Harton Paige E, Chamberlain Allison T, Moore Amy, Fletcher Grace, Nelson Kristin N, Dean Natalie, Lopman Benjamin, Rogawski McQuade Elizabeth T
Department of Epidemiology, Emory University, United States.
Department of Epidemiology, Emory University, United States.
Vaccine. 2025 Aug 13;61:127292. doi: 10.1016/j.vaccine.2025.127292. Epub 2025 May 31.
BACKGROUND/OBJECTIVES: Observational evidence of COVID-19 vaccine effectiveness (VE) against SARS-CoV-2 infection is often limited by differences in testing behavior between vaccinated and unvaccinated persons. This study aimed to estimate VE against SARS-CoV-2 infection among students using data from a school district opt-in weekly testing program.
An observational, matched cohort study to emulate a target vaccine trial was conducted among students attending an urban school district in the Southeastern United States. Between 9/7/21 and 5/26/22, 9172 children, among 24,188 total students participating in the testing program, were followed from vaccination date, determined by state immunizations information systems (IIS) records, to first positive SARS-CoV-2 rapid antigen test, regardless of symptoms, conducted through the testing program. Hazard ratios and their 95 % confidence intervals were calculated using Cox proportional hazards models, and VE was calculated as (1-hazard ratio)*100. All analyses were stratified by age group (5-11 years and 12 years and older) and sensitivity analyses were conducted.
Among students aged 5-11 years, VE against SARS-CoV-2 infection within 60 days of first dose of any COVID-19 vaccine was 42.9 % (95 % CI, 7.1 % to 78.7 %) and waned to 20.7 % (95 %, CI 0.0 % to 41.8 %) by 180 days. Over the full study period, VE against SARS-CoV-2 infection was 14.9 % (95 % CI, -5.0 % to 34.7 %). Among students 12 years and older, VE against SARS-CoV-2 infection was -5.0 % (95 % CI, -37.0 % to 26.5 %) over the full study period. Insufficient data was available to estimate VE within 60 days of vaccination in this age group.
Among 5-11 year olds participating in a routine SARS-CoV-2 surveillance testing program, VE against SARS-CoV-2 infection was modest immediately following vaccination but waned over the school year. This analysis limits biases found in traditional VE studies related to differential testing behaviors and allows estimation of VE against infection, regardless of symptoms.
背景/目的：新冠病毒疾病（COVID-19）疫苗针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的有效性（VE）的观察性证据，常常受到接种疫苗者和未接种疫苗者在检测行为上差异的限制。本研究旨在利用一个学区自愿参与的每周检测项目的数据，估算学生群体中疫苗针对SARS-CoV-2感染的有效性。
在美国东南部一个城市学区的学生中，开展了一项观察性匹配队列研究，以模拟目标疫苗试验。在2021年9月7日至2022年5月26日期间，在参与检测项目的24188名学生中，有9172名儿童从由州免疫信息系统（IIS）记录确定的接种日期开始，一直追踪到通过检测项目进行的首次SARS-CoV-2快速抗原检测呈阳性，无论有无症状。使用Cox比例风险模型计算风险比及其95%置信区间，并将疫苗有效性计算为（1 - 风险比）*100。所有分析按年龄组（5至11岁和12岁及以上）分层，并进行了敏感性分析。
在5至11岁的学生中，接种任何一种COVID-19疫苗第一剂后60天内，疫苗针对SARS-CoV-2感染的有效性为42.9%（95%置信区间，7.1%至78.7%），到180天时降至20.7%（95%置信区间，0.0%至41.8%）。在整个研究期间，疫苗针对SARS-CoV-2感染的有效性为14.9%（95%置信区间，-5.0%至34.7%）。在12岁及以上的学生中，整个研究期间疫苗针对SARS-CoV-2感染的有效性为-5.0%（95%置信区间，-37.0%至26.5%）。该年龄组接种疫苗后60天内估算疫苗有效性的数据不足。
在参与常规SARS-CoV-2监测检测项目且年龄在5至11岁的儿童中，接种疫苗后疫苗针对SARS-CoV-2感染的有效性在短期内适中，但在整个学年中有所下降。本分析限制了传统疫苗有效性研究中因检测行为差异而产生的偏差，并能够估算疫苗针对感染的有效性，无论有无症状。
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