Vaccination and COVID-19 Dynamics in Dialysis Patients
Vaccination and COVID-19 Dynamics in Dialysis Patients
复制标题
DOI：
10.2215/cjn.10300721
复制
发表时间：
2022-02-10
影响因子：
9.8
通讯作者：
EIN Registry
中科院分区：
文献类型：
--
作者：
El Karoui, Khalil;Hourmant, Maryvonne;EIN Registry
背景和目的透析患者在2019冠状病毒病（COVID-19）后具有高死亡风险，并且对疫苗的免疫反应发生改变，但疫苗在该人群中的临床有效性仍然未知。nbsp;你好设计，设置，参与者和测量使用贝叶斯多变量时空模型，我们估计了疫苗暴露和严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）严重感染（住院）之间的关系，透析患者在一般人群中同时发病。对于透析患者，2020年3月11日至2021年4月29日，法国终末期肾病REIN登记研究报告了病例，自2021年1月以来，每周全国调查报告了疫苗暴露（第一剂）。一般人群中的病例来自国家详尽住院监测系统（SI-VIC数据库），疫苗接种覆盖率（第一剂）来自国家监测系统（VAC-SI数据库）。结果在第一波中，透析患者的发病率与一般人群大致成比例。然而，我们发现透析患者在第二波期间的相对发病率较低（与非透析患者相比），表明预防措施的效果。此外，从疫苗接种开始，透析患者的发病率低于基于第一波和第二波的预测。在透析和非透析患者中添加疫苗接种覆盖率作为预测因子，可以使报告的病例正确拟合（3685例预测病例，95%置信区间，3552 - 3816，与3620例报告病例）。发病率比值为0.37（95%置信区间，0.18 - 0.71），透析患者的疫苗暴露量为0.50（95%置信区间，0.40 - 0.61）在相同年龄的一般人群中，疫苗接种覆盖率每高10%，这意味着透析患者和普通人群的疫苗暴露与透析患者的住院率较低独立相关。nbsp;你好结论我们的研究结果表明，尽管免疫疫苗反应发生了变化，但疫苗接种可能会对透析患者的严重COVID-19产生保护作用。
Background and objectives Dialysis patients have a high mortality risk after coronavirus disease 2019 (COVID-19) and an altered immunologic response to vaccines, but vaccine clinical effectiveness remains unknown in this population.& nbsp;Design, setting, participants, & measurements Using Bayesian multivariable spatiotemporal models, we estimated the association between vaccine exposure and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) severe infections (with hospital admission) in dialysis patients from simultaneous incidence in the general population. For dialysis patients, cases were reported within the French end-stage kidney disease REIN registry from March 11, 2020, to April 29, 2021, and vaccine exposure (first dose) was reported in weekly national surveys since January 2021. Cases in the general population were obtained from the national exhaustive inpatient surveillance system (SI-VIC database), and vaccination coverage (first dose) was obtained from the national surveillance system (VAC-SI database).& nbsp;Results During the first wave, incidence in dialysis patients was approximately proportional to the general population. However, we showed a lower relative incidence for dialysis patients during the second wave (compared with that observed in nondialysis patients), suggesting an effect of prevention measures. Moreover, from the beginning of the vaccination rollout, incidence in dialysis patients was lower compared with predictions based on the first and second waves. Adding vaccination coverages in dialysis and nondialysis patients as predictors allowed the reported cases to be fit correctly (3685 predicted cases, 95% confidence interval, 3552 to 3816, versus 3620 reported). Incidence rate ratios were 0.37 (95% confidence interval, 0.18 to 0.71) for vaccine exposure in dialysis patients and 0.50 (95% confidence interval, 0.40 to 0.61) per 10% higher in vaccination coverage in the same-age general population, meaning that vaccine exposure in dialysis patients and the general population was independently associated with lower hospitalization rate of dialysis patients.& nbsp;Conclusions Our findings suggest that vaccination may yield a protective effect against severe forms of COVID-19 in dialysis patients, despite altered immunologic vaccine responses.