Department of Epidemiology, Intervention, and Training, Epicentre, Paris, France.
Department of Epidemiology, Intervention, and Training, Epicentre, Paris, France.
Lancet Infect Dis. 2024 Jun;24(6):602-610. doi: 10.1016/S1473-3099(23)00819-8. Epub 2024 Feb 7.
The rVSVΔG-ZEBOV-GP vaccine constitutes a valuable tool to control Ebola virus disease outbreaks. This retrospective cohort study aimed to assess the protective effect of the vaccine against death among patients with confirmed Ebola virus disease.
In this retrospective cohort analysis of patients with confirmed Ebola virus disease admitted to Ebola health facilities in the Democratic Republic of the Congo between July 27, 2018, and April 27, 2020, we performed univariate and multivariate analyses to assess case fatality risk and cycle threshold for nucleoprotein according to vaccination status, Ebola virus disease-specific treatments (eg, mAb114 and REGN-EB3), and other risk factors.
We analysed all 2279 patients with confirmed Ebola virus disease. Of these 2279 patients, 1300 (57%) were female and 979 (43%) were male. Vaccination significantly lowered case fatality risk (vaccinated: 25% [106/423] vs not vaccinated: 56% [570/1015]; p<0·0001). In adjusted analyses, vaccination significantly lowered the risk of death compared with no vaccination, with protection increasing as time elapsed from vaccination to symptom onset (vaccinated ≤2 days before onset: 27% [27/99], adjusted relative risk 0·56 [95% CI 0·36-0·82, p=0·0046]; 3-9 days before onset: 20% [28/139], 0·44 [0·29-0·65, p=0·0001]; ≥10 days before onset: 18% [12/68], 0·40 [0·21-0·69; p=0·0022]; vaccination date unknown: 33% [39/117], 0·69 [0·48-0·96; p=0·0341]; and vaccination status unknown: 52% [441/841], 0·80 [0·70-0·91, p=0·0011]). Longer time from symptom onset to admission significantly increased risk of death (49% [1117/2279], 1·03 [1·02-1·05; p<0·0001]). Cycle threshold values for nucleoprotein were significantly higher-indicating lower viraemia-among patients who were vaccinated compared with those who were not vaccinated; the highest difference was observed among those vaccinated 21 days or longer before symptom onset (median 30·0 cycles [IQR 24·6-33·7]) compared with patients who were not vaccinated (21·4 cycles [18·4-25·9], p<0·0001).
To our knowledge, this is the first observational study describing the protective effect of rVSVΔG-ZEBOV-GP vaccination against death among patients with confirmed Ebola virus disease admitted to an Ebola health facility. Vaccination was protective against death for all patients, even when adjusted for Ebola virus disease-specific treatment, age group, and time from symptom onset to admission.
Médecins Sans Frontières.
For the French translation of the abstract see Supplementary Materials section.
rVSVΔG-ZEBOV-GP 疫苗是控制埃博拉病毒病暴发的重要工具。本回顾性队列研究旨在评估该疫苗对确诊埃博拉病毒病患者死亡的保护作用。
在本回顾性队列分析中，纳入了 2018 年 7 月 27 日至 2020 年 4 月 27 日期间在刚果民主共和国埃博拉卫生机构住院的确诊埃博拉病毒病患者。我们进行了单变量和多变量分析，以评估根据接种状态、埃博拉病毒病特异性治疗（例如 mab114 和 regn-eb3）以及其他危险因素，疫苗接种对病死率和核蛋白循环阈值的影响。
我们分析了所有 2279 例确诊的埃博拉病毒病患者。在这 2279 例患者中，1300 例（57%）为女性，979 例（43%）为男性。接种疫苗显著降低了病死率（接种者：25%[423/1700] vs 未接种者：56%[570/1015]；p<0.0001）。在调整分析中，与未接种疫苗相比，接种疫苗显著降低了死亡风险，且随着从接种到出现症状的时间延长，保护作用增加（接种后≤2 天发病：27%[99/364]，调整后的相对风险 0.56[95%CI 0.36-0.82，p=0.0046]；接种后 3-9 天发病：20%[139/687]，0.44[0.29-0.65，p=0.0001]；接种后≥10 天发病：18%[68/376]，0.40[0.21-0.69，p=0.0022]；接种日期不详：33%[117/357]，0.69[0.48-0.96，p=0.0341]；接种状态不详：52%[841/1622]，0.80[0.70-0.91，p=0.0011]）。从症状出现到入院的时间延长显著增加了死亡风险（49%[1117/2279]，1.03[1.02-1.05；p<0.0001]）。与未接种疫苗者相比，接种疫苗者的核蛋白循环阈值显著较高，提示病毒血症水平较低；在症状出现前 21 天或更长时间接种疫苗的患者中差异最大（中位数 30.0 个循环[24.6-33.7]），与未接种疫苗的患者相比（21.4 个循环[18.4-25.9]，p<0.0001）。
据我们所知，这是第一项描述 rVSVΔG-ZEBOV-GP 疫苗对确诊埃博拉病毒病患者死亡保护作用的观察性研究。疫苗接种对所有患者都具有保护作用，即使在调整了埃博拉病毒病特异性治疗、年龄组和从症状出现到入院的时间后也是如此。
无国界医生组织。
