Association of Prior BNT162b2 COVID-19 Vaccination With Symptomatic SARS-CoV-2 Infection in Children and Adolescents During Omicron Predominance
Association of Prior BNT162b2 COVID-19 Vaccination With Symptomatic SARS-CoV-2 Infection in Children and Adolescents During Omicron Predominance
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DOI：
10.1001/jama.2022.7493
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发表时间：
2022-05-13
影响因子：
120.7
通讯作者：
Schrag, Stephanie J.
中科院分区：
文献类型：
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作者：
Fleming-Dutra, Katherine E.;Britton, Amadea;Schrag, Stephanie J.
在SARS-CoV-2 Omicron变异体出现之前进行的儿科试验中，2剂BNT 162 b2 COVID-19疫苗（辉瑞BioNTech）对COVID-19的有效性很高。在成人中，与先前的变体相比，2剂BNT 162 b2对症状性Omicron感染的估计疫苗有效性（VE）降低，迅速减弱，并随着加强剂的增加而增加。目的评估症状性感染与之前接种BNT 162 b2疫苗的相关性，以估计Omicron变异优势期间儿童和青少年中的VE。设计，设置和参与者使用来自美国6897个基于药房的驾车通过SARS-CoV-2测试站点的数据进行测试阴性，病例对照分析，这些数据来自增加社区获得测试平台的单一药房连锁店。这项分析包括从2021年12月26日至2021年2月21日接受SARS-CoV-2核酸扩增检测的5至11岁儿童的74208次检测和12至15岁患有COVID-19样疾病的青少年的47744次检测。2022.在SARS-CoV-2检测前2周或更长时间接种两剂BNT 162 b2，而儿童不接种疫苗;青少年在检测前2周或更长时间接种2或3剂疫苗vs未接种疫苗（建议接受加强剂量）。主要结局和指标症状感染。使用既往接种疫苗与症状性SARS-CoV-2感染相关性的校正比值比（OR）来估计VE：VE =（1 - OR）× 100%。结果共纳入5 ~ 11岁儿童30 999例检测阳性和43 209例检测阴性对照，以及来自12至15岁青少年的22273例检测阳性病例和25471例检测阴性对照。纳入试验的患者中位年龄为10岁（IQR，7-13岁）; 61 189例（50.2%）为女性，75 758例（70.1%）为白色，29 034例（25.7%）为西班牙裔/拉丁裔。在第2次给药后2至4周，儿童中，校正的OR为0.40（95% CI，0.35-0.45;估计VE，60.1% [95% CI，54.7%-64.8%]），在青少年中，OR为0.40（95% CI，0.29-0.56;估计VE，59.5%[95% CI，44.3%-70.6%]）。在第2次给药后2个月内，儿童中的OR为0.71（95% CI，0.67-0.76;估计VE，28.9% [95% CI，24.5%-33.1%]），青少年中的OR为0.83（95% CI，0.76-0.92;估计VE，16.6%[95% CI，8.1%-24.3%]）。在青少年中，给药后2至6.5周的加强剂量OR为0.29（95%CI，0.24-0.35;估计VE，71.1% [95%CI，65.5%-75.7%]）。结论和相关性在儿童和青少年中，2剂BNT 162 b2对抗症状性感染的估计VE是适度的，并迅速下降。在青少年中，估计的有效性在加强剂量后增加。
IMPORTANCE Efficacy of 2 doses of the BNT162b2 COVID-19 vaccine (Pfizer-BioNTech) against COVID-19 was high in pediatric trials conducted before the SARS-CoV-2 Omicron variant emerged. Among adults, estimated vaccine effectiveness (VE) of 2 BNT162b2 doses against symptomatic Omicron infection was reduced compared with prior variants, waned rapidly, and increased with a booster. OBJECTIVE To evaluate the association of symptomatic infection with prior vaccination with BNT162b2 to estimate VE among children and adolescents during Omicron variant predominance.DESIGN, SETTING, AND PARTICIPANTS A test-negative, case-control analysiswas conducted using data from 6897 pharmacy-based, drive-through SARS-CoV-2 testing sites across the US from a single pharmacy chain in the Increasing Community Access to Testing platform. This analysis included 74 208 tests from children 5 to 11 years of age and 47 744 tests from adolescents 12 to 15 years of age with COVID-19-like illness who underwent SARS-CoV-2 nucleic acid amplification testing from December 26, 2021, to February 21, 2022.EXPOSURES Two BNT162b2 doses 2 weeks or more before SARS-CoV-2 testing vs no vaccination for children; 2 or 3 doses 2 weeks or more before testing vs no vaccination for adolescents (who are recommended to receive a booster dose).MAIN OUTCOMES AND MEASURES Symptomatic infection. The adjusted odds ratio (OR) for the association of prior vaccination and symptomatic SARS-CoV-2 infection was used to estimate VE: VE = (1 - OR) x 100%.RESULTS A total of 30 999 test-positive cases and 43 209 test-negative controls were included from children 5 to 11 years of age, as well as 22 273 test-positive cases and 25 471 test-negative controls from adolescents 12 to 15 years of age. The median age among those with included tests was 10 years (IQR, 7-13); 61 189 (50.2%) were female, 75 758 (70.1%) were White, and 29 034 (25.7%) were Hispanic/Latino. At 2 to 4 weeks after dose 2, among children, the adjusted OR was 0.40 (95% CI, 0.35-0.45; estimated VE, 60.1% [95% CI, 54.7%-64.8%]) and among adolescents, the OR was 0.40 (95% CI, 0.29-0.56; estimated VE, 59.5%[95% CI, 44.3%-70.6%]). During month 2 after dose 2, among children, the OR was 0.71 (95% CI, 0.67-0.76; estimated VE, 28.9% [95% CI, 24.5%-33.1%]) and among adolescents, the OR was 0.83 (95% CI, 0.76-0.92; estimated VE, 16.6%[95% CI, 8.1%-24.3%]). Among adolescents, the booster dose OR 2 to 6.5 weeks after the dose was 0.29 (95% CI, 0.24-0.35; estimated VE, 71.1% [95% CI, 65.5%-75.7%]).CONCLUSIONS AND RELEVANCE Among children and adolescents, estimated VE for 2 doses of BNT162b2 against symptomatic infection was modest and decreased rapidly. Among adolescents, the estimated effectiveness increased after a booster dose.