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BNT162b2和mRNA-1273疫苗对COVID-19的预防和减轻效果
Prevention and Attenuation of Covid-19 with the BNT162b2 and mRNA-1273 Vaccines


Mark G. Thompson ... 传染病 呼吸系统疾病 • 2021.07.22
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摘要


背景

关于在真实世界条件下,两剂信使RNA(mRNA)疫苗BNT162b2(辉瑞-BioNTech)和mRNA-1273(Moderna)对SARS-CoV-2感染的预防效果和对COVID-19的减轻效果,目前获得的信息有限。

 

方法

我们开展了一项纳入3,975名医护人员、第一出动人员及其他必需和一线工作人员的前瞻性队列研究。从2020年12月14日至2021年4月10日,参与者提供了中鼻甲拭子样本用于定性和定量逆转录聚合酶链反应(RT-PCR)分析,并通过这一方式完成了每周SARS-CoV-2检测。疫苗效果的计算式为100%×(1-接种疫苗参与者与未接种疫苗参与者相比的SARS-CoV-2感染风险比),并针对接种疫苗倾向、研究中心、职业和当地病毒流行情况进行了校正。

 

结果

本研究在204例参与者(5%)中检出SARS-CoV-2,其中5例已全程接种疫苗(接种第二剂后≥14日),11例已部分接种疫苗(接种第一剂后≥14日且接种第二剂后<14日),156例未接种疫苗;疫苗接种状态不确定的32例参与者(接种第一剂后<14日)被排除。全程接种疫苗后,经校正的疫苗预防效果为91%(95%置信区间[CI],76~97),部分接种疫苗后,效果为81%(95% CI,64~90)。在感染SARS-CoV-2的参与者中,部分或全程接种疫苗参与者的平均病毒RNA载量比未接种疫苗的参与者低40%(95% CI,16~57)。此外,接种疫苗参与者的发热症状风险低58%(相对危险度,0.42;95% CI,0.18~0.98),并且患病时间较短,患病卧床天数少2.3日(95% CI,0.8~3.7)。

 

结论

在真实世界条件下应用时,劳动年龄的成人接种已获批准的mRNA疫苗后,疫苗可高效预防SARS-CoV-2感染,此外对于虽接种疫苗但仍发生突破性感染的参与者,疫苗降低了病毒RNA载量、发热症状风险并缩短了患病时间(由美国国立免疫和呼吸疾病中心[National Center for Immunization and Respiratory Diseases]及美国疾病控制和预防中心资助)。





作者信息

Mark G. Thompson, Ph.D., Jefferey L. Burgess, M.D., M.P.H., Allison L. Naleway, Ph.D., Harmony Tyner, M.D., M.P.H., Sarang K. Yoon, D.O., Jennifer Meece, Ph.D., Lauren E.W. Olsho, Ph.D., Alberto J. Caban-Martinez, D.O., Ph.D., M.P.H., C.P.H., Ashley L. Fowlkes, Sc.D., M.P.H., Karen Lutrick, Ph.D., Holly C. Groom, M.P.H., Kayan Dunnigan, M.P.H., Marilyn J. Odean, M.S., Kurt Hegmann, M.D., Elisha Stefanski, B.S., Laura J. Edwards, M.P.H., Natasha Schaefer-Solle, Ph.D., Lauren Grant, M.S., Katherine Ellingson, Ph.D., Jennifer L. Kuntz, Ph.D., Tnelda Zunie, B.S., Matthew S. Thiese, Ph.D., Lynn Ivacic, B.S., Meredith G. Wesley, M.P.H., Julie Mayo Lamberte, M.S.P.H., Xiaoxiao Sun, Ph.D., Michael E. Smith, B.S., Andrew L. Phillips, M.D., Kimberly D. Groover, Ph.D., Young M. Yoo, M.S.P.H., Joseph Gerald, M.D., Rachel T. Brown, Ph.D., Meghan K. Herring, M.P.H., Gregory Joseph, M.P.H., Shawn Beitel, M.Sc., Tyler C. Morrill, M.S., Josephine Mak, M.P.H., Patrick Rivers, M.P.P., Brandon P. Poe, M.P.A., Brian Lynch, B.S., Yingtao Zhou, Ph.D., Jing Zhang, Ph.D., Anna Kelleher, M.S., Yan Li, B.S., Monica Dickerson, B.S., Erika Hanson, M.S., Kyley Guenther, B.S., Suxiang Tong, Ph.D., Allen Bateman, Ph.D., Erik Reisdorf, M.P.H., John Barnes, Ph.D., Eduardo Azziz-Baumgartner, M.D., Danielle R. Hunt, Ph.D., Melissa L. Arvay, Ph.D., M.P.H., Preeta Kutty, M.D., Alicia M. Fry, M.D., M.P.H., and Manjusha Gaglani, M.B.B.S.
From the Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta (M.G.T., A.L.F., L.G., J.M.L., Y.M.Y., G.J., J. Mak, B.L., Y.Z., J.Z., A.K., Y.L., M.D., S.T., J.B., E.A.-B., M.L.A., P.K., A.M.F.); the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson (J.L.B., K.L., K.E., X.S., J.G., S.B., P.R.); Kaiser Permanente Northwest Center for Health Research, Portland, OR (A.L.N., H.C.G., J.L.K.); the Whiteside Institute for Clinical Research (M.J.O.), St. Luke’s Regional Health Care System (H.T., M.J.O.), Duluth, MN; University of Utah, Salt Lake City (S.K.Y., K.H., M.S.T., A.L.P., R.T.B.); the Marshfield Clinic Research Institute, Marshfield (J. Meece, E.S., L.I.), and the Wisconsin State Laboratory of Hygiene, Madison (E.H., K.G., A.B., E.R.) — both in Wisconsin; Abt Associates, Rockville, MD (L.E.W.O., L.J.E., M.G.W., K.D.G., M.K.H., T.C.M., B.P.P., D.R.H.); the Leonard M. Miller School of Medicine, University of Miami, Miami (A.J.C.-M., N.S.-S.); and Baylor Scott and White Health, Dallas (K.D., T.Z., M.E.S., M.G.), and Texas A&M University College of Medicine, Bryan (M.G.) — both in Texas. Address reprint requests to Dr. Thompson at the Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop H24-7, Atlanta, GA 30333, or at isq8@cdc.gov.

