Protection by a Fourth Dose of BNT162b2 against Omicron in Israel.
Protection by a Fourth Dose of BNT162b2 against Omicron in Israel.
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DOI：
10.1056/nejmoa2201570
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发表时间：
2022-05-05
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2022年1月2日，以色列开始为60岁或以上的人接种第四剂BNT162b2疫苗。需要关于第四剂疫苗对确诊的严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)感染率和2019年严重冠状病毒病(新冠肺炎)感染率的影响的数据。使用以色列卫生部的数据库，我们提取了1,252,331人的数据，这些人年龄在60岁或以上，有资格获得第四剂疫苗，期间(2022年1月10日至3月2日)SARS-CoV-2的B.1.1.529(Omicron)变异株占主导地位。我们估计了确诊感染和严重新冠肺炎的比率是从接受第四剂后8天开始(四剂组)开始的时间的函数，与只接受三剂(三剂组)和提前3到7天接受第四剂(内部对照组)的人相比。对于比率的估计，我们使用了准泊松回归，并对年龄、性别、人口统计组和日历日进行了调整。每10万人日重度新冠肺炎病例数(未调整率)：四剂量组为1.5例，三剂组为3.9例，内对照组为4.2例。在拟泊松分析中，第4剂后第4周重度新冠肺炎的调整率比3剂组低3.5倍(95%可信区间为2.7~4.6)，比内对照组低2.3倍(95%CI为1.7~3.3)。在接受第四剂疫苗后的6周内，对严重疾病的保护并未减弱。累计四剂组每10万人日确诊感染病例数(未调整率)为177例，三剂组361例，内对照组388例。在准泊松分析中，第4剂接种后第4周的调整感染确诊率比3剂组低2.0倍(95%CI，1.9~2.1)，比内对照组低1.8倍(95%CI，1.7~1.9)。然而，这种保护在后来的几周里减弱了。在接种第四针BNT162b2疫苗后，确诊的SARS-CoV-2感染率和严重新冠肺炎的发生率低于只接种三针的患者。在研究期间，对确认感染的保护似乎是短暂的，而对严重疾病的保护并没有减弱。
On January 2, 2022, Israel began administering a fourth dose of BNT162b2 vaccine to persons 60 years of age or older. Data are needed regarding the effect of the fourth dose on rates of confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and of severe coronavirus disease 2019 (Covid-19). Using the Israeli Ministry of Health database, we extracted data on 1,252,331 persons who were 60 years of age or older and eligible for the fourth dose during a period in which the B.1.1.529 (omicron) variant of SARS-CoV-2 was predominant (January 10 through March 2, 2022). We estimated the rate of confirmed infection and severe Covid-19 as a function of time starting at 8 days after receipt of a fourth dose (four-dose groups) as compared with that among persons who had received only three doses (three-dose group) and among persons who had received a fourth dose 3 to 7 days earlier (internal control group). For the estimation of rates, we used quasi-Poisson regression with adjustment for age, sex, demographic group, and calendar day. The number of cases of severe Covid-19 per 100,000 person-days (unadjusted rate) was 1.5 in the aggregated four-dose groups, 3.9 in the three-dose group, and 4.2 in the internal control group. In the quasi-Poisson analysis, the adjusted rate of severe Covid-19 in the fourth week after receipt of the fourth dose was lower than that in the three-dose group by a factor of 3.5 (95% confidence interval [CI], 2.7 to 4.6) and was lower than that in the internal control group by a factor of 2.3 (95% CI, 1.7 to 3.3). Protection against severe illness did not wane during the 6 weeks after receipt of the fourth dose. The number of cases of confirmed infection per 100,000 person-days (unadjusted rate) was 177 in the aggregated four-dose groups, 361 in the three-dose group, and 388 in the internal control group. In the quasi-Poisson analysis, the adjusted rate of confirmed infection in the fourth week after receipt of the fourth dose was lower than that in the three-dose group by a factor of 2.0 (95% CI, 1.9 to 2.1) and was lower than that in the internal control group by a factor of 1.8 (95% CI, 1.7 to 1.9). However, this protection waned in later weeks. Rates of confirmed SARS-CoV-2 infection and severe Covid-19 were lower after a fourth dose of BNT162b2 vaccine than after only three doses. Protection against confirmed infection appeared short-lived, whereas protection against severe illness did not wane during the study period.