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Microbiology and outcomes of tubo-ovarian abscesses: A 5-year cohort of 105 cases 输卵管卵巢脓肿的微生物学和治疗效果:105 个病例的 5 年队列
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-10 DOI: 10.1016/j.jinf.2024.106253
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引用次数: 0
Machine learning to attribute the source of Campylobacter infections in the United States: A retrospective analysis of national surveillance data 通过机器学习确定美国弯曲杆菌感染来源:对国家监测数据的回顾性分析。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-07 DOI: 10.1016/j.jinf.2024.106265

Objectives

Integrating pathogen genomic surveillance with bioinformatics can enhance public health responses by identifying risk and guiding interventions. This study focusses on the two predominant Campylobacter species, which are commonly found in the gut of birds and mammals and often infect humans via contaminated food. Rising incidence and antimicrobial resistance (AMR) are a global concern, and there is an urgent need to quantify the main routes to human infection.

Methods

During routine US national surveillance (2009–2019), 8856 Campylobacter genomes from human infections and 16,703 from possible sources were sequenced. Using machine learning and probabilistic models, we target genetic variation associated with host adaptation to attribute the source of human infections and estimate the importance of different disease reservoirs.

Results

Poultry was identified as the primary source of human infections, responsible for an estimated 68% of cases, followed by cattle (28%), and only a small contribution from wild birds (3%) and pork sources (1%). There was also evidence of an increase in multidrug resistance, particularly among isolates attributed to chickens.

Conclusions

National surveillance and source attribution can guide policy, and our study suggests that interventions targeting poultry will yield the greatest reductions in campylobacteriosis and spread of AMR in the US.

Data availability

All sequence reads were uploaded and shared on NCBI’s Sequence Read Archive (SRA) associated with BioProjects; PRJNA239251 (CDC / PulseNet surveillance), PRJNA287430 (FSIS surveillance), PRJNA292668 & PRJNA292664 (NARMS) and PRJNA258022 (FDA surveillance). Publicly available genomes, including reference genomes and isolates sampled worldwide from wild birds are associated with BioProject accessions: PRJNA176480, PRJNA177352, PRJNA342755, PRJNA345429, PRJNA312235, PRJNA415188, PRJNA524300, PRJNA528879, PRJNA529798, PRJNA575343, PRJNA524315 and PRJNA689604. Contiguous assemblies of all genome sequences compared are available at Mendeley data (assembled C. coli genomes doi: 10.17632/gxswjvxyh3.1; assembled C. jejuni genomes doi: 10.17632/6ngsz3dtbd.1) and individual project and accession numbers can be found in Supplementary tables S1 and S2, which also includes pubMLST identifiers for assembled genomes. Figshare (10.6084/m9.figshare.20279928). Interactive phylogenies are hosted on microreact separately for C. jejuni (https://microreact.org/project/pascoe-us-cjejuni) and C. coli (https://microreact.org/project/pascoe-us-ccoli).

目的:将病原体基因组监测与生物信息学相结合,可以通过识别风险和指导干预措施来加强公共卫生应对措施。本研究的重点是两种主要的弯曲杆菌,它们通常存在于鸟类和哺乳动物的肠道中,并经常通过受污染的食物感染人类。发病率上升和抗菌药耐药性(AMR)是全球关注的问题,因此迫切需要量化人类感染的主要途径:方法:在美国国家例行监测期间(2009-2019 年),对来自人类感染的 8856 个弯曲杆菌基因组和来自可能来源的 16703 个弯曲杆菌基因组进行了测序。利用机器学习和概率模型,我们锁定了与宿主适应性相关的基因变异,以确定人类感染的来源,并估计不同疾病储库的重要性:结果:家禽被确定为人类感染的主要来源,估计占病例的 68%,其次是牛(28%),野鸟(3%)和猪肉来源(1%)只占很小比例。还有证据表明,耐多药的情况有所增加,尤其是在鸡的分离物中:我们的研究表明,针对家禽的干预措施将在最大程度上减少美国的弯曲杆菌病和 AMR 传播:所有序列读数都已上传并共享到与 BioProjects 相关的 NCBI 序列读数档案 (SRA);PRJNA239251(CDC / PulseNet 监测)、PRJNA287430(FSIS 监测)、PRJNA292668 和 PRJNA292664(NARMS)以及 PRJNA258022(FDA 监测)。公开的基因组,包括参考基因组和从全球野生鸟类中采样的分离物,都与 BioProject 项目的登录相关联:PRJNA176480、PRJNA177352、PRJNA342755、PRJNA345429、PRJNA312235、PRJNA415188、PRJNA524300、PRJNA528879、PRJNA529798、PRJNA575343、PRJNA524315 和 PRJNA689604。比较的所有基因组序列的连续组装结果可在 Mendeley data(组装的大肠杆菌基因组 doi:10.17632/gxswjvxyh3.1;组装的空肠杆菌基因组 doi:10.17632/6ngsz3dtbd.1)中找到,单个项目和登录号可在补充表 S1 和 S2 中找到,其中还包括组装基因组的 pubMLST 标识符。Figshare (10.6084/m9.figshare.20279928).空肠大肠杆菌 (https://microreact.org/project/pascoe-us-cjejuni) 和大肠杆菌 (https://microreact.org/project/pascoe-us-ccoli) 的交互式系统发生分别托管在 microreact 上。
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引用次数: 0
Antecedent and persistent symptoms in COVID-19 and other respiratory illnesses: Insights from prospectively collected data in the BRACE trial COVID-19 和其他呼吸道疾病的前驱症状和持续症状:从 BRACE 试验的前瞻性数据中获得的启示。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-06 DOI: 10.1016/j.jinf.2024.106267

