Association of COVID-19 Vaccination With Symptomatic SARS-CoV-2 Infection by Time Since Vaccination and Delta Variant Predominance
Association of COVID-19 Vaccination With Symptomatic SARS-CoV-2 Infection by Time Since Vaccination and Delta Variant Predominance
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DOI：
10.1001/jama.2022.2068
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发表时间：
2022-02-14
影响因子：
120.7
通讯作者：
Verani, Jennifer R.
中科院分区：
文献类型：
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作者：
Britton, Amadea;Fleming-Dutra, Katherine E.;Verani, Jennifer R.
重要性监测COVID-19疫苗自接种以来随时间推移的性能以及针对新出现的变异体的性能，为控制措施和疫苗政策提供信息。目的评估有症状的SARS-CoV-2感染与自Delta变异体优势之前和期间接种以来每天接受BNT 162 b2、mRNA-1273和Ad26.COV2.S之间的相关性（前Delta期：2021年3月13日至5月29日; Delta期：2021年7月18日至10月17日）。设计、设置和参与者测试阴性、病例对照设计，数据来自基于药房的增加社区检测平台中的6884个美国COVID-19检测点。这项研究包括3月13日至10月17日期间对20岁及以上成年人进行的1634271次基于实验室的SARS-CoV-2核酸扩增检测（NAAT），以及对12至19岁患有COVID-19样疾病的青少年进行的180112次NAAT，2021.曝光COVID-19疫苗（1Ad26.COV2.S剂量或2次mRNA剂量）14天或更长时间前。主要结果和测量使用来自样条函数的比值比（OR）测量的症状性感染和先前疫苗接种之间的关联。结果共纳入390 762例检测阳性病例（21.5%）和1 423 621例试验阴性对照（78.5%）（59.9%为20-44岁; 9.9%为12-19岁; 58.9%为女性; 71.8%为白色）。在20岁及以上的成人中，第二次给药后14至60天的BNT 162 b2平均OR（初始OR）在Delta前期间较低（0.10 [95% CI，0.09-0.11]）（0.16 [95% CI，0.16-0.17]），并随接种后时间推移而增加（OR的每月变化，前Delta：0.04 [95% CI，0.02-0.05]; Delta：0.03 [95% CI，0.02-0.03]）。mRNA-1273的初始OR值为0.05（95% CI，0.04-0.05）Delta前阶段，0.10（95% CI，0.10-0.11），并随时间增加（OR的每月变化，前Delta：0.02 [95% CI，0.005-0.03]; Delta：0.03 [95% CI，0.03-0.04]）。Ad26.COV2.S的初始OR在Delta前阶段为0.42（95%CI，0.37-0.47），在Delta阶段为0.62（95%CI，0.58-0.65），并且自接种以来未随时间显著增加。在青少年中，Delta期间BNT 162 b2的初始OR为0.06（95% CI。0.05-0.06），每月增加0.02（95%CI，0.01-0.03），16- 19岁增加0.10（95%CI，0.09-0.11），每月增加0.04（95%CI，0.01-0.03）。结论和相关性在成年人中，在Delta变异体占优势期间，症状性SARS-CoV-2感染与COVID-19疫苗接种（作为疫苗有效性的估计值）之间的关联性OR较高，表明保护作用较低。对于mRNA疫苗接种，自接种以来每月OR的稳定增加与估计有效性随时间的衰减一致;与时间相关的衰减大于与变体相关的衰减。
IMPORTANCE Monitoring COVID-19 vaccine performance over time since vaccination and against emerging variants informs control measures and vaccine policies.OBJECTIVE To estimate the associations between symptomatic SARS-CoV-2 infection and receipt of BNT162b2, mRNA-1273, and Ad26.COV2.S by day since vaccination before and during Delta variant predominance (pre-Delta period: March 13-May 29, 2021; Delta period: July 18-October 17, 2021).DESIGN, SETTING, AND PARTICIPANTS Test-negative, case-control design with data from 6884 US COVID-19 testing sites in the pharmacy-based Increasing Community Access to Testing platform. This study included 1 634271 laboratory-based SARS-CoV-2 nucleic acid amplification tests (NAATs) from adults 20 years and older and 180 112 NAATs from adolescents 12 to 19 years old with COVID-19-like illness from March 13 to October 17, 2021.EXPOSURES COVID-19 vaccination (1Ad26.COV2.S dose or 2 mRNA doses)14 or more days prior.MAIN OUTCOMES AND MEASURES Association between symptomatic infection and prior vaccination measured using the odds ratio (OR) from spline-based multivariable logistic regression.RESULTS The analysis included 390 762 test-positive cases (21.5%) and 1 423 621 test-negative controls (78.5%) (59.9% were 20-44 years old; 9.9% were 12-19 years old; 58.9% were female; 71.8% were White). Among adults 20 years and older, the BNT162b2 mean OR for days 14 to 60 after a second dose (initial OR) was lower during the pre-Delta period (0.10 [95% CI, 0.09-0.11]) than during the Delta period (0.16 [95% CI, 0.16-0.17]) and increased with time since vaccination (per-month change in OR, pre-Delta: 0.04 [95% CI, 0.02-0.05]; Delta: 0.03 [95% CI, 0.02-0.03]). The initial mRNA-1273 OR was 0.05 (95% CI, 0.04-0.05) during the pre-Delta period, 0.10 (95% CI, 0.10-0.11) during the Delta period, and increased with time (per-month change in OR, pre-Delta: 0.02 [95% CI, 0.005-0.03]; Delta: 0.03 [95% CI, 0.03-0.04]). The Ad26.COV2.S initial OR was 0.42 (95% CI, 0.37-0.47) during the pre-Delta period and 0.62 (95% CI, 0.58-0.65) during the Delta period and did not significantly increase with time since vaccination. Among adolescents, the BNT162b2 initial OR during the Delta period was 0.06 (95% CI. 0.05-0.06) among 12- to 15-year-olds, increasing by 0.02 (95% CI, 0.01-0.03) per month, and 0.10 (95% CI, 0.09-0.11) among 16- to 19-year-olds, increasing by 0.04 (95% CI. 0.03-0.06) per month.CONCLUSIONS AND RELEVANCE Among adults, the OR for the association between symptomatic SARS-CoV-2 infection and COVID-19 vaccination (as an estimate of vaccine effectiveness) was higher during Delta variant predominance, suggesting lower protection. For mRNA vaccination, the steady increase in OR by month since vaccination was consistent with attenuation of estimated effectiveness over time; attenuation related to time was greater than that related to variant.