Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity
Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity
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DOI：
10.1001/jama.2021.19499
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发表时间：
2021-11-04
影响因子：
120.7
通讯作者：
Patel, Manish M.
中科院分区：
文献类型：
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作者：
Tenforde, Mark W.;Self, Wesley H.;Patel, Manish M.
重要性全面了解COVID-19疫苗接种的益处需要考虑疾病衰减，即尽管接种疫苗但仍发生COVID-19的人是否比未接种疫苗的人具有更低的疾病严重程度。目的评估接种mRNA COVID-19疫苗-mRNA-1273（Moderna）和BNT 162 b2之间的相关性（辉瑞-BioNTech）-和COVID-19住院，以及在COVID-19住院患者中，与进展为危重疾病的相关性。设计、设置和参与者对2021年3月11日至8月15日期间住院的4513名成人进行了美国21个研究中心的病例对照分析，截至2021年7月14日，可获得入组患者的死亡和机械通气的28天结局数据。最终随访日期为2021年8月8日。暴露COVID-19疫苗接种。主要结局和指标评价既往疫苗接种与（1）因COVID-19住院之间的关联，其中患者为因COVID-19住院的患者，对照患者为因其他诊断住院的患者;以及（2）因COVID-19住院的患者中的疾病进展，其中病例和对照分别为进展至死亡或机械通气的COVID-19患者和未进展至死亡或机械通气的患者。相关性用多因素Logistic回归分析。（中位年龄，59岁[IQR，45-69]; 2202 [48.8%]女性; 23.0%非西班牙裔黑人个体，15.9%西班牙裔个体，20.1%免疫功能低下），1983例为COVID-19病例患者，2530例为非COVID-19对照。未接种疫苗的患者占COVID-19住院患者的84.2%（1669/1983）。因COVID-19住院与接种疫苗的可能性降低显著相关（病例组，15.8%;对照组，54.8%;校正OR，0.15; 95%CI，0.13-0.18），包括测序的SARS-CoV-2 α（8.7% vs 51.7%; aOR，0.10; 95% CI，0.06-0.16）和Delta变体（21.9% vs 61.8%; aOR，0.14; 95% CI，0.10-0.21）。免疫功能正常的患者（11.2%vs53.5%; aOR，0.10; 95%CI，0.09-0.13）与免疫功能低下的患者（40.1%vs58.8%; aOR，0.49; 95%CI，0.35-0.69）之间的相关性更强（P
IMPORTANCE A comprehensive understanding of the benefits of COVID-19 vaccination requires consideration of disease attenuation, determined as whether people who develop COVID-19 despite vaccination have lower disease severity than unvaccinated people.OBJECTIVE To evaluate the association between vaccination with mRNA COVID-19 vaccines-mRNA-1273 (Moderna) and BNT162b2 (Pfizer-BioNTech)-and COVID-19 hospitalization, and, among patients hospitalized with COVID-19, the association with progression to critical disease.DESIGN, SETTING, AND PARTICIPANTS A US 21-site case-control analysis of 4513 adults hospitalized between March 11 and August 15, 2021, with 28-day outcome data on death and mechanical ventilation available for patients enrolled through July 14, 2021. Date of final follow-up was August 8, 2021.EXPOSURES COVID-19 vaccination.MAIN OUTCOMES AND MEASURES Associations were evaluated between prior vaccination and (1) hospitalization for COVID-19, in which case patients were those hospitalized for COVID-19 and control patients were those hospitalized for an alternative diagnosis; and (2) disease progression among patients hospitalized for COVID-19, in which cases and controls were COVID-19 patients with and without progression to death or mechanical ventilation, respectively. Associations were measured with multivariable logistic regression.RESULTS Among 4513 patients (median age, 59 years [IQR, 45-69]; 2202 [48.8%] women; 23.0% non-Hispanic Black individuals, 15.9% Hispanic individuals, and 20.1% with an immunocompromising condition), 1983 were case patients with COVID-19 and 2530 were controls without COVID-19. Unvaccinated patients accounted for 84.2%(1669/1983) of COVID-19 hospitalizations. Hospitalization for COVID-19 was significantly associated with decreased likelihood of vaccination (cases, 15.8%; controls, 54.8%; adjusted OR, 0.15; 95% CI, 0.13-0.18), including for sequenced SARS-CoV-2 Alpha (8.7% vs 51.7%; aOR, 0.10; 95% CI, 0.06-0.16) and Delta variants (21.9% vs 61.8%; aOR, 0.14; 95% CI, 0.10-0.21). This association was stronger for immunocompetent patients (11.2% vs 53.5%; aOR, 0.10; 95% CI, 0.09-0.13) than immunocompromised patients(40.1%vs58.8%; aOR, 0.49;95% CI, 0.35-0.69)(P