Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant.
Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant.
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DOI：
10.1056/nejmoa2119451
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发表时间：
2022-04-21
期刊：
影响因子：
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通讯作者：
Lopez Bernal J
中科院分区：
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作者：
Andrews N;Stowe J;Kirsebom F;Toffa S;Rickeard T;Gallagher E;Gower C;Kall M;Groves N;O'Connell AM;Simons D;Blomquist PB;Zaidi A;Nash S;Iwani Binti Abdul Aziz N;Thelwall S;Dabrera G;Myers R;Amirthalingam G;Gharbia S;Barrett JC;Elson R;Ladhani SN;Ferguson N;Zambon M;Campbell CNJ;Brown K;Hopkins S;Chand M;Ramsay M;Lopez Bernal J
在高度接种疫苗的人群中，由于严重急性呼吸综合征冠状病毒2型组粒（B.1.1.529）变异，2019年冠状病毒病（Covid-19）病例迅速增加，引发了对现有疫苗有效性的担忧。在英国，我们采用检测阴性病例对照设计来评估疫苗对由组粒和δ (B.1.617.2)变异引起的症状性疾病的有效性。在初次接种两剂BNT162b2（辉瑞- biontech）、ChAdOx1 nCoV-19（阿斯利康）或mRNA-1273 （Moderna）疫苗后，再接种一剂BNT162b2、ChAdOx1 nCoV-19或mRNA-1273疫苗后，计算疫苗的有效性。在2021年11月27日至2022年1月12日期间，共有886,774名符合条件的人感染了组粒变异，204,154名符合条件的人感染了德尔塔变异，以及1,572,621名符合条件的检测阴性对照。在调查的所有时间点以及所有初级疫苗和加强疫苗的组合中，δ型变异对症状性疾病的疫苗有效性高于组粒变异。在两次ChAdOx1 nCoV-19剂量后的20周内，对组粒变异没有影响，而两次BNT162b2剂量后的疫苗有效性在2至4周为65.5%(95%置信区间[CI]， 63.9至67.0)，在25周或更长时间内下降到8.8% （95% CI， 7.0至10.5）。在ChAdOx1 nCoV-19初级病程接受者中，在接种BNT162b2增强剂后2至4周，疫苗有效性增加到62.4% (95% CI， 61.8至63.0)，而在10周或更长时间后，疫苗有效性下降到39.6% （95% CI， 38.0至41.1）。在初次接种BNT162b2疫苗的人群中，在接种BNT162b2增强剂后2 - 4周，疫苗有效性增加到67.2% (95% CI, 66.5 - 67.8)，而在10周或更长时间后，疫苗有效性下降到45.7% （95% CI, 44.7 - 46.7）。ChAdOx1 nCoV-19初级病程后的疫苗有效性在mRNA-1273增强剂后2至4周增加至70.1% (95% CI， 69.5至70.7)，在5至9周时下降至60.9% （95% CI， 59.7至62.1）。在BNT162b2初级疗程后，mRNA-1273增强剂在2至4周时将疫苗有效性提高至73.9% (95% CI， 73.1至74.6)；5至9周时，疫苗有效性降至64.4% （95% CI， 62.6至66.1）。初次接种两剂ChAdOx1 nCoV-19或BNT162b2疫苗对由组粒变异引起的症状性疾病提供有限的保护。在ChAdOx1 nCoV-19或BNT162b2初级疗程后，BNT162b2或mRNA-1273增强剂显着增加了保护作用，但这种保护作用随着时间的推移而减弱。（由英国健康安全局资助。）
A rapid increase in coronavirus disease 2019 (Covid-19) cases due to the omicron (B.1.1.529) variant of severe acute respiratory syndrome coronavirus 2 in highly vaccinated populations has aroused concerns about the effectiveness of current vaccines. We used a test-negative case–control design to estimate vaccine effectiveness against symptomatic disease caused by the omicron and delta (B.1.617.2) variants in England. Vaccine effectiveness was calculated after primary immunization with two doses of BNT162b2 (Pfizer–BioNTech), ChAdOx1 nCoV-19 (AstraZeneca), or mRNA-1273 (Moderna) vaccine and after a booster dose of BNT162b2, ChAdOx1 nCoV-19, or mRNA-1273. Between November 27, 2021, and January 12, 2022, a total of 886,774 eligible persons infected with the omicron variant, 204,154 eligible persons infected with the delta variant, and 1,572,621 eligible test-negative controls were identified. At all time points investigated and for all combinations of primary course and booster vaccines, vaccine effectiveness against symptomatic disease was higher for the delta variant than for the omicron variant. No effect against the omicron variant was noted from 20 weeks after two ChAdOx1 nCoV-19 doses, whereas vaccine effectiveness after two BNT162b2 doses was 65.5% (95% confidence interval [CI], 63.9 to 67.0) at 2 to 4 weeks, dropping to 8.8% (95% CI, 7.0 to 10.5) at 25 or more weeks. Among ChAdOx1 nCoV-19 primary course recipients, vaccine effectiveness increased to 62.4% (95% CI, 61.8 to 63.0) at 2 to 4 weeks after a BNT162b2 booster before decreasing to 39.6% (95% CI, 38.0 to 41.1) at 10 or more weeks. Among BNT162b2 primary course recipients, vaccine effectiveness increased to 67.2% (95% CI, 66.5 to 67.8) at 2 to 4 weeks after a BNT162b2 booster before declining to 45.7% (95% CI, 44.7 to 46.7) at 10 or more weeks. Vaccine effectiveness after a ChAdOx1 nCoV-19 primary course increased to 70.1% (95% CI, 69.5 to 70.7) at 2 to 4 weeks after an mRNA-1273 booster and decreased to 60.9% (95% CI, 59.7 to 62.1) at 5 to 9 weeks. After a BNT162b2 primary course, the mRNA-1273 booster increased vaccine effectiveness to 73.9% (95% CI, 73.1 to 74.6) at 2 to 4 weeks; vaccine effectiveness fell to 64.4% (95% CI, 62.6 to 66.1) at 5 to 9 weeks. Primary immunization with two doses of ChAdOx1 nCoV-19 or BNT162b2 vaccine provided limited protection against symptomatic disease caused by the omicron variant. A BNT162b2 or mRNA-1273 booster after either the ChAdOx1 nCoV-19 or BNT162b2 primary course substantially increased protection, but that protection waned over time. (Funded by the U.K. Health Security Agency.)