Risk of severe COVID-19 outcomes after autumn 2022 COVID-19 booster vaccinations: a pooled analysis of national prospective cohort studies involving 7.4 million adults in England, Northern Ireland, Scotland and Wales.
Risk of severe COVID-19 outcomes after autumn 2022 COVID-19 booster vaccinations: a pooled analysis of national prospective cohort studies involving 7.4 million adults in England, Northern Ireland, Scotland and Wales.
复制标题
DOI：
10.1016/j.lanepe.2023.100816
复制
发表时间：
2024-02
影响因子：
20.9
通讯作者：
Shi, Ting
中科院分区：
文献类型：
--
作者：
Bedston, Stuart;Almaghrabi, Fatima;Patterson, Lynsey;Agrawal, Utkarsh;Woolford, Lana;Anand, Sneha N;Joy, Mark;Crawford, Anna;Goudie, Rosalind;Byford, Rachel;Abbasizanjani, Hoda;Smith, Deb;Laidlaw, Lynn;Akbari, Ashley;Sullivan, Christopher;Bradley, Declan T;Lyons, Ronan A;de Lusignan, Simon;Hobbs, F D Richard;Robertson, Chris;Sheikh, Sir Aziz;Shi, Ting
英国COVID-19疫苗接种政策已演变为向因COVID-19而患严重疾病风险增加的个人提供COVID-19加强剂。基于我们对第一次、第二次和初始加强剂量的疫苗有效性的分析，我们的目标是确定严重后果风险增加的个体（即，COVID-19相关住院或死亡）。我们通过相关的初级保健，疫苗接种，住院和死亡率数据，在所有四个英国国家进行了基于全国人口的队列分析。我们纳入了在2022年9月1日至2022年12月31日期间接受2022年秋季BNT 162 b2（Comirnaty）或mRNA-1273（Spikevax）加强剂量的个体，以研究严重COVID-19结果的风险。使用考克斯比例风险模型估计人口统计学和临床因素与秋季加强剂量后严重COVID-19结局之间关联的校正风险比（aHR）和95%置信区间（CI）。分析调整了年龄，性别，体重指数（BMI），贫困，城市/农村地区和合并症。按疫苗类型进行分层分析。然后，我们进行了一项固定效应荟萃分析，以联合收割机在四个英国国家的结果。2022年9月1日至2022年12月31日期间，7，451，890名≥18岁的人接受了秋季加强剂量。3500人出现严重COVID-19结局（每1000人-年2.9起事件）。是男性（男性vs女性，aHR 1.41（1.32-1.51）），老年人（≥80岁vs 18-49岁; 10.43（8.06-13.50）），体重不足（BMI <18.5 vs BMI 25.0-29.9; 2.94（2.51-3.44）），有合并症（≥5种合并症vs无合并症; 9.45（8.15-10.96））的患者在秋季加强剂量后COVID-19住院或死亡的风险更高。家庭规模较大的人（家庭中≥11人对2人; 1.56（1.23-1.98））和来自更贫困地区的人（最贫困对最贫困的五分之一; 1.35（1.21-1.51））的风险略高。我们还观察到患有各种慢性神经系统疾病的患者的风险至少增加了两倍，包括唐氏综合征，免疫缺陷，慢性肾脏疾病，癌症，慢性呼吸道疾病或心血管疾病。于二零二二年秋季疫苗加强剂量后，男性、年长人士、体重过轻人士、患有越来越多合并症的人士、来自较大家庭或较贫困地区的人士，以及有特定基础健康状况的人士，因COVID-19而住院及死亡的风险仍然增加。现在需要关注这些风险组，以研究进一步加强剂量或治疗的免疫原性和有效性。、（）、、和。
UK COVID-19 vaccination policy has evolved to offering COVID-19 booster doses to individuals at increased risk of severe Illness from COVID-19. Building on our analyses of vaccine effectiveness of first, second and initial booster doses, we aimed to identify individuals at increased risk of severe outcomes (i.e., COVID-19 related hospitalisation or death) post the autumn 2022 booster dose. We undertook a national population-based cohort analysis across all four UK nations through linked primary care, vaccination, hospitalisation and mortality data. We included individuals who received autumn 2022 booster doses of BNT162b2 (Comirnaty) or mRNA-1273 (Spikevax) during the period September 1, 2022 to December 31, 2022 to investigate the risk of severe COVID-19 outcomes. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for the association between demographic and clinical factors and severe COVID-19 outcomes after the autumn booster dose. Analyses were adjusted for age, sex, body mass index (BMI), deprivation, urban/rural areas and comorbidities. Stratified analyses were conducted by vaccine type. We then conducted a fixed-effect meta-analysis to combine results across the four UK nations. Between September 1, 2022 and December 31, 2022, 7,451,890 individuals ≥18 years received an autumn booster dose. 3500 had severe COVID-19 outcomes (2.9 events per 1000 person-years). Being male (male vs female, aHR 1.41 (1.32–1.51)), older adults (≥80 years vs 18–49 years; 10.43 (8.06–13.50)), underweight (BMI <18.5 vs BMI 25.0–29.9; 2.94 (2.51–3.44)), those with comorbidities (≥5 comorbidities vs none; 9.45 (8.15–10.96)) had a higher risk of COVID-19 hospitalisation or death after the autumn booster dose. Those with a larger household size (≥11 people within household vs 2 people; 1.56 (1.23–1.98)) and from more deprived areas (most deprived vs least deprived quintile; 1.35 (1.21–1.51)) had modestly higher risks. We also observed at least a two-fold increase in risk for those with various chronic neurological conditions, including Down's syndrome, immunodeficiency, chronic kidney disease, cancer, chronic respiratory disease, or cardiovascular disease. Males, older individuals, underweight individuals, those with an increasing number of comorbidities, from a larger household or more deprived areas, and those with specific underlying health conditions remained at increased risk of COVID-19 hospitalisation and death after the autumn 2022 vaccine booster dose. There is now a need to focus on these risk groups for investigating immunogenicity and efficacy of further booster doses or therapeutics. , (), , and the .