Effectiveness of mRNA Covid-19 Vaccine among U.S. Health Care Personnel.
Effectiveness of mRNA Covid-19 Vaccine among U.S. Health Care Personnel.
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DOI：
10.1056/nejmoa2106599
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发表时间：
2021-12-16
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影响因子：
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通讯作者：
Vaccine Effectiveness among Healthcare Personnel Study Team
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Pilishvili T;Gierke R;Fleming-Dutra KE;Farrar JL;Mohr NM;Talan DA;Krishnadasan A;Harland KK;Smithline HA;Hou PC;Lee LC;Lim SC;Moran GJ;Krebs E;Steele MT;Beiser DG;Faine B;Haran JP;Nandi U;Schrading WA;Chinnock B;Henning DJ;Lovecchio F;Lee J;Barter D;Brackney M;Fridkin SK;Marceaux-Galli K;Lim S;Phipps EC;Dumyati G;Pierce R;Markus TM;Anderson DJ;Debes AK;Lin MY;Mayer J;Kwon JH;Safdar N;Fischer M;Singleton R;Chea N;Magill SS;Verani JR;Schrag SJ;Vaccine Effectiveness among Healthcare Personnel Study Team
美国卫生保健人员优先考虑早期接受针对严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）的信使RNA（mRNA）疫苗，该病毒导致2019冠状病毒病（Covid-19），允许在现实世界中评估这些新疫苗的有效性。我们进行了一项测试阴性病例对照研究，涉及美国25个州的医疗保健人员。病例的定义是基于SARS-CoV-2的聚合酶链反应（PCR）或抗原检测阳性以及至少一种Covid-19样症状。对照组的定义是基于SARS-CoV-2的PCR检测阴性，无论症状如何，并根据检测日期和地点的周数与病例相匹配。使用条件logistic回归，并调整年龄、种族和民族、基础疾病和对Covid-19患者的暴露，我们估计了部分疫苗接种（在接受第一剂后14天至接受第二剂后6天进行评估）和完全疫苗接种（在接受第二剂后≥ 7天进行评估）的疫苗有效性。该研究包括1482例病例参与者和3449例对照参与者。部分接种的疫苗有效率为77.6%（95%置信区间[CI]，70.9 - 82.7）（辉瑞-BioNTech）和88.9%（95% CI，78.7至94.2）与mRNA-1273疫苗（Moderna）;对于完全接种，疫苗有效性分别为88.8%（95%CI，84.6至91.8）和96.3%（95%CI，91.3至98.4）。根据年龄（<50岁或≥ 50岁）、种族和民族、基础疾病的存在和患者接触水平定义的亚组中，疫苗有效性相似。第二剂接种后第9 - 14周的疫苗有效性估计值低于第3 - 8周，但置信区间重叠很大。BNT162b2和mRNA-1273疫苗在实际条件下非常有效地预防了医护人员的症状性Covid-19，包括那些有严重Covid-19风险的人以及那些受大流行影响不成比例的种族和族裔群体。（由疾病控制和预防中心资助。
The prioritization of U.S. health care personnel for early receipt of messenger RNA (mRNA) vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), allowed for the evaluation of the effectiveness of these new vaccines in a real-world setting. We conducted a test-negative case–control study involving health care personnel across 25 U.S. states. Cases were defined on the basis of a positive polymerase-chain-reaction (PCR) or antigen-based test for SARS-CoV-2 and at least one Covid-19–like symptom. Controls were defined on the basis of a negative PCR test for SARS-CoV-2, regardless of symptoms, and were matched to cases according to the week of the test date and site. Using conditional logistic regression with adjustment for age, race and ethnic group, underlying conditions, and exposures to persons with Covid-19, we estimated vaccine effectiveness for partial vaccination (assessed 14 days after receipt of the first dose through 6 days after receipt of the second dose) and complete vaccination (assessed ≥7 days after receipt of the second dose). The study included 1482 case participants and 3449 control participants. Vaccine effectiveness for partial vaccination was 77.6% (95% confidence interval [CI], 70.9 to 82.7) with the BNT162b2 vaccine (Pfizer–BioNTech) and 88.9% (95% CI, 78.7 to 94.2) with the mRNA-1273 vaccine (Moderna); for complete vaccination, vaccine effectiveness was 88.8% (95% CI, 84.6 to 91.8) and 96.3% (95% CI, 91.3 to 98.4), respectively. Vaccine effectiveness was similar in subgroups defined according to age (<50 years or ≥50 years), race and ethnic group, presence of underlying conditions, and level of patient contact. Estimates of vaccine effectiveness were lower during weeks 9 through 14 than during weeks 3 through 8 after receipt of the second dose, but confidence intervals overlapped widely. The BNT162b2 and mRNA-1273 vaccines were highly effective under real-world conditions in preventing symptomatic Covid-19 in health care personnel, including those at risk for severe Covid-19 and those in racial and ethnic groups that have been disproportionately affected by the pandemic. (Funded by the Centers for Disease Control and Prevention.)