奥密克戎主导的 COVID-19 大流行早期，具有或不具有混合免疫的接种疫苗员工中 SARS-CoV-2 后续感染的风险。
Risk of subsequent SARS-CoV-2 infection among vaccinated employees with or without hybrid immunity acquired early in the Omicron-predominant era of the COVID-19 pandemic.
机构信息
Department of Medicine, Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA.
Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA.
出版信息
Am J Ind Med. 2024 Apr;67(4):334-340. doi: 10.1002/ajim.23570. Epub 2024 Feb 5.
BACKGROUND
Hybrid immunity, from COVID-19 vaccination followed by SARS-CoV-2 infection acquired after its Omicron variant began predominating, has provided greater protection than vaccination alone against subsequent infection over 1-3 months of observation. Its longer-term protection is unknown.
METHODS
We conducted a retrospective cohort study of COVID-19 case incidence among healthcare personnel (HCP) mandated to be vaccinated and report on COVID-19-associated symptoms, high-risk exposures, or known-positive test results to an employee health hotline. We compared cases with hybrid immunity, defined as incident COVID-19 during the first 6 weeks of Omicron-variant predominance (run-in period), to those with immunity from vaccination alone during the run-in period. Time until COVID-19 infection over 13 subsequent months (observation period) was analyzed by standard survival analysis.
RESULTS
Of 5867 employees, 641 (10.9%, 95% confidence interval [CI]: 10.1%-11.8%) acquired hybrid immunity during the run-in period. Of these, 104 (16.2%, 95% CI: 13.5%-19.3%) experienced new SARS-CoV-2 infection during the 13-month observation period, compared to 2177 (41.7%, 95% CI: 40.3%-43.0%) of the 5226 HCP without hybrid immunity. Time until incident infection was shorter among the latter (hazard ratio: 3.09, 95% CI: 2.54-3.78).
CONCLUSIONS
In a cohort of vaccinated employees, Omicron-era acquired SARS-CoV-2 hybrid immunity was associated with significantly lower risk of subsequent infection over more than a year of observation-a time period far longer than previously reported and during which three, progressively more resistant, Omicron subvariants became predominant. These findings can inform institutional policy and planning for future COVID-19 additional vaccine dosing requirements for employees, for surveillance programs, and for risk modification efforts.
背景
COVID-19 疫苗接种后紧接着感染 SARS-CoV-2，且感染发生在其奥密克戎变异株占主导地位之后，这种混合免疫在 1-3 个月的观察期内比单独接种疫苗能提供更好的针对后续感染的保护。其长期保护效果尚不清楚。
方法
我们对医疗保健人员（HCP）进行了一项回顾性队列研究，这些人员被强制接种疫苗，并向员工健康热线报告 COVID-19 相关症状、高风险暴露或已知阳性检测结果。我们将在奥密克戎变异株占主导地位的前 6 周内发生的 COVID-19 新发病例（运行期）定义为混合免疫的病例与在运行期内仅通过疫苗接种获得免疫的病例进行比较。通过标准生存分析分析在随后的 13 个月（观察期）内 COVID-19 感染的时间。
结果
在 5867 名员工中，有 641 名（10.9%，95%置信区间[CI]：10.1%-11.8%）在运行期内获得了混合免疫。在这些人中，有 104 名（16.2%，95% CI：13.5%-19.3%）在 13 个月的观察期内经历了新的 SARS-CoV-2 感染，而在 5226 名没有混合免疫的 HCP 中，有 2177 名（41.7%，95% CI：40.3%-43.0%）发生了新的 SARS-CoV-2 感染。后者发生感染的时间更短（风险比：3.09，95% CI：2.54-3.78）。
结论
在接种疫苗的员工队列中，奥密克戎时代获得的 SARS-CoV-2 混合免疫与随后 1 年以上观察期内感染的风险显著降低相关-这一时间远远长于以前的报告，并且在此期间，三种逐渐具有更强耐药性的奥密克戎亚变异株占主导地位。这些发现可为未来 COVID-19 员工额外疫苗接种要求的机构政策和规划、监测计划以及风险修正工作提供信息。
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