National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA.
National Center for Immunizations and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA.
Vaccine. 2024 Apr 11;42(10):2543-2552. doi: 10.1016/j.vaccine.2023.10.072. Epub 2023 Nov 14.
BACKGROUND: Bivalent mRNA vaccines were recommended since September 2022. However, coverage with a recent vaccine dose has been limited, and there are few robust estimates of bivalent VE against symptomatic SARS-CoV-2 infection (COVID-19). We estimated VE of a bivalent mRNA vaccine dose against COVID-19 among eligible U.S. healthcare personnel who had previously received monovalent mRNA vaccine doses. METHODS: We conducted a case-control study in 22 U.S. states, and enrolled healthcare personnel with COVID-19 (case-participants) or without COVID-19 (control-participants) during September 2022-May 2023. Participants were considered eligible for a bivalent mRNA dose if they had received 2-4 monovalent (ancestral-strain) mRNA vaccine doses, and were ≥67 days after the most recent vaccine dose. We estimated VE of a bivalent mRNA dose using conditional logistic regression, accounting for matching by region and four-week calendar period. We adjusted estimates for age group, sex, race and ethnicity, educational level, underlying health conditions, community COVID-19 exposure, prior SARS-CoV-2 infection, and days since the last monovalent mRNA dose. RESULTS: Among 3,647 healthcare personnel, 1,528 were included as case-participants and 2,119 as control-participants. Participants received their last monovalent mRNA dose a median of 404 days previously; 1,234 (33.8%) also received a bivalent mRNA dose a median of 93 days previously. Overall, VE of a bivalent dose was 34.1% (95% CI, 22.6%-43.9%) against COVID-19 and was similar by product, days since last monovalent dose, number of prior doses, age group, and presence of underlying health conditions. However, VE declined from 54.8% (95% CI, 40.7%-65.6%) after 7-59 days to 21.6% (95% CI 5.6%-34.9%) after ≥60 days. CONCLUSIONS: Bivalent mRNA COVID-19 vaccines initially conferred approximately 55% protection against COVID-19 among U.S. healthcare personnel. However, protection waned after two months. These findings indicate moderate initial protection against symptomatic SARS-CoV-2 infection by remaining up-to-date with COVID-19 vaccines.
背景：自 2022 年 9 月以来，推荐使用二价 mRNA 疫苗。然而，最近一剂疫苗的接种率有限，并且针对有症状的 SARS-CoV-2 感染（COVID-19）的二价疫苗有效性（VE）的可靠估计很少。我们估计了在美国医疗保健人员中，先前接种单价 mRNA 疫苗的情况下，接种一剂二价 mRNA 疫苗对 COVID-19 的 VE。
方法：我们在 22 个美国州进行了一项病例对照研究，招募了在 2022 年 9 月至 2023 年 5 月期间患有 COVID-19（病例参与者）或未患有 COVID-19（对照参与者）的医疗保健人员。如果参与者已接种 2-4 剂单价（原始株）mRNA 疫苗，并且距最近一次疫苗接种后≥67 天，则被认为有资格接种二价 mRNA 疫苗。我们使用条件逻辑回归估计了一剂二价 mRNA 疫苗的 VE，同时考虑了区域和四周日历期的匹配。我们根据年龄组、性别、种族和民族、教育水平、基础健康状况、社区 COVID-19 暴露、先前的 SARS-CoV-2 感染以及距最后一剂单价 mRNA 疫苗的天数调整了估计值。
结果：在 3647 名医疗保健人员中，有 1528 人被纳入病例参与者，2119 人被纳入对照参与者。参与者最后一次接种单价 mRNA 疫苗的中位数时间为 404 天前；1234 人（33.8%）还在中位数 93 天前接种了一剂二价 mRNA 疫苗。总体而言，二价剂量对 COVID-19 的 VE 为 34.1%（95%CI，22.6%-43.9%），在产品、距最后一剂单价疫苗的天数、之前接种的疫苗剂量数、年龄组和基础健康状况方面相似。然而，VE 从 7-59 天后的 54.8%（95%CI，40.7%-65.6%）下降到≥60 天后的 21.6%（95%CI，5.6%-34.9%）。
结论：二价 mRNA COVID-19 疫苗最初为美国医疗保健人员提供了约 55%的 COVID-19 保护。然而，两个月后保护作用减弱。这些发现表明，通过及时接种 COVID-19 疫苗，对有症状的 SARS-CoV-2 感染有适度的初始保护作用。
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