背景:冠状病毒病2019(COVID-19)信使RNA(mRNA)疫苗于2020年12月在美国获得批准。尽管疫苗对轻度感染的有效性(VE)在几个月后明显下降,对COVID-19相关住院防护措施的长期耐久性了解有限。
方法:对2021年3月11日至12月15日在18个州的21家医院住院的成年人(≥18岁)进行病例对照分析,包括COVID-19病例患者和逆转录酶聚合酶链反应阴性对照。我们包括在发病日期之前未接种疫苗或接种2剂mRNA疫苗的成年人。使用逻辑回归比较病例与对照疫苗接种的几率,评估随时间变化的VE。适应混杂因素。模型包括二分时间(自剂量2起<180vs≥180天)和使用有限三次样条进行建模的连续时间。
结果:共纳入10078例患者,4906例(23%接种疫苗)和5172例对照(62%接种疫苗)。中位年龄为60岁(四分位间距,46-70),56%是非西班牙裔白人,81%的患者有≥1种疾病。在有免疫能力的成年人中,VE<180天为90%(95%置信区间[CI],88-91)与≥180天的82%(95%CI,79-85)(P<.001)。辉瑞-BioNTech的VE下降(88%至79%,P<.001)和Moderna(93%至87%,P<.001)产品,对于年轻人(18-64岁)(91%至87%,P=.005),对于≥65岁的成年人(87%至78%,P<.001)。在使用受限三次样条的模型中,观察到类似的变化。
结论:在很大程度上早于Omicron变异循环的时期,2种mRNA剂量对COVID-19相关住院的有效性在很大程度上持续了9个月.
Coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccines were authorized in the United States in December 2020. Although vaccine effectiveness (VE) against mild infection declines markedly after several months, limited understanding exists on the long-term durability of protection against COVID-19-associated hospitalization.
Case-control analysis of adults (≥18 years) hospitalized at 21 hospitals in 18 states 11 March-15 December 2021, including COVID-19 case patients and reverse transcriptase-polymerase chain reaction-negative controls. We included adults who were unvaccinated or vaccinated with 2 doses of a mRNA vaccine before the date of illness onset. VE over time was assessed using logistic regression comparing odds of vaccination in cases versus controls, adjusting for confounders. Models included dichotomous time (<180 vs ≥180 days since dose 2) and continuous time modeled using restricted cubic splines.
A total of 10 078 patients were included, 4906 cases (23% vaccinated) and 5172 controls (62% vaccinated). Median age was 60 years (interquartile range, 46-70), 56% were non-Hispanic White, and 81% had ≥1 medical condition. Among immunocompetent adults, VE <180 days was 90% (95% confidence interval [CI], 88-91) versus 82% (95% CI, 79-85) at ≥180 days (P < .001). VE declined for Pfizer-BioNTech (88% to 79%, P < .001) and Moderna (93% to 87%, P < .001) products, for younger adults (18-64 years) (91% to 87%, P = .005), and for adults ≥65 years of age (87% to 78%, P < .001). In models using restricted cubic splines, similar changes were observed.
In a period largely predating Omicron variant circulation, effectiveness of 2 mRNA doses against COVID-19-associated hospitalization was largely sustained through 9 months.