二价加强针与疫苗突破性SARS-CoV-2奥密克戎感染后的急性后遗症风险：一项队列研究

Bivalent Boosters and Risk of Postacute Sequelae Following Vaccine-Breakthrough SARS-CoV-2 Omicron Infection: A Cohort Study.

作者信息

Wee Liang En, Lim Jue Tao, Goel Mayank, Malek Muhammad Ismail Abdul, Chiew Calvin J, Ong Benjamin, Lye David Chien Boon, Tan Kelvin Bryan

机构信息

National Centre for Infectious Diseases, Singapore, Singapore.

Duke-National University of Singapore Graduate Medical School, National University of Singapore, Singapore, Singapore.

出版信息

Clin Infect Dis. 2025 Mar 17;80(3):520-528. doi: 10.1093/cid/ciae598.

DOI:10.1093/cid/ciae598

PMID:39657038

Abstract

BACKGROUND

Vaccination has been shown to attenuate the risk of postacute sequelae following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, no prior population-based studies have evaluated if updated bivalent boosters reduce risk of postacute sequelae following Omicron variant infection, versus ancestral vaccines.

METHODS

National databases were utilized to construct a population-based cohort of adult individuals infected during Omicron-predominant transmission. Risk and excess burden (EB) of prespecified multiorgan new-incident diagnoses at 31-365 days post-SARS-CoV-2 infection were compared between individuals who received prior bivalent boosters and those boosted with ancestral messenger RNA (mRNA) vaccines, using competing-risks regression.

RESULTS

A total of 1 080 348 vaccine-breakthrough infections after an ancestral mRNA booster were contrasted against 9824 vaccine-breakthrough infections following a bivalent mRNA booster. There was an estimated 37.8% (hazard ratio [HR], 0.62 [95 confidence interval {CI}, .53-.73]) decrease in risk and lower overall EB per 1000 (-28.73 [95% CI, -40.47 to -16.99]) of any postacute sequelae, as well as a 39.9% (HR, 0.62 [95% CI, .52-.73]) decrease in risk and lower EB (-22.95 [95% CI, -32.71 to -13.19]) of any postacute neurological sequelae, among individuals who received prior bivalent boosters, versus those boosted with ancestral mRNA vaccines. Specifically, there was reduced risk of thrombotic disorders (HR, 0.54 [95% CI, .29-.99]), episodic neurological disorders (HR, 0.55 [95% CI, .43-.72]), movement disorders (HR, 0.57 [95% CI, .47-.70]), and autoimmune vasculitis (HR, 0.54 [95% CI, .29-.99]) 31-365 days postinfection among those who received prior bivalent boosters, versus those boosted with ancestral mRNA vaccines.

CONCLUSIONS

Boosting with updated bivalent mRNA vaccines was associated with greater attenuation of risk for postacute sequelae following Omicron variant infection, compared with ancestral mRNA boosters.

摘要

背景

疫苗接种已被证明可降低严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染后急性后遗症的风险。然而，此前尚无基于人群的研究评估与原始疫苗相比，更新后的二价加强针是否能降低奥密克戎变异株感染后急性后遗症的风险。

方法

利用国家数据库构建了一个以奥密克戎为主导传播期间感染的成年人群队列。使用竞争风险回归比较接受过二价加强针和接受过原始信使核糖核酸（mRNA）疫苗加强针的个体在SARS-CoV-2感染后31至365天内预先指定的多器官新发病诊断的风险和超额负担（EB）。

结果

共对比了1080348例原始mRNA加强针后的疫苗突破感染病例与9824例二价mRNA加强针后的疫苗突破感染病例。与接受原始mRNA疫苗加强针的个体相比，接受二价加强针的个体中，任何急性后遗症的风险估计降低37.8%（风险比[HR]，0.62[95%置信区间{CI}，0.53 - 0.73]），每1000例的总体EB更低（-28.73[95%CI，-40.47至-16.99]）；任何急性神经后遗症的风险降低39.9%（HR，0.62[95%CI，0.52 - 0.73]），EB更低（-22.95[95%CI，-32.71至-13.19]）。具体而言，与接受原始mRNA疫苗加强针的个体相比，接受二价加强针的个体在感染后31至365天内血栓性疾病风险降低（HR，0.54[95%CI，0.29 - 0.99]）、发作性神经疾病风险降低（HR，0.55[95%CI，0.43 - 0.72]）、运动障碍风险降低（HR，0.57[95%CI，0.47 - 0.70]）以及自身免疫性血管炎风险降低（HR，0.54[95%CI，0.29 - 0.99]）。