奥密克戎时代新冠病毒病对免疫功能低下人群的影响：基于观察性人群的INFORM研究的见解
Impact of COVID-19 on immunocompromised populations during the Omicron era: insights from the observational population-based INFORM study.
作者信息
Evans Rachael A, Dube Sabada, Lu Yi, Yates Mark, Arnetorp Sofie, Barnes Eleanor, Bell Samira, Carty Lucy, Evans Kathryn, Graham Sophie, Justo Nahila, Moss Paul, Venkatesan Sudhir, Yokota Renata, Ferreira Catia, McNulty Richard, Taylor Sylvia, Quint Jennifer K
机构信息
Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.
AstraZeneca UK Limited, BioPharmaceuticals Medical, Vaccines & Immunotherapies, Eastbrook House, First Floor, Shaftesbury Road, Cambridge, CB2 8DU, United Kingdom.
出版信息
Lancet Reg Health Eur. 2023 Oct 13;35:100747. doi: 10.1016/j.lanepe.2023.100747. eCollection 2023 Dec.
BACKGROUND
Immunocompromised individuals are not optimally protected by COVID-19 vaccines and potentially require additional preventive interventions to mitigate the risk of severe COVID-19. We aimed to characterise and describe the risk of severe COVID-19 across immunocompromised groups as the pandemic began to transition to an endemic phase.
METHODS
COVID-19-related hospitalisations, intensive care unit (ICU) admissions, and deaths (01/01/2022-31/12/2022) were compared among different groups of immunocompromised individuals the general population, using a retrospective cohort design and electronic health data from a random 25% sample of the English population aged ≥12 years (Registration number: ISRCTN53375662).
FINDINGS
Overall, immunocompromised individuals accounted for 3.9% of the study population, but 22% (4585/20,910) of COVID-19 hospitalisations, 28% (125/440) of COVID-19 ICU admissions, and 24% (1145/4810) of COVID-19 deaths in 2022. Restricting to those vaccinated with ≥3 doses of COVID-19 vaccine (∼84% of immunocompromised and 51% of the general population), all immunocompromised groups remained at increased risk of severe COVID-19 outcomes, with adjusted incidence rate ratios (aIRR) for hospitalisation ranging from 1.3 to 13.1. At highest risk for COVID-19 hospitalisation were individuals with: solid organ transplant (aIRR 13.1, 95% confidence interval [95% CI] 11.2-15.3), moderate to severe primary immunodeficiency (aIRR 9.7, 95% CI 6.3-14.9), stem cell transplant (aIRR 11.0, 95% CI 6.8-17.6), and recent treatment for haematological malignancy (aIRR 10.6, 95% CI 9.5-11.9). Results were similar for COVID-19 ICU admissions and deaths.
INTERPRETATION
Immunocompromised individuals continue to be impacted disproportionately by COVID-19 and have an urgent need for additional preventive measures beyond current vaccination programmes. These data can help determine the immunocompromised groups for which targeted prevention strategies may have the highest impact.
FUNDING
This study was funded by AstraZeneca UK.
背景
免疫功能低下的个体未受到新冠病毒疫苗的最佳保护，可能需要额外的预防干预措施来降低患重症新冠的风险。随着疫情开始向地方流行阶段过渡，我们旨在描述和刻画不同免疫功能低下群体患重症新冠的风险。
方法
采用回顾性队列研究设计，利用来自英国≥12岁人群中25%随机样本的电子健康数据（注册号：ISRCTN53375662），比较了免疫功能低下个体的不同群体与普通人群中2022年1月1日至2022年12月31日期间与新冠相关的住院、重症监护病房（ICU）收治情况及死亡情况。
研究结果
总体而言，免疫功能低下个体占研究人群的3.9%，但在2022年的新冠住院患者中占22%（4585/20910），新冠ICU收治患者中占28%（125/440），新冠死亡患者中占24%（1145/4810）。将范围限定为接种≥3剂新冠疫苗的人群（免疫功能低下个体中约84%，普通人群中51%），所有免疫功能低下群体患重症新冠的风险仍然增加，住院调整发病率比（aIRR）范围为1.3至13.1。患新冠住院风险最高的是以下个体：实体器官移植者（aIRR 13.1，95%置信区间[95%CI] 11.2 - 15.3）、中度至重度原发性免疫缺陷者（aIRR 9.7，95%CI 6.3 - 14.9）、干细胞移植者（aIRR 11.0，95%CI 6.8 - 17.6）以及近期接受血液系统恶性肿瘤治疗者（aIRR 10.6，95%CI 9.5 - 11.9）。新冠ICU收治情况及死亡情况的结果相似。
解读
免疫功能低下个体仍然受到新冠的不成比例的影响，迫切需要除当前疫苗接种计划之外的额外预防措施。这些数据有助于确定哪些免疫功能低下群体可能从针对性预防策略中获益最大。
资金来源
本研究由阿斯利康英国公司资助。
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