2023-2024年COVID-19疫苗对≥18岁终末期肾病患者与COVID-19相关住院治疗的有效性——美国，2023年9月至2024年4月

IF 4.5 3区医学 Q2 IMMUNOLOGY

Vaccine Pub Date : 2025-04-03 DOI:10.1016/j.vaccine.2025.127010

Amanda B. Payne , Shannon Novosad , Heng-Ming Sung , Yue Zhang , Ryan Wiegand , Carla S. Gomez Victor , Megan Wallace , Danica J. Gomes , Morgan Najdowski , Bradley Lufkin , Yoganand Chillarige , Eduardo Lacson , Lorien S. Dalrymple , Ruth Link-Gelles

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引用次数: 0

摘要

终末期肾脏疾病（ESKD）透析患者发生严重COVID-19疾病的风险很高。2023年9月，美国建议所有年龄≥6个月的人接种2023 - 2024年COVID-19疫苗。由于ESKD患者可能存在免疫功能障碍、高龄和其他基础疾病（包括免疫功能低下疾病）的高发，疫苗有效性（VE）降低是一个值得关注的问题。了解2023-2024年COVID-19疫苗在ESKD患者中的有效性可以为该人群的COVID-19疫苗推荐提供信息。方法对年龄≥18岁的接受透析治疗的ESKD患者进行回顾性队列调查。随访从2023年9月17日开始，一直持续到最早发生与covid -19相关的结果索赔、其他审查事件或随访结束。采用边际结构Cox模型估计VE（计算为[1 -风险比]* 100%），解释为2023-2024年接种COVID-19疫苗与未接种2023-2024疫苗相比的获益。VE通过存在额外的免疫损害条件、年龄组和接种疫苗后的时间来估计。结果在2023年9月17日至2024年4月13日期间，17,749/112,250（16%）年龄≥18岁且无额外免疫功能低下的ESKD医疗保险受益人接种了2023 - 2024年COVID-19疫苗剂量，接种后随访时间最长为209天。在随访期间，共记录了6539例医疗参与的COVID-19事件，包括3605例与COVID-19相关的住院治疗，789例与COVID-19相关的死亡，以及896例与COVID-19相关的血栓栓塞事件。在接种疫苗后7-59天，与covid -19相关的住院治疗的VE为55%(95%置信区间[CI]: 42% - 65%)，在接种疫苗后≥60天，VE为47% （95% CI: 35% - 57%）。在接种疫苗后7-59天，covid -19相关死亡的VE为71% (95% CI: 46% - 84%)，接种疫苗后≥60天，VE为51% （95% CI: 24% - 69%）。抗covid -19相关血栓栓塞事件的VE为44% （95% CI, 24%, 59%）。结论2023-2024年COVID-19疫苗可预防ESKD成人患者与COVID-19相关的住院、死亡和血栓栓塞事件。这些数据支持ESKD成人接种更新的COVID-19疫苗的建议。

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Effectiveness of 2023–2024 COVID-19 vaccines against COVID-19–associated hospitalizations among adults aged ≥18 years with end stage kidney disease — United States, September 2023–April 2024

Background

Persons with end stage kidney disease (ESKD) on dialysis are at high risk for severe COVID-19 disease. In September 2023, 2023–2024 COVID-19 vaccination was recommended in the United States for all persons aged ≥6 months. Due to possible immune dysfunction, advanced age, and high prevalence of additional underlying conditions, including immunocompromising conditions, among individuals with ESKD, reduced vaccine effectiveness (VE) is a concern. Understanding effectiveness of 2023–2024 COVID-19 vaccine among persons with ESKD can inform COVID-19 vaccine recommendations for this population.

Methods

A retrospective cohort investigation was conducted among Medicare fee-for-service beneficiaries aged ≥18 years with ESKD receiving dialysis using Medicare enrollment and claims records. Follow-up began on September 17, 2023, and continued until the earliest occurrence of claim for a COVID-19–associated outcome, other censoring event, or end of follow-up. A marginal structural Cox model was used to estimate VE (calculated as [1 – hazard ratio]*100 %), interpreted as the benefit of 2023–2024 COVID-19 vaccination compared with no 2023–2024 vaccine dose. VE was estimated by presence of additional immunocompromising conditions, age group, and time since vaccination.

Results

During September 17, 2023 – April 13, 2024, 17,749/112,250 (16 %) Medicare beneficiaries aged ≥18 years with ESKD without additional immunocompromising conditions received a 2023–2024 COVID-19 vaccine dose, with a maximum 209 days of follow-up since vaccination. During the follow-up period 6539 medically attended COVID-19 events, including 3605 COVID-19-associated hospitalizations, 789 COVID-19-associated deaths, and 896 COVID-19-associated thromboembolic events, were recorded. VE against COVID-19-associated hospitalization was 55 % (95 % confidence interval [CI]: 42 % - 65 %) at 7–59 days after vaccination and 47 % (95 % CI: 35 % – 57 %) at ≥60 days after vaccination. VE against COVID-19-associated death was 71 % (95 % CI: 46 % - 84 %) at 7–59 days after vaccination and 51 % (95 % CI: 24 % – 69 %) ≥60 days after vaccination. VE against COVID-19-associated thromboembolic events was 44 % (95 % CI, 24 %, 59 %).

Conclusions

The 2023–2024 COVID-19 vaccines provided protection against COVID-19-associated hospitalization, death, and thromboembolic events among adults with ESKD. These data support the recommendation that adults with ESKD receive the updated COVID-19 vaccine.

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来源期刊

Vaccine 医学-免疫学

CiteScore

8.70

自引率

5.50%

发文量

992

审稿时长

131 days

期刊介绍： Vaccine is unique in publishing the highest quality science across all disciplines relevant to the field of vaccinology - all original article submissions across basic and clinical research, vaccine manufacturing, history, public policy, behavioral science and ethics, social sciences, safety, and many other related areas are welcomed. The submission categories as given in the Guide for Authors indicate where we receive the most papers. Papers outside these major areas are also welcome and authors are encouraged to contact us with specific questions.