Background

Some individuals have a persistence of symptoms following both COVID-19 (post-acute COVID-19 syndrome; PACS) and other viral infections. This study used prospectively collected data from an international trial to compare symptoms following COVID-19 and non-COVID-19 respiratory illness, to identify factors associated with the risk of PACS, and to explore symptom patterns before and after COVID-19 and non-COVID-19 respiratory illnesses.

Methods

Data from a multicentre randomised controlled trial (BRACE trial) involving healthcare workers across four countries were analysed. Symptom data were prospectively collected over 12 months, allowing detailed characterisation of symptom patterns. Participants with COVID-19 and non-COVID-19 respiratory illness episodes were compared, focussing on symptom severity, duration (including PACS using NICE and WHO definitions), and pre-existing symptoms.

Findings

Compared to those with a non-COVID-19 illness, participants with COVID-19 had significantly more severe illness (OR 7·4, 95%CI 5·6–9·7). Symptom duration meeting PACS definitions occurred in a higher proportion of COVID-19 cases than non-COVID-19 respiratory controls using both the NICE definition (2·5% vs 0·5%, OR 6·6, 95%CI 2·4–18·3) and the WHO definition (8·8% vs 3·7%, OR 2·5, 95%CI 1·4–4·3). When considering only participants with COVID-19, age 40-59 years (aOR 2·8, 95%CI 1·3–6·2), chronic respiratory disease (aOR 5·5, 95%CI 1·3–23·1), and pre-existing symptoms (aOR 3·0, 95%CI 1·4–6·3) were associated with an increased risk of developing PACS. Symptoms associated with PACS were also reported by participants in the months preceding their COVID-19 or non-COVID-19 respiratory illnesses (32% fatigue and muscle ache, 11% intermittent cough and shortness of breath).

Interpretation

Healthcare workers with COVID-19 were more likely to have severe and longer-lasting symptoms than those with a non-COVID-19 respiratory illness, with a higher proportion meeting the WHO or NICE definitions of PACS. Age, chronic respiratory disease, and pre-existing symptoms increased the risk of developing PACS following COVID-19.
背景:有些人在感染 COVID-19 (急性 COVID-19 后综合征;PACS)和其他病毒感染后症状持续存在。本研究利用一项国际试验的前瞻性数据,比较 COVID-19 和非 COVID-19 呼吸道疾病后的症状,确定与 PACS 风险相关的因素,并探讨 COVID-19 和非 COVID-19 呼吸道疾病前后的症状模式:分析了来自四个国家医护人员参与的多中心随机对照试验(BRACE 试验)的数据。前瞻性地收集了12个月的症状数据,以便详细描述症状模式。研究人员对患有 COVID-19 和未患有 COVID-19 的呼吸道疾病的参与者进行了比较,重点关注症状的严重程度、持续时间(包括使用 NICE 和 WHO 定义的 PACS)以及之前存在的症状:研究结果:与非 COVID-19 呼吸系统疾病患者相比,COVID-19 患者的病情明显更严重(OR 7-4,95%CI 5-6-9-7)。根据NICE定义(2-5% vs 0-5%,OR 6-6,95%CI 2-4-18-3)和WHO定义(8-8% vs 3-7%,OR 2-5,95%CI 1-4-4-3),COVID-19病例中符合PACS定义的症状持续时间比例高于非COVID-19呼吸系统对照组。如果仅考虑 COVID-19 的参与者,年龄(aOR 2-8,95%CI 1-3-6-2)、慢性呼吸道疾病(aOR 5-5,95%CI 1-3-23-1)和原有症状(aOR 3-0,95%CI 1-4-6-3)与 PACS 患病风险的增加有关。参与者在患 COVID-19 或非 COVID-19 呼吸系统疾病前的几个月中也报告了与 PACS 相关的症状(32% 疲劳和肌肉酸痛,11% 间歇性咳嗽和呼吸急促):患 COVID-19 的医护人员比未患 COVID-19 呼吸系统疾病的医护人员症状更严重、持续时间更长,符合世界卫生组织或 NICE PACS 定义的比例更高。年龄、慢性呼吸道疾病和原有症状会增加感染 COVID-19 后出现 PACS 的风险:比尔及梅琳达-盖茨基金会 [INV-017302] 及其他(见致谢)。
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引用次数: 0
Real-world performance of a single-use, analyser-free, molecular point-of-care test for COVID-19 used in the emergency department: Results of a prospective trial (ED-POC) 急诊科使用的一次性、无分析仪、COVID-19分子床旁检验的实际性能:前瞻性试验(ED-POC)的结果。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-05 DOI: 10.1016/j.jinf.2024.106264

