Two-Dose Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine Effectiveness With Mixed Schedules and Extended Dosing Intervals: Test-Negative Design Studies From British Columbia and Quebec, Canada.
Two-Dose Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine Effectiveness With Mixed Schedules and Extended Dosing Intervals: Test-Negative Design Studies From British Columbia and Quebec, Canada.
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DOI：
10.1093/cid/ciac290
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发表时间：
2022-11-30
期刊：
影响因子：
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中科院分区：
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加拿大 2019 年冠状病毒病 (COVID-19) 免疫策略推迟了第二剂疫苗接种，并允许混合接种计划。我们在加拿大两个较大的省份按疫苗类型（mRNA 和/或 ChAdOx1）、剂量间隔以及自第二剂接种以来的时间比较了两剂疫苗的有效性 (VE)。 2021 年 5 月 30 日至 11 月 27 日（接种后第 22 至 47 周）期间，在加拿大不列颠哥伦比亚省和魁北克省分别进行了测试阴性设计研究，对 18 岁以上成人（包括由于 Alpha、Gamma 和 Delta 变体（VOC）引起的）两剂 VE 进行了评估，以预防严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染或住院治疗。同源或异源 mRNA 和/或 ChAdOx1 2 剂方案与 SARS-CoV-2 住院风险降低 90% 以上且持续 7 个月相关。从 >90% 的峰值略有下降，在同源 mRNA 疫苗接种后 ≥6 个月内，抗感染的 VE ≥80%，当两种剂量均为 ChAdOx1 时降低约 10%，但在接受异源 ChAdOx1 + mRNA 后相对较高。不同年龄组、性别和挥发性有机化合物的结果相似。与制造商指定的 mRNA 剂量之间的 3-4 周间隔相比，7-8 周更长的 VE 显着更高。任何 mRNA 和/或 ChAdOx1 组合的两剂剂量均可在 Delta 主导循环中针对 SARS-CoV-2 住院治疗提供实质性和持续的保护。 ChAdOx1 VE 抗感染能力通过异源 mRNA 系列完成得到改善。第一剂和第二剂之间间隔 7-8 周可改善 mRNA VE，可能是疫情严重高峰期之外的最佳方案。研究结果支持 SARS-CoV-2 疫苗剂量之间的互换性和延长间隔，这对低覆盖率地区以及未来的儿童具有潜在的全球影响。在加拿大不列颠哥伦比亚省和魁北克省的成年人中进行的测试阴性设计研究表明，两种剂量的同源或异源 SARS-CoV-2 疫苗可提供实质性和持续的保护，防止住院，并加强使用混合时间表和更长的剂量间隔。
The Canadian coronavirus disease 2019 (COVID-19) immunization strategy deferred second doses and allowed mixed schedules. We compared 2-dose vaccine effectiveness (VE) by vaccine type (mRNA and/or ChAdOx1), interval between doses, and time since second dose in 2 of Canada’s larger provinces. Two-dose VE against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or hospitalization among adults ≥18 years, including due to Alpha, Gamma, and Delta variants of concern (VOCs), was assessed ≥14 days postvaccination by test-negative design studies separately conducted in British Columbia and Quebec, Canada, between 30 May and 27 November (epi-weeks 22–47) 2021. In both provinces, all homologous or heterologous mRNA and/or ChAdOx1 2-dose schedules were associated with ≥90% reduction in SARS-CoV-2 hospitalization risk for ≥7 months. With slight decline from a peak of >90%, VE against infection was ≥80% for ≥6 months following homologous mRNA vaccination, lower by ∼10% when both doses were ChAdOx1 but comparably high following heterologous ChAdOx1 + mRNA receipt. Findings were similar by age group, sex, and VOC. VE was significantly higher with longer 7–8-week versus manufacturer-specified 3–4-week intervals between mRNA doses. Two doses of any mRNA and/or ChAdOx1 combination gave substantial and sustained protection against SARS-CoV-2 hospitalization, spanning Delta-dominant circulation. ChAdOx1 VE against infection was improved by heterologous mRNA series completion. A 7–8-week interval between first and second doses improved mRNA VE and may be the optimal schedule outside periods of intense epidemic surge. Findings support interchangeability and extended intervals between SARS-CoV-2 vaccine doses, with potential global implications for low-coverage areas and, going forward, for children. Test-negative design studies conducted among adults in British Columbia and Quebec, Canada, show two doses of homologous or heterologous SARS-CoV-2 vaccines provide substantial and sustained protection against hospitalization, and reinforce the use of mixed schedules and longer intervals between doses.
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