Waning effectiveness of BNT162b2 and ChAdOx1 covid-19 vaccines over six months since second dose: OpenSAFELY cohort study using linked electronic health records.
Waning effectiveness of BNT162b2 and ChAdOx1 covid-19 vaccines over six months since second dose: OpenSAFELY cohort study using linked electronic health records.
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DOI：
10.1136/bmj-2022-071249
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发表时间：
2022-07-20
影响因子：
105.7
通讯作者：
Sterne, Jonathan A. C.
中科院分区：
文献类型：
--
作者：
Horne, Elsie M. F.;Hulme, William J.;Keogh, Ruth H.;Palmer, Tom M.;Williamson, Elizabeth J.;Parker, Edward P. K.;Green, Amelia;Walker, Venexia;Walker, Alex J.;Curtis, Helen;Fisher, Louis;MacKenna, Brian;Croker, Richard;Hopcroft, Lisa;Park, Robin Y.;Massey, Jon;Morley, Jessica;Mehrkar, Amir;Bacon, Sebastian;Evans, David;Inglesby, Peter;Morton, Caroline E.;Hickman, George;Davy, Simon;Ward, Tom;Dillingham, Iain;Goldacre, Ben;Hernan, Miguel A.;Sterne, Jonathan A. C.
估计第二次接种后6个月内covid-19疫苗有效性的下降。队列研究，由英国国家医疗服务体系批准。在opensafety - tpp数据库中链接初级保健、医院和covid-19记录。以前没有感染过SARS-CoV-2的成年人符合条件，不包括养老院居民和医疗保健专业人员。接种了两剂BNT162b2或ChAdOx1（在全国疫苗推广期间接种）的人与未接种疫苗的人在六个连续的比较期内进行了比较，每个周期为四周。调整了covid-19相关住院、covid-19相关死亡、SARS-CoV-2检测阳性和非covid-19相关死亡的风险比，比较了接种疫苗和未接种疫苗的人群。在≥65岁、18-64岁及临床易感人群、40-64岁和18-39岁亚组中，用每4周调整后的风险比分别量化疫苗有效性减弱。1 951 866名和3 219 349名符合条件的成年人分别接种了两剂BNT162b2和ChAdOx1, 2 422 980名仍未接种疫苗。据估计，疫苗有效性的下降在不同的结果和不同的疫苗品牌之间是相似的。在≥65岁亚组中，covid-19相关住院、covid-19相关死亡和SARS-CoV-2检测阳性的校正风险比为每四周1.19(95%可信区间1.14 ~ 1.24)~ 1.34（95%可信区间1.09 ~ 1.64）。尽管疫苗有效性下降，但在第二次接种后26周内，接种疫苗的成年人与covid-19相关的住院率和死亡率显著低于未接种疫苗的成年人，估计BNT162b2的疫苗有效性≥80%，ChAdOx1的疫苗有效性≥75%。到第23-26周，接种疫苗的人的SARS-CoV-2检测阳性率与未接种疫苗的人相似或更高(调整后的风险比，BNT162b2为1.72（1.11至2.68)，ChAdOx1为1.86(1.79至1.93)）。在与covid-19相关的住院率、与covid-19相关的死亡率和SARS-CoV-2阳性检测中，估计疫苗有效性减弱的速率是一致的，并且在按年龄和临床易感性定义的亚组中是相似的。如果对组粒变异感染的结果和加强疫苗接种持续，这些发现将有助于加强疫苗接种的安排。
To estimate waning of covid-19 vaccine effectiveness over six months after second dose. Cohort study, approved by NHS England. Linked primary care, hospital, and covid-19 records within the OpenSAFELY-TPP database. Adults without previous SARS-CoV-2 infection were eligible, excluding care home residents and healthcare professionals. People who had received two doses of BNT162b2 or ChAdOx1 (administered during the national vaccine rollout) were compared with unvaccinated people during six consecutive comparison periods, each of four weeks. Adjusted hazard ratios for covid-19 related hospital admission, covid-19 related death, positive SARS-CoV-2 test, and non-covid-19 related death comparing vaccinated with unvaccinated people. Waning vaccine effectiveness was quantified as ratios of adjusted hazard ratios per four week period, separately for subgroups aged ≥65 years, 18-64 years and clinically vulnerable, 40-64 years, and 18-39 years. 1 951 866 and 3 219 349 eligible adults received two doses of BNT162b2 and ChAdOx1, respectively, and 2 422 980 remained unvaccinated. Waning of vaccine effectiveness was estimated to be similar across outcomes and vaccine brands. In the ≥65 years subgroup, ratios of adjusted hazard ratios for covid-19 related hospital admission, covid-19 related death, and positive SARS-CoV-2 test ranged from 1.19 (95% confidence interval 1.14 to 1.24)to 1.34 (1.09 to 1.64) per four weeks. Despite waning vaccine effectiveness, rates of covid-19 related hospital admission and death were substantially lower among vaccinated than unvaccinated adults up to 26 weeks after the second dose, with estimated vaccine effectiveness ≥80% for BNT162b2, and ≥75% for ChAdOx1. By weeks 23-26, rates of positive SARS-CoV-2 test in vaccinated people were similar to or higher than in unvaccinated people (adjusted hazard ratios up to 1.72 (1.11 to 2.68) for BNT162b2 and 1.86 (1.79 to 1.93) for ChAdOx1). The rate at which estimated vaccine effectiveness waned was consistent for covid-19 related hospital admission, covid-19 related death, and positive SARS-CoV-2 test and was similar across subgroups defined by age and clinical vulnerability. If sustained to outcomes of infection with the omicron variant and to booster vaccination, these findings will facilitate scheduling of booster vaccination.
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10.1136/bmj-2021-068848
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