Emergency Department, Vancouver General Hospital, 810 West 12(th)Avenue Vancouver, BC V5Z 1M9, Canada; Department of Emergency Medicine, University of British Columbia, 855 West 12(th)Avenue Vancouver, BC V5Z 1M9, Canada.
Department of Pediatrics, University of Alberta, 11405 87 Avenue NW, Edmonton, Alberta T6G 1C9, Canada.
Vaccine. 2024 Oct 3;42(23):126058. doi: 10.1016/j.vaccine.2024.06.025. Epub 2024 Jun 15.
During the COVID-19 pandemic, clinical care shifted toward virtual and Emergency Department care. We explored the feasibility of mRNA vaccine effectiveness (VE) estimation against SARS-CoV-2-related Emergency Department visits and hospitalizations using prospectively collected Emergency Department data.
We estimated two-dose VE using a test-negative design and data from 10 participating sites of the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). We included Emergency Department patients presenting with COVID-19 symptoms and nucleic acid amplification testing for SARS-CoV-2 between July 19 and December 31, 2021. We excluded patients with unclear vaccination and one or more than 2 vaccine doses by their Emergency Department visit.
Among 3,405 eligible patients, adjusted two-dose mRNA VE against SARS-CoV-2-related Emergency Department visits was 93.3 % (95 % CI 87.9-96.3 %) between 7-55 days, sustained over 80 % through 139 days post-vaccination. In stratified analyses, VE was similar among patients with select immune-compromising conditions, chronic kidney disease, lung disease, unstable housing, and reported illicit substance use.
Two-dose mRNA VE against SARS-CoV-2-related Emergency Department visit was high and sustained, including among vulnerable subgroups. Compared to administrative datasets, active Emergency Department enrolment enables standardization for testing access and indication and supports separate VE assessment among special population subgroups. Compared to other active enrolment settings, Emergency Departments more consistently function during crises when alternate healthcare sectors become variably closed.
Clinicaltrials.gov, NCT0470294.
在 COVID-19 大流行期间，临床护理转向了虚拟医疗和急诊护理。我们使用前瞻性收集的急诊数据探索了使用 mRNA 疫苗对与 SARS-CoV-2 相关的急诊就诊和住院的有效性（VE）进行估计的可行性。
我们使用测试阴性设计和加拿大 COVID-19 急诊快速反应网络（CCEDRRN）的 10 个参与站点的数据来估计两剂 mRNA VE。我们纳入了 2021 年 7 月 19 日至 12 月 31 日期间出现 COVID-19 症状并接受 SARS-CoV-2 核酸扩增检测的急诊患者。我们排除了急诊就诊时疫苗接种情况不明确且一剂或多剂疫苗的患者。
在 3405 名符合条件的患者中，调整后的两剂 mRNA VE 对 SARS-CoV-2 相关的急诊就诊的效力在 7-55 天之间为 93.3%（95%CI 87.9-96.3%），在接种后 139 天内保持 80%以上。在分层分析中，在具有特定免疫功能低下状况、慢性肾脏疾病、肺部疾病、不稳定住房和报告非法药物使用的患者中，VE 相似。
两剂 mRNA VE 对 SARS-CoV-2 相关的急诊就诊具有较高且持续的效力，包括在脆弱亚组中。与行政数据集相比，主动急诊登记允许对检测途径和适应证进行标准化，并支持在特殊人群亚组中进行单独的 VE 评估。与其他主动登记设置相比，急诊部门在其他医疗保健部门因各种原因关闭时，在危机期间更能持续运作。
Clinicaltrials.gov，NCT0470294。
