Effectiveness of mRNA Covid-19 Vaccine among U.S. Health Care Personnel,The New England Journal of Medicine

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Effectiveness of mRNA Covid-19 Vaccine among U.S. Health Care Personnel
The New England Journal of Medicine ( IF 96.2 ) Pub Date : 2021-09-22 , DOI: 10.1056/nejmoa2106599
Tamara Pilishvili ₁ , Ryan Gierke ₁ , Katherine E Fleming-Dutra ₁ , Jennifer L Farrar ₁ , Nicholas M Mohr ₁ , David A Talan ₁ , Anusha Krishnadasan ₁ , Karisa K Harland ₁ , Howard A Smithline ₁ , Peter C Hou ₁ , Lilly C Lee ₁ , Stephen C Lim ₁ , Gregory J Moran ₁ , Elizabeth Krebs ₁ , Mark T Steele ₁ , David G Beiser ₁ , Brett Faine ₁ , John P Haran ₁ , Utsav Nandi ₁ , Walter A Schrading ₁ , Brian Chinnock ₁ , Daniel J Henning ₁ , Frank Lovecchio ₁ , Jane Lee ₁ , Devra Barter ₁ , Monica Brackney ₁ , Scott K Fridkin ₁ , Kaytlynn Marceaux-Galli ₁ , Sarah Lim ₁ , Erin C Phipps ₁ , Ghinwa Dumyati ₁ , Rebecca Pierce ₁ , Tiffanie M Markus ₁ , Deverick J Anderson ₁ , Amanda K Debes ₁ , Michael Y Lin ₁ , Jeanmarie Mayer ₁ , Jennie H Kwon ₁ , Nasia Safdar ₁ , Marc Fischer ₁ , Rosalyn Singleton ₁ , Nora Chea ₁ , Shelley S Magill ₁ , Jennifer R Verani ₁ , Stephanie J Schrag ₁ ,

Affiliation

From the Covid-19 Response Team, Centers for Disease Control and Prevention (T.P., R.G., K.E.F.-D., J.L.F., M.F., N.C., S.S.M., J.R.V., S.J.S.), and the Georgia Emerging Infections Program and Emory University School of Medicine (S.K.F.) - both in Atlanta; the University of Iowa, Iowa City (N.M.M., D.A.T., K.K.H., B.F.); Olive View and University of California Los Angeles Ronald Reagan Medical Centers, Los Angeles (D.A.T., A.K., G.J.M.), the University of California San Francisco, Fresno (B.C.), and the California Emerging Infections Program, Oakland (J.L.); Baystate Medical Center, Springfield (H.A.S.), Brigham and Women's Hospital, Boston (P.C.H.), and the University of Massachusetts Medical Center, Worcester (J.P.H.) - all in Massachusetts; Jackson Memorial Hospital, Miami (L.C.L.); University Medical Center, Louisiana State University, New Orleans (S.C.L.); Thomas Jefferson University Hospital, Philadelphia (E.K.); Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City (M.T.S.); the University of Chicago (D.G.B.) and the Department of Medicine, Rush University Medical Center (M.Y.L.) - both in Chicago; the University of Mississippi Medical Center, Jackson (U.N.); the University of Alabama at Birmingham, Birmingham (W.A.S.); the University of Washington, Seattle (D.J.H.); Valleywise Health Medical Center, Arizona State University, Phoenix (F.L.); the Colorado Department of Public Health and Environment, Denver (D.B.); the Connecticut Emerging Infections Program and Yale School of Public Health, New Haven (M.B.); the Maryland Department of Health (K.M.-G.) and Johns Hopkins University School of Medicine (A.K.D.) - both in Baltimore; the Minnesota Emerging Infections Program, Minnesota Department of Health, St. Paul (S.L.); the University of New Mexico, Albuquerque (E.C.P.), and the New Mexico Emerging Infections Program, Santa Fe (E.C.P.); the University of Rochester Medical Center and the New York State-Rochester Emerging Infections Program, Rochester (G.D.); the Public Health Division, Oregon Health Authority, Portland (R.P.); Vanderbilt University Medical Center, Nashville (T.M.M.); the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC (D.J.A.); the University of Utah Veterans Affairs Salt Lake City Health Care System, Salt Lake City (J.M.); Washington University School of Medicine, Division of Infectious Diseases, St. Louis (J.H.K.); the University of Wisconsin-Madison and the William S. Middleton Memorial Veterans Hospital, Madison (N.S.); and the Alaska Native Tribal Health Consortium, Anchorage (R.S.).

