Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings.
Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings.
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DOI：
10.1056/nejmoa2110362
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发表时间：
2021-10-07
期刊：
影响因子：
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通讯作者：
Klein NP
中科院分区：
文献类型：
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作者：
Thompson MG;Stenehjem E;Grannis S;Ball SW;Naleway AL;Ong TC;DeSilva MB;Natarajan K;Bozio CH;Lewis N;Dascomb K;Dixon BE;Birch RJ;Irving SA;Rao S;Kharbanda E;Han J;Reynolds S;Goddard K;Grisel N;Fadel WF;Levy ME;Ferdinands J;Fireman B;Arndorfer J;Valvi NR;Rowley EA;Patel P;Zerbo O;Griggs EP;Porter RM;Demarco M;Blanton L;Steffens A;Zhuang Y;Olson N;Barron M;Shifflett P;Schrag SJ;Verani JR;Fry A;Gaglani M;Azziz-Baumgartner E;Klein NP
关于美国目前批准的2019年冠状病毒病（Covid-19）疫苗在住院、入住重症监护室（ICU）或急诊科或紧急护理诊所的门诊护理方面的有效性，数据有限。我们进行了一项研究，研究对象为患有Covid-19样疾病的成年人（≥50岁），他们接受了严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）的分子检测。我们评估了2021年1月1日至6月22日期间在多个州187家医院的41，552次入院和221个急诊科或紧急护理诊所的21，522次就诊。患者的疫苗接种状态记录在电子健康记录和免疫登记处。我们使用阴性试验设计，通过比较接种疫苗患者与未接种疫苗患者中SARS-CoV-2感染阳性试验的几率来评估疫苗有效性。根据接种倾向评分以及年龄、地理区域、日历时间（从2021年1月1日到每次医疗访视的索引日期的天数）和当地病毒传播情况，对疫苗有效性进行了权重调整。全信使RNA（mRNA）疫苗的有效性（第二次给药后≥14天）为89%（95%置信区间[CI]，87至91），针对实验室确认的SARS-CoV-2感染导致住院，90%（95% CI，86 - 93），而91%（95% CI，89 - 93）的受试者因感染而需入住ICU，而91%（95% CI，89 - 93）的受试者因感染而需前往急诊科或急诊诊所就诊。在85岁或以上的成年人、慢性疾病患者以及黑人或西班牙裔成年人中，全面接种疫苗对Covid-19相关住院或急诊科或紧急护理诊所就诊的有效性与BNT 162 b2和mRNA-1273疫苗相似，范围为81%至95%。Ad26.COV2.S疫苗对实验室确认的导致住院的SARS-CoV-2感染的有效性为68%（95%CI，50至79），对导致急诊科或紧急护理诊所就诊的感染的有效性为73%（95%CI，59至82）。美国的Covid-19疫苗对SARS-CoV-2感染非常有效，需要住院治疗，ICU住院，或急诊科或紧急护理诊所就诊。这种疫苗的有效性扩展到受SARS-CoV-2感染影响不成比例的人群。（由疾病控制和预防中心资助。
There are limited data on the effectiveness of the vaccines against symptomatic coronavirus disease 2019 (Covid-19) currently authorized in the United States with respect to hospitalization, admission to an intensive care unit (ICU), or ambulatory care in an emergency department or urgent care clinic. We conducted a study involving adults (≥50 years of age) with Covid-19–like illness who underwent molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed 41,552 admissions to 187 hospitals and 21,522 visits to 221 emergency departments or urgent care clinics during the period from January 1 through June 22, 2021, in multiple states. The patients’ vaccination status was documented in electronic health records and immunization registries. We used a test-negative design to estimate vaccine effectiveness by comparing the odds of a positive test for SARS-CoV-2 infection among vaccinated patients with those among unvaccinated patients. Vaccine effectiveness was adjusted with weights based on propensity-for-vaccination scores and according to age, geographic region, calendar time (days from January 1, 2021, to the index date for each medical visit), and local virus circulation. The effectiveness of full messenger RNA (mRNA) vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization, 90% (95% CI, 86 to 93) against infection leading to an ICU admission, and 91% (95% CI, 89 to 93) against infection leading to an emergency department or urgent care clinic visit. The effectiveness of full vaccination with respect to a Covid-19–associated hospitalization or emergency department or urgent care clinic visit was similar with the BNT162b2 and mRNA-1273 vaccines and ranged from 81% to 95% among adults 85 years of age or older, persons with chronic medical conditions, and Black or Hispanic adults. The effectiveness of the Ad26.COV2.S vaccine was 68% (95% CI, 50 to 79) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization and 73% (95% CI, 59 to 82) against infection leading to an emergency department or urgent care clinic visit. Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARS-CoV-2 infection. (Funded by the Centers for Disease Control and Prevention.)