Risk of subsequent SARS-CoV-2 infection among vaccinated employees with or without hybrid immunity acquired early in the Omicron-predominant era of the COVID-19 pandemic

IF 2.7 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH American journal of industrial medicine Pub Date : 2024-02-05 DOI:10.1002/ajim.23570

Mark A. Jacobson MD, Paul D. Blanc MD, MSPH, Jacqueline Tulsky MD, Monica Tilly MD, MPH, Raymond Meister MD, Will Huen MD, MS, MPH, James E. McNicholas Jr. DO, MPH, FACP

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Abstract

Background

Hybrid immunity, from COVID-19 vaccination followed by SARS-CoV-2 infection acquired after its Omicron variant began predominating, has provided greater protection than vaccination alone against subsequent infection over 1–3 months of observation. Its longer-term protection is unknown.

Methods

We conducted a retrospective cohort study of COVID-19 case incidence among healthcare personnel (HCP) mandated to be vaccinated and report on COVID-19-associated symptoms, high-risk exposures, or known-positive test results to an employee health hotline. We compared cases with hybrid immunity, defined as incident COVID-19 during the first 6 weeks of Omicron-variant predominance (run-in period), to those with immunity from vaccination alone during the run-in period. Time until COVID-19 infection over 13 subsequent months (observation period) was analyzed by standard survival analysis.

Results

Of 5867 employees, 641 (10.9%, 95% confidence interval [CI]: 10.1%–11.8%) acquired hybrid immunity during the run-in period. Of these, 104 (16.2%, 95% CI: 13.5%–19.3%) experienced new SARS-CoV-2 infection during the 13-month observation period, compared to 2177 (41.7%, 95% CI: 40.3%–43.0%) of the 5226 HCP without hybrid immunity. Time until incident infection was shorter among the latter (hazard ratio: 3.09, 95% CI: 2.54–3.78).

Conclusions

In a cohort of vaccinated employees, Omicron-era acquired SARS-CoV-2 hybrid immunity was associated with significantly lower risk of subsequent infection over more than a year of observation—a time period far longer than previously reported and during which three, progressively more resistant, Omicron subvariants became predominant. These findings can inform institutional policy and planning for future COVID-19 additional vaccine dosing requirements for employees, for surveillance programs, and for risk modification efforts.

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在 COVID-19 大流行的 Omicron 主导时代早期获得或未获得混合免疫力的已接种疫苗的员工随后感染 SARS-CoV-2 的风险。

背景：接种 COVID-19 疫苗后，在其 Omicron 变体开始占主导地位后感染 SARS-CoV-2 可产生混合免疫力，在 1-3 个月的观察期内，混合免疫力比单独接种疫苗对后续感染的保护作用更大。其长期保护效果尚不清楚：我们对必须接种疫苗并向员工健康热线报告 COVID-19 相关症状、高危暴露或已知阳性检测结果的医护人员（HCP）中的 COVID-19 病例发生率进行了一项回顾性队列研究。我们将混合免疫病例（定义为在Omicron变异体占优势的前6周（磨合期）内发生COVID-19事件）与磨合期内仅接种疫苗获得免疫力的病例进行了比较。通过标准生存分析法对随后13个月（观察期）内感染COVID-19的时间进行了分析：在 5867 名员工中，有 641 人（10.9%，95% 置信区间 [CI]：10.1%-11.8%）在磨合期获得了混合免疫力。其中 104 人（16.2%，95% 置信区间：13.5%-19.3%）在 13 个月的观察期内新感染了 SARS-CoV-2，而在 5226 名未获得混合免疫的 HCP 中，有 2177 人（41.7%，95% 置信区间：40.3%-43.0%）新感染了 SARS-CoV-2。后者发生感染的时间更短（危险比：3.09，95% CI：2.54-3.78）：在一组接种过疫苗的员工中，奥米克龙时代获得的 SARS-CoV-2 混合免疫与一年多的观察期中较低的后续感染风险有关--这段时间远远长于之前的报道，在此期间，三种抗药性逐渐增强的奥米克龙亚变体成为主要变体。这些研究结果可以为机构政策和规划提供参考，以便在未来对员工、监控项目和风险调整工作提出 COVID-19 额外疫苗剂量要求。

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来源期刊

American journal of industrial medicine 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.90

自引率

5.70%

发文量

108

审稿时长

4-8 weeks

期刊介绍： American Journal of Industrial Medicine considers for publication reports of original research, review articles, instructive case reports, and analyses of policy in the fields of occupational and environmental health and safety. The Journal also accepts commentaries, book reviews and letters of comment and criticism. The goals of the journal are to advance and disseminate knowledge, promote research and foster the prevention of disease and injury. Specific topics of interest include: occupational disease; environmental disease; pesticides; cancer; occupational epidemiology; environmental epidemiology; disease surveillance systems; ergonomics; dust diseases; lead poisoning; neurotoxicology; endocrine disruptors.