Department of Health Policy and Organization, The University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States of America.
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America.
PLoS One. 2024 Mar 7;19(3):e0300198. doi: 10.1371/journal.pone.0300198. eCollection 2024.
In the United States, most real-world estimates of COVID-19 vaccine effectiveness are based on data drawn from large health systems or sentinel populations. More data is needed to understand how the benefits of vaccination may vary across US populations with disparate risk profiles and policy contexts. We aimed to provide estimates of mRNA COVID-19 vaccine effectiveness against moderate and severe outcomes of COVID-19 based on state population-level data sources. Using statewide integrated administrative and clinical data and a test-negative case-control study design, we assessed mRNA COVID-19 vaccine effectiveness against SARS-CoV-2-related hospitalizations and emergency department visits among adults in South Carolina. We presented estimates of vaccine effectiveness at discrete time intervals for adults who received one, two or three doses of mRNA COVID-19 vaccine compared to adults who were unvaccinated. We also evaluated changes in vaccine effectiveness over time (waning) for the overall sample and in subgroups defined by age. We showed that while two doses of mRNA COVID-19 vaccine were initially highly effective, vaccine effectiveness waned as time elapsed since the second dose. Compared to protection against hospitalizations, protection against emergency department visits was found to wane more sharply. In all cases, a third dose of mRNA COVID-19 vaccine conferred significant gains in protection relative to waning protection after two doses. Further, over more than 120 days of follow-up, the data revealed relatively limited waning of vaccine effectiveness after a third dose of mRNA COVID-19 vaccine.
在美国，大多数关于 COVID-19 疫苗有效性的真实世界估计都是基于从大型医疗系统或监测人群中提取的数据。需要更多的数据来了解疫苗接种的益处如何因具有不同风险特征和政策背景的美国人群而有所不同。我们旨在利用州级人口水平数据源，提供针对 COVID-19 中度和重度结局的 mRNA COVID-19 疫苗有效性的估计。我们使用全州范围内的综合行政和临床数据以及阴性检测病例对照研究设计，评估了南卡罗来纳州成年人中 mRNA COVID-19 疫苗对与 SARS-CoV-2 相关的住院和急诊就诊的有效性。我们根据成年人接种一剂、两剂或三剂 mRNA COVID-19 疫苗与未接种疫苗的成年人，在离散时间间隔呈现疫苗有效性的估计。我们还评估了疫苗有效性随时间（衰减）的变化，包括整体样本和按年龄划分的亚组。结果表明，尽管两剂 mRNA COVID-19 疫苗最初具有高度有效性，但随着第二剂疫苗接种后时间的推移，疫苗有效性逐渐减弱。与预防住院相比，预防急诊就诊的效果发现衰减更为明显。在所有情况下，mRNA COVID-19 疫苗的第三剂都能显著提高对两剂疫苗衰减后保护效果的增益。此外，在超过 120 天的随访中，数据显示 mRNA COVID-19 疫苗第三剂接种后疫苗有效性的衰减相对有限。