 

参考文献

1. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med 2021;384:403-416.

2. Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 2020;383:2603-2615.

3. Thompson MG, Burgess JL, Naleway AL, et al. Interim estimates of vaccine effectiveness of BNT162b2 and mRNA-1273 COVID-19 vaccines in preventing SARS-CoV-2 infection among health care personnel, first responders, and other essential and frontline workers — eight U.S. locations, December 2020–March 2021. MMWR Morb Mortal Wkly Rep 2021;70:495-500.

4. Paden CR, Tao Y, Queen K, et al. Rapid, sensitive, full-genome sequencing of severe acute respiratory syndrome Coronavirus 2. Emerg Infect Dis 2020;26:2401-2405.

5. Robins JM, Hernán MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology 2000;11:550-560.

6. McCaffrey DF, Ridgeway G, Morral AR. Propensity score estimation with boosted regression for evaluating causal effects in observational studies. Psychol Methods 2004;9:403-425.

7. Hall VJ, Foulkes S, Saei A, et al. COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study. Lancet 2021;397:1725-1735.

8. Levine-Tiefenbrun M, Yelin I, Katz R, et al. Initial report of decreased SARS-CoV-2 viral load after inoculation with the BNT162b2 vaccine. Nat Med 2021;27:790-792.

9. Fontana LM, Villamagna AH, Sikka MK, McGregor JC. Understanding viral shedding of severe acute respiratory coronavirus virus 2 (SARS-CoV-2): review of current literature. Infect Control Hosp Epidemiol 2020 October 20 (Epub ahead of print).

10. Ferdinands JM, Thompson MG, Blanton L, Spencer S, Grant L, Fry AM. Does influenza vaccination attenuate the severity of breakthrough infections? A narrative review and recommendations for further research. Vaccine 2021;39:3678-3695.

11. Préziosi MP, Halloran ME. Effects of pertussis vaccination on disease: vaccine efficacy in reducing clinical severity. Clin Infect Dis 2003;37:772-779.

12. Préziosi MP, Halloran ME. Effects of pertussis vaccination on transmission: vaccine efficacy for infectiousness. Vaccine 2003;21:1853-1861.

13. Vesikari T, Ruuska T, Delem A, André FE, Beards GM, Flewett TH. Efficacy of two doses of RIT 4237 bovine rotavirus vaccine for prevention of rotavirus diarrhoea. Acta Paediatr Scand 1991;80:173-180.

14. Hickman CJ, Hyde TB, Sowers SB, et al. Laboratory characterization of measles virus infection in previously vaccinated and unvaccinated individuals. J Infect Dis 2011;204:Suppl 1:S549-S558.

15. Rota JS, Hickman CJ, Sowers SB, Rota PA, Mercader S, Bellini WJ. Two case studies of modified measles in vaccinated physicians exposed to primary measles cases: high risk of infection but low risk of transmission. J Infect Dis 2011;204:Suppl 1:S559-S563.

16. Marin M, Yawn BP, Hales CM, et al. Herpes zoster vaccine effectiveness and manifestations of herpes zoster and associated pain by vaccination status. Hum Vaccin Immunother 2015;11:1157-1164.

17. Jain VK, Rivera L, Zaman K, et al. Vaccine for prevention of mild and moderate-to-severe influenza in children. N Engl J Med 2013;369:2481-2491.

18. Arriola C, Garg S, Anderson EJ, et al. Influenza vaccination modifies disease severity among community-dwelling adults hospitalized with influenza. Clin Infect Dis 2017;65:1289-1297.

19. Vázquez M, LaRussa PS, Gershon AA, Steinberg SP, Freudigman K, Shapiro ED. The effectiveness of the varicella vaccine in clinical practice. N Engl J Med 2001;344:955-960.

20. Sadoff J, Gray G, Vandebosch A, et al. Safety and efficacy of single-dose Ad26.COV2.S vaccine against Covid-19. N Engl J Med 2021;384:2187-2201.

21. Skowronski DM, De Serres G. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 2021;384:1576-1578.

22. Amit S, Regev-Yochay G, Afek A, Kreiss Y, Leshem E. Early rate reductions of SARS-CoV-2 infection and COVID-19 in BNT162b2 vaccine recipients. Lancet 2021;397:875-877.

23. McCulloch DJ, Kim AE, Wilcox NC, et al. Comparison of unsupervised home self-collected midnasal swabs with clinician-collected nasopharyngeal swabs for detection of SARS-CoV-2 infection. JAMA Netw Open 2020;3(7):e2016382-e2016382.

24. Tsang TK, Cowling BJ, Fang VJ, et al. Influenza A virus shedding and infectivity in households. J Infect Dis 2015;212:1420-1428.

25. Anand BS, Velez M. Assessment of correlation between serum titers of hepatitis C virus and severity of liver disease. World J Gastroenterol 2004;10:2409-2411.

26. MacDonald M, Crofts N, Kaldor J. Transmission of hepatitis C virus: rates, routes, and cofactors. Epidemiol Rev 1996;18:137-148.

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