利用南非哨兵监测估算针对与 SARS-CoV-2 相关住院的疫苗有效性。
Estimation of vaccine effectiveness against SARS-CoV-2-associated hospitalization using sentinel surveillance in South Africa.
机构信息
Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
Int J Epidemiol. 2024 Aug 14;53(5). doi: 10.1093/ije/dyae116.
BACKGROUND
COVID-19 vaccine effectiveness (VE) studies leveraging systematic surveillance in sub-Saharan Africa are limited. We assessed the effectiveness of two vaccines (Pfizer BNT162b2 and Johnson & Johnson Ad26.COV2.S) against SARS-CoV-2-associated hospitalization in South African adults aged ≥18 years.
METHODS
We conducted a test-negative case-control study using pneumonia surveillance data in South Africa. Inpatients with physician-diagnosed lower respiratory tract infection or suspected COVID-19, testing SARS-CoV-2 positive or negative from June 2021-March 2022, were cases or controls, respectively. Fully vaccinated individuals received one Ad26.COV2.S dose or two BNT162b2 doses ≥14-days before enrollment. VE was estimated using multivariable logistic regression for Delta- and Omicron BA.1/BA.2-predominant periods, stratified by age and HIV status.
RESULTS
The study included 925 cases and 1890 controls; 38 (4%) cases and 186 (10%) controls were fully vaccinated with BNT162b2, and 30 (3%) cases and 94 (5%) controls with Ad26.COV2.S. The vaccine effectiveness of BNT162b2 against SARS-CoV-2-associated hospitalization over Delta and Omicron BA.1/BA.2 periods was 91% (95% CI: 52%, 98%) and 33% (-16%, 86%), respectively. The vaccine effectiveness of Ad26.COV2.S against hospitalization over Delta and Omicron BA.1/BA.2 periods was 72% (-36% ,94%), and -19% (-130%, 39%), respectively. The vaccine effectiveness of BNT162b2 against hospitalization over the Delta period was 94% (50%, 99%) and 89% (27%, 98%) among adults aged ≥60 years and HIV-uninfected, respectively.
CONCLUSIONS
The BNT162b2 vaccine was effective against SARS-CoV-2-associated hospitalization during the Delta period for adults aged ≥18 years, ≥60 years and those HIV-uninfected. VE for Ad26.COV2.S was inconclusive, potentially due to limited sample size or residual confounding. These findings highlight the utility of sentinel surveillance for estimating VE.
背景
利用撒哈拉以南非洲系统监测的 COVID-19 疫苗效力（VE）研究有限。我们评估了两种疫苗（辉瑞 BNT162b2 和强生 Ad26.COV2.S）对南非 18 岁及以上成年人 SARS-CoV-2 相关住院的有效性。
方法
我们使用南非肺炎监测数据开展了一项病例对照研究。2021 年 6 月至 2022 年 3 月，有医生诊断为下呼吸道感染或疑似 COVID-19、SARS-CoV-2 检测阳性或阴性的住院患者分别为病例或对照。完全接种疫苗的个体在入组前 14 天内接受过一次 Ad26.COV2.S 剂量或两次 BNT162b2 剂量。对于 Delta 和 Omicron BA.1/BA.2 为主的时期，使用多变量逻辑回归估计 VE，并按年龄和 HIV 状况进行分层。
结果
该研究纳入了 925 例病例和 1890 例对照；38 例（4%）病例和 186 例（10%）对照完全接种了 BNT162b2，30 例（3%）病例和 94 例（5%）对照完全接种了 Ad26.COV2.S。在 Delta 和 Omicron BA.1/BA.2 时期，BNT162b2 对 SARS-CoV-2 相关住院的疫苗有效性分别为 91%（95%CI：52%，98%）和 33%（-16%，86%）。Ad26.COV2.S 对住院的疫苗有效性在 Delta 和 Omicron BA.1/BA.2 时期分别为 72%（-36%，94%）和-19%（-130%，39%）。在 Delta 时期，对于年龄≥60 岁和 HIV 未感染者，BNT162b2 对 SARS-CoV-2 相关住院的疫苗有效性分别为 94%（50%，99%）和 89%（27%，98%）。
结论
在 Delta 时期，BNT162b2 疫苗对≥18 岁成年人、≥60 岁成年人和未感染 HIV 的成年人的 SARS-CoV-2 相关住院有效。Ad26.COV2.S 的 VE 不确定，可能是由于样本量有限或存在残余混杂。这些发现强调了利用哨点监测来估计 VE 的效用。
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