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Vaccine Pub Date : 2025-04-02 DOI:10.1016/j.vaccine.2025.127068

Siobhan L Johnstone, Daniel Shapiro, Nicola Chiwandire, Lundi Matoti, Carmen Whyte, Jolene Bultinck-Human, Selaelo Mametja, Craig Getz, Boldwin Moyo, Mabatlo Semenya, Sibongile Walaza, Cheryl Cohen, Michelle J Groome

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摘要

背景：来自非洲的 COVID-19 疫苗有效性估计数据有限。这些数据可为疫苗计划中选择优先群体的决策提供指导。本研究估算了 BNT162b2 和 Ad26.COV2.S 对 COVID-19 相关住院治疗的 VE 值，并根据年龄组、接种疫苗后的时间以及南非三次 SARS-CoV-2 高峰期的 HIV 感染状况进行了分层：我们对医疗保险计划成员在三角洲（2021 年 5 月 9 日至 2021 年 9 月 18 日）、BA.1（2021 年 11 月 28 日至 2022 年 2 月 5 日）和 BA.4/5（2022 年 4 月 17 日至 2022 年 5 月 28 日）变异期间因急性呼吸道感染住院的情况进行了阴性病例对照设计。包括疫苗接种史在内的所有数据均来自保险计划理赔。采用逻辑回归模型计算 VE，并对年龄、合并症、接种疫苗后的时间、收入水平和既往 SARS-CoV-2 感染记录进行了调整：在所有变异期，BNT162b2 对与 COVID-19 相关的住院治疗均有保护作用（delta 的 VE 为 89.3%（95 % CI，85.9-91.9），而 omicron BA.1 和 BA.4/5 的 VE 分别降至 31.4%（95 % CI，19.1-41.9）和 22.7%（95 % CI，2.2-38.9））。Ad26.COV2-S的VE估计值虽然低于BNT162b2，但在所有时期都具有保护作用（delta、ocmicron BA.1和BA.4/5分别为48.8%（95% CI，39.6-56.5）、19.8%（95% CI，5.8-31.6）和45.0%（95% CI，29.8-57.0））。≥60岁和更年轻的年龄组以及艾滋病毒感染者（PLWH）和未感染艾滋病毒的人接种疫苗可预防严重感染：结论：接种疫苗可有效预防艾滋病毒感染者和老年人因感染 COVID-19 而住院，因此是减少南非这些高危人群严重后果的有效手段。接种 BA.4/5 疫苗后，随着时间的推移，VE 会逐渐减弱，这表明可能有必要加强接种。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Effectiveness of BNT162b2 and Ad26.COV2.S vaccines against COVID-19-related hospitalisation amongst adult members of a private health insurance plan in South Africa during the Delta and Omicron periods: A test-negative case-control study.

Background: COVID-19 vaccine effectiveness estimates from Africa are limited. These data can guide decisions on selecting priority groups in vaccine programs. This study estimated VE for BNT162b2 and Ad26.COV2.S against COVID-19-related hospitalisation, stratified by age group, time since vaccination, and HIV-infection status for three SARS-CoV-2 surges in South Africa.

Methods: We applied a test-negative case-control design to hospitalisations for acute respiratory infections amongst members of a medical insurance plan during the delta (9 May 2021-18 September 2021), omicron BA.1 (28 November 2021-5 February 2022), and BA.4/5 (17 April 2022-28 May 2022) variant periods. All data, including vaccination history, were extracted from insurance plan claims. Logistic regression models adjusted for age, comorbidities, time since vaccination, income level and documentation of previous SARS-CoV-2 infection, were used to calculate VE.

Results: BNT162b2 was protective against COVID-19-related hospitalisation for all variant periods (VE 89.3 % (95 % CI, 85.9-91.9) for delta, reduced to 31.4 % (95 % CI, 19.1-41.9) and 22.7 % (95 % CI, 2.2-38.9) for omicron BA.1, and BA.4/5 respectively). VE estimates for Ad26.COV2·S, although lower than BNT162b2, were protective for all periods (48.8 % (95 % CI, 39.6-56.5), 19.8 % (95 % CI, 5.8-31.6), and 45.0 % (95 % CI, 29.8-57.0) for delta, omicron BA.1, and BA.4/5 respectively). Protection against severe infection was shown in those ≥60 years and younger age groups, as well as in people living with HIV (PLWH) and HIV-uninfected individuals.

Conclusion: Vaccination offered significant protection against COVID-19-related hospitalisation in PLWH and the elderly, and is therefore an effective means of reducing severe outcomes in these high-risk populations in South Africa. VE against BA.4/5 waned with time since vaccination suggesting boosters may be necessary.

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Vaccine

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