Background

A novel single-use, analyser-free, molecular point-of-care test for SARS-CoV-2 (Veros COVID-19 test, Sherlock Biosciences) could reduce time to results and improve patient care and flow in the emergency department (ED), but its performance in this setting is unknown.

Methods

Adults aged ≥18 years presenting to Southampton General Hospital (UK) with suspected COVID-19 were tested with the Veros COVID-19 test in addition to standard of care near-patient PCR. Measures of diagnostic accuracy were calculated for the Veros COVID-19 test stratified by Ct value. Discrepant results underwent viral culture.

Findings

Between Jan 16 and May 2, 2023, 400 patients were enrolled with a median (IQR) age of 60 (34−77) and 141 (35·3%) were SARS-CoV-2 positive by PCR. The Veros test gave valid results on the first test in 384 (96·0%), and sensitivity and specificity were 127/141 (90·1%, 95%CI 83·9–94·5) and 258/259 (99·6%, 95%CI 97·9–100) overall. For those with high or moderate viral load (Ct ≤30), sensitivity was 125/129 (96·9%, 95%CI 92·3–99·2). One (7·1%) of 14 PCR positive/Veros test negative samples was culture positive. Median (IQR) time from sample collection to result was 19 (18−20) mins with the Veros test versus 73 (59−92) mins with PCR (p < 0·0001).

Interpretation

The Veros COVID-19 test generated results in near real-time, around 1 h sooner than rapid, near-patient, analyser-based PCR, and accuracy was excellent for samples with moderate and high viral loads. The Veros test represents a step-change in molecular diagnostics for infection and could significantly reduce time to results and improve patient management in EDs and other settings.

背景:一种新型的一次性、无需分析仪的SARS-CoV-2分子床旁检测试剂盒(Veros COVID-19检测试剂盒,Sherlock Biosciences公司)可以缩短检测结果产生的时间,改善急诊科(ED)的病人护理和流程,但其在这种情况下的性能尚不清楚:方法:在英国南安普顿综合医院就诊的≥18 岁疑似 COVID-19 的成人除了接受标准的就近病人 PCR 检测外,还接受了 Veros COVID-19 检测。根据 Ct 值分层计算了 Veros COVID-19 检验的诊断准确度。对结果不明确者进行病毒培养:2023年1月16日至5月2日期间,400名患者入组,中位(IQR)年龄为60(34-77)岁,141人(35-3%)PCR检测结果为SARS-CoV-2阳性。384 人(96-0%)在第一次检测时就得到了有效的 Veros 检测结果,总体敏感性和特异性分别为 127/141(90-1%,95%CI 83-9-94-5)和 258/259(99-6%,95%CI 97-9-100)。对于高或中度病毒载量(Ct ≤30)的患者,灵敏度为 125/129(96-9%,95%CI 92-3-99-2)。14 份 PCR 阳性/Veros 检测阴性样本中有 1 份(7-1%)培养阳性。从样本采集到检测结果的时间中位数(IQR)为:Veros 检测 19 (18-20) 分钟,PCR 检测 73 (59-92) 分钟(p解释:Veros COVID-19 检测从样本采集到检测结果的时间中位数(IQR)为 19 (18-20) 分钟,PCR 检测 73 (59-92) 分钟:Veros COVID-19 检验结果几乎是实时生成的,比基于分析仪的快速、接近病人的 PCR 早约 1 小时,而且对于中度和高度病毒载量样本的准确性非常高。Veros检验代表了感染分子诊断的一个进步,可以大大缩短检验结果的产生时间,改善急诊室和其他环境中的病人管理:数据共享:本研究中分析和展示的所有去身份化参与者数据可在发表后向相应作者索取。
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引用次数: 0
Plasma MERTK is causally associated with infection mortality 血浆 MERTK 与感染死亡率存在因果关系。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-04 DOI: 10.1016/j.jinf.2024.106262

Background

Infectious diseases are a major cause of mortality in spite of existing public health, anti-microbial and vaccine interventions. We aimed to define plasma proteomic associates of infection mortality and then apply Mendelian randomisation (MR) to yield biomarkers that may be causally associated.

