Risk of infection, hospitalisation, and death up to 9 months after a second dose of COVID-19 vaccine: a retrospective, total population cohort study in Sweden.
Risk of infection, hospitalisation, and death up to 9 months after a second dose of COVID-19 vaccine: a retrospective, total population cohort study in Sweden.
复制标题
DOI：
10.1016/s0140-6736(22)00089-7
复制
发表时间：
2022-02-26
期刊：
影响因子：
--
通讯作者：
Nordström A
中科院分区：
文献类型：
--
作者：
Nordström P;Ballin M;Nordström A
疫苗对COVID-19的有效性超过6个月仍然不完全清楚。我们的目的是调查瑞典总人口接种COVID-19疫苗后前9个月内对感染、住院和死亡风险的有效性。这项回顾性的总人群队列研究使用瑞典全国登记的数据进行。该队列包括接种两剂ChAdOx 1 nCoV-19、mRNA-1273或BNT 162 b2的所有个体，以及匹配的未接种个体，疫苗接种和感染数据更新至2021年10月4日。评价了两个结果。第一个是2021年1月12日至10月4日期间任何严重程度的SARS-CoV-2感染。第二个是严重的COVID-19，定义为2021年3月15日至9月28日期间因COVID-19住院或确诊感染后30天内全因死亡。2020年12月28日至2021年10月4日期间，842，974人完全接种了疫苗（两剂），并与同等数量的未接种疫苗的人进行了匹配（1：1）（总研究队列n=1，685，948）。对于任何严重程度的SARS-CoV-2感染，BNT 162 b2的疫苗有效性随着时间的推移逐渐减弱，从92%（95% CI 92 - 93; p<0.001），121-180天时为47%（39 - 55; p<0.001），从第211天开始为23%（-2至41; p= 0.07）。mRNA-1273的减弱稍慢，在15-30天的疫苗有效性为96%（94至97; p<0.001），从第181天开始为59%（18至79; p= 0.012）。异源ChAdOx 1 nCoV-19加mRNA疫苗的衰减也稍慢，其疫苗有效性在15-30天时为89%（79至94; p<0.001），从第121天开始为66%（41至80; p<0.001）。相比之下，同源ChAdOx 1 nCoV-19疫苗在15-30天的疫苗有效性为68%（52至79; p<0.001），从第121天起没有检测到有效性（-19%[-98至28]; p= 0.49）。对于严重COVID-19的结果，疫苗有效性从15-30天的89%（82至93; p<0.001）下降到从第121天开始的64%（44至77; p<0.001）。总体而言，有一些证据表明，男性的疫苗有效性低于女性，老年人的疫苗有效性低于年轻人。我们发现，在所有亚组中，疫苗对任何严重程度的SARS-CoV-2感染的有效性都在逐渐减弱，但减弱的速度因疫苗类型而异。对于严重的COVID-19，疫苗的有效性似乎得到了更好的维持，尽管4个月后出现了一些明显的减弱。这些结果加强了第三剂疫苗作为加强剂的循证理由。没有。
Vaccine effectiveness against COVID-19 beyond 6 months remains incompletely understood. We aimed to investigate the effectiveness of COVID-19 vaccination against the risk of infection, hospitalisation, and death during the first 9 months after vaccination for the total population of Sweden. This retrospective, total population cohort study was done using data from Swedish nationwide registers. The cohort comprised all individuals vaccinated with two doses of ChAdOx1 nCoV-19, mRNA-1273, or BNT162b2, and matched unvaccinated individuals, with data on vaccinations and infections updated until Oct 4, 2021. Two outcomes were evaluated. The first was SARS-CoV-2 infection of any severity from Jan 12 to Oct 4, 2021. The second was severe COVID-19, defined as hospitalisation for COVID-19 or all-cause 30-day mortality after confirmed infection, from March 15 to Sept 28, 2021. Between Dec 28, 2020, and Oct 4, 2021, 842 974 individuals were fully vaccinated (two doses), and were matched (1:1) to an equal number of unvaccinated individuals (total study cohort n=1 685 948). For the outcome SARS-CoV-2 infection of any severity, the vaccine effectiveness of BNT162b2 waned progressively over time, from 92% (95% CI 92 to 93; p<0·001) at 15–30 days, to 47% (39 to 55; p<0·001) at 121–180 days, and to 23% (−2 to 41; p=0·07) from day 211 onwards. Waning was slightly slower for mRNA-1273, with a vaccine effectiveness of 96% (94 to 97; p<0·001) at 15–30 days and 59% (18 to 79; p=0·012) from day 181 onwards. Waning was also slightly slower for heterologous ChAdOx1 nCoV-19 plus an mRNA vaccine, for which vaccine effectiveness was 89% (79 to 94; p<0·001) at 15–30 days and 66% (41 to 80; p<0·001) from day 121 onwards. By contrast, vaccine effectiveness for homologous ChAdOx1 nCoV-19 vaccine was 68% (52 to 79; p<0·001) at 15–30 days, with no detectable effectiveness from day 121 onwards (−19% [–98 to 28]; p=0·49). For the outcome of severe COVID-19, vaccine effectiveness waned from 89% (82 to 93; p<0·001) at 15–30 days to 64% (44 to 77; p<0·001) from day 121 onwards. Overall, there was some evidence for lower vaccine effectiveness in men than in women and in older individuals than in younger individuals. We found progressively waning vaccine effectiveness against SARS-CoV-2 infection of any severity across all subgroups, but the rate of waning differed according to vaccine type. With respect to severe COVID-19, vaccine effectiveness seemed to be better maintained, although some waning became evident after 4 months. The results strengthen the evidence-based rationale for administration of a third vaccine dose as a booster. None.