Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China.
Department of Psychiatry, The University of Tasmania, Hobart, Tasmania, Australia; Centre for Mental Health Service Innovation, Statewide Mental Health Services, Hobart, Tasmania, Australia.
Psychiatry Res. 2023 Nov;329:115515. doi: 10.1016/j.psychres.2023.115515. Epub 2023 Oct 4.
Concerns have been raised regarding potential weaker vaccine immunogenicity with higher immune suppression for individuals with pre-existing mental disorders. Yet, data on the effectiveness of COVID-19 vaccinations among this vulnerable population are limited. A case-control study was conducted to investigate the risks of COVID-19-related hospitalisation and mortality among individuals with mental disorders following one to three doses of BNT162b2 and CoronaVac vaccinations in Hong Kong. Data were extracted from electronic health records, vaccination and COVID-19 confirmed case records. Conditional logistic regression was applied with adjustment for comorbidities and medication history. Subgroup analyses were performed with stratification: by age (< 65 and ≥ 65) and mental disorders diagnosis (depression, schizophrenia, anxiety disorder, and bipolar disorder). Two doses of BNT162b2 and CoronaVac significantly reduced COVID-19-related hospitalisation and mortality. Further protection for both outcomes was provided after three doses of BNT162b2 and CoronaVac. The vaccine effectiveness magnitude of BNT162b2 was generally higher than CoronaVac, but the difference diminished after the third dose. Individuals with mental disorders should be prioritised in future mass vaccination programmes of booster doses or bivalent COVID-19 vaccines. Targeted strategies should be developed to resolve the reasons behind vaccine hesitancy among this population and increase their awareness on the benefits of vaccination.
人们担心，对于先前存在精神障碍的个体，较高的免疫抑制可能会导致疫苗免疫原性减弱。然而，针对这一脆弱人群的 COVID-19 疫苗有效性数据有限。本项在香港开展的病例对照研究旨在调查在接受一剂、两剂或三剂 BNT162b2 和科兴疫苗接种后，精神障碍个体发生 COVID-19 相关住院和死亡的风险。数据从电子健康记录、疫苗接种和 COVID-19 确诊病例记录中提取。采用条件逻辑回归进行分析，并对合并症和用药史进行了调整。通过分层进行亚组分析：按年龄（<65 岁和≥65 岁）和精神障碍诊断（抑郁症、精神分裂症、焦虑症和双相情感障碍）进行分层。两剂 BNT162b2 和科兴疫苗显著降低了 COVID-19 相关住院和死亡风险。接种三剂 BNT162b2 和科兴疫苗后，对这两种结局的保护作用进一步增强。BNT162b2 的疫苗有效性大小通常高于科兴疫苗，但在接种第三剂后，两者的差异缩小。在未来的大规模疫苗接种计划中，应优先为精神障碍个体接种加强针或二价 COVID-19 疫苗。应制定有针对性的策略，以解决该人群对接种疫苗犹豫不决的原因，并提高他们对接种疫苗益处的认识。