Methods

We used UK Biobank plasma proteomic data to associate 2923 plasma proteins with infection mortality before 31st December 2019 (240 events in 52,520 participants). Since many plasma proteins also predict non-infection mortality, we focussed on those associated with >1.5-fold risk of infection mortality in an analysis excluding survivors. Protein quantitative trait scores (pQTS) were then used to identify whether genetically predicted protein levels also associated with infection mortality. To conduct Two Sample MR, we performed a genome-wide association study (GWAS) of infection mortality using UK Biobank participants without plasma proteomic data (n = 363,953 including 984 infection deaths).

Findings

After adjusting for clinical risk factors, 1142 plasma proteins were associated with risk of infection mortality (false discovery rate <0.05). 259 proteins were associated with >1.5-fold increased risk of infection versus non-infection mortality. Of these, we identified genetically predicted increasing MERTK concentration was associated with increased risk of infection mortality. MR supported a causal association between increasing plasma MERTK protein and infection mortality (odds ratio 1.46 per unit; 95% CI 1.15- 1.85; p = 0.002).

Conclusion

Plasma MERTK is causally associated with infection mortality and warrants exploration as a potential therapeutic target.

背景:尽管已有公共卫生、抗微生物和疫苗干预措施,但传染病仍是导致死亡的主要原因。我们的目的是确定与感染死亡率相关的血浆蛋白质组,然后应用孟德尔随机化(MR)方法得出可能存在因果关系的生物标志物:我们利用英国生物库血浆蛋白质组数据,将2923种血浆蛋白质与2019年12月31日前的感染死亡率联系起来(52520名参与者中的240起事件)。由于许多血浆蛋白也能预测非感染死亡率,因此在排除幸存者的分析中,我们将重点放在与感染死亡风险>1.5倍相关的血浆蛋白上。然后使用蛋白质定量性状评分(pQTS)来确定基因预测的蛋白质水平是否也与感染死亡率相关。为了进行两个样本 MR,我们利用没有血浆蛋白质组数据的英国生物库参与者(n=363,953,包括 984 例感染死亡病例)对感染死亡率进行了全基因组关联研究(GWAS):在对临床风险因素进行调整后,1,142种血浆蛋白与感染死亡风险相关(感染与非感染死亡风险的误发现率增加1.5倍)。其中,我们发现基因预测的 MERTK 浓度增加与感染死亡风险增加有关。MR支持血浆MERTK蛋白增加与感染死亡率之间的因果关系(每单位的几率比1.46;95% CI 1.15- 1.85;P=0.002):结论:血浆 MERTK 与感染死亡率存在因果关系,值得将其作为潜在的治疗靶点进行研究。
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引用次数: 0
16S ribosomal RNA gene amplicons in diagnosis of infectious diseases 16S 核糖体 RNA 基因扩增片段在传染病诊断中的应用。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-03 DOI: 10.1016/j.jinf.2024.106263
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引用次数: 0
Looming threat of Mpox in Pakistan: Time to take urgent measures 巴基斯坦迫在眉睫的麻风腮威胁:采取紧急措施的时候到了
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-03 DOI: 10.1016/j.jinf.2024.106266
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引用次数: 0
The IL-6 hypothesis in COVID-19: A phase 2, randomised, double-blind, placebo-controlled study to evaluate the efficacy and safety of free IL-6 sequestration by the monoclonal antibody sirukumab in severe and critical COVID-19 COVID-19中的IL-6假说:一项 2 期随机、双盲、安慰剂对照研究,评估单克隆抗体 Sirukumab 封闭游离 IL-6 对严重和危重 COVID-19 的疗效和安全性。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-02 DOI: 10.1016/j.jinf.2024.106241

Background

Upregulation of IL-6 has been associated with worse prognosis in COVID-19 patients. Impact on IL-6 signalling has mostly been limited to clinical outcomes in IL-6 receptor antagonist trials.

Methods

We performed a phase 2, randomised, double-blind, placebo-controlled trial (NCT04380961) of US-based hospitalised adults (<85 years) with laboratory-confirmed SARS-CoV-2 infection and severe (low levels of supplemental oxygen) or critical disease (high levels of oxygen supplementation). Patients received sirukumab 5 mg/kg or placebo single dose IV on Day 1 plus standard of care. The primary endpoint was time to sustained clinical improvement up to Day 28 based on an ordinal scale. Secondary endpoints included clinical improvement, all-cause mortality, and safety. Following an interim analysis, the protocol was amended to only recruit patients with critical COVID-19.

Findings

From May 2020 to March 2021, 209 patients were randomised; 112 had critical disease (72 sirukumab, 40 placebo) at baseline. Median time to sustained clinical improvement