Background

The prioritization of U.S. health care personnel for early receipt of messenger RNA (mRNA) vaccines against severe acute respiratory disease coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), allowed for the evaluation of the effectiveness of these new vaccines in a real-world setting.

Methods

We conducted a test-negative case–control study involving health care personnel across 25 U.S. states. Cases were defined on the basis of a positive polymerase-chain-reaction (PCR) or antigen-based test for SARS-CoV-2 and at least one Covid-19–like symptom. Controls were defined on the basis of a negative PCR test for SARS-CoV-2, regardless of symptoms, and were matched to cases according to the week of the test date and site. Using conditional logistic regression with adjustment for age, race and ethnic group, underlying conditions, and exposures to persons with Covid-19, we estimated vaccine effectiveness for partial vaccination (assessed 14 days after receipt of the first dose through 6 days after receipt of the second dose) and complete vaccination (assessed ≥7 days after receipt of the second dose).

Results

The study included 1482 case participants and 3449 control participants. Vaccine effectiveness for partial vaccination was 77.6% (95% confidence interval [CI], 70.9 to 82.7) with the BNT162b2 vaccine (Pfizer–BioNTech) and 88.9% (95% CI, 78.7 to 94.2) with the mRNA-1273 vaccine (Moderna); for complete vaccination, vaccine effectiveness was 88.8% (95% CI, 84.6 to 91.8) and 96.3% (95% CI, 91.3 to 98.4), respectively. Vaccine effectiveness was similar in subgroups defined according to age (<50 years or ≥50 years), race and ethnic group, presence of underlying conditions, and level of patient contact. Estimates of vaccine effectiveness were lower during weeks 9 through 14 than during weeks 3 through 8 after receipt of the second dose, but confidence intervals overlapped widely.

Conclusions

The BNT162b2 and mRNA-1273 vaccines were highly effective under real-world conditions in preventing symptomatic Covid-19 in health care personnel, including those at risk for severe Covid-19 and those in racial and ethnic groups that have been disproportionately affected by the pandemic. (Funded by the Centers for Disease Control and Prevention.)

中文翻译：

mRNA Covid-19 疫苗对美国医护人员的有效性

背景

美国卫生保健人员优先考虑尽早接种针对严重急性呼吸道疾病冠状病毒 2 (SARS-CoV-2)（导致 2019 年冠状病毒病 (Covid-19) 的病毒）的信使 RNA (mRNA) 疫苗，从而可以评估这些新疫苗在现实世界中的有效性。

方法

我们对美国 25 个州的医护人员进行了一项测试呈阴性的病例对照研究。病例是根据 SARS-CoV-2 聚合酶链反应 (PCR) 或基于抗原的检测呈阳性以及至少一种类似 Covid-19 的症状来定义的。无论症状如何，根据 SARS-CoV-2 PCR 检测阴性来定义对照，并根据检测日期和地点的周数与病例进行匹配。使用条件逻辑回归并调整年龄、种族和民族、基础疾病以及与 Covid-19 感染者的接触情况，我们估计了部分疫苗接种的疫苗有效性（在收到第一剂疫苗后 14 天到收到疫苗后 6 天进行评估）第二剂）并完成疫苗接种（在收到第二剂后 ≥7 天进行评估）。

结果

该研究包括 1482 名病例参与者和 3449 名对照参与者。 BNT162b2 疫苗 (Pfizer-BioNTech) 部分疫苗接种的疫苗有效性为 77.6%（95% 置信区间 [CI]，70.9 至 82.7），而 mRNA-1273 疫苗（Moderna）的疫苗有效性为 88.9%（95% CI，78.7 至 94.2）。）；对于完全疫苗接种，疫苗有效率分别为 88.8%（95% CI，84.6 至 91.8）和 96.3%（95% CI，91.3 至 98.4）。根据年龄（<50 岁或≥50 岁）、种族和族裔群体、潜在疾病的存在以及患者接触程度定义的亚组中，疫苗效果相似。接受第二剂疫苗后第 9 至 14 周的疫苗有效性估计值低于第 3 至 8 周，但置信区间广泛重叠。