，有记录的既往实验室确诊 COVID-19 或自我报告的既往感染。在既往未感染者中，三剂疫苗对 Delta 的 VE 为 97%（95%置信区间 [CI]，60%-99%），但对奥密克戎无统计学意义。在既往感染者中，三剂疫苗对奥密克戎的 VE 为 57%（CI，20%-76%）；对 Delta 的 VE 无法估计。
三剂 mRNA COVID-19 疫苗为既往感染患者提供了针对 SARS-CoV-2 奥密克戎变异株相关疾病的额外保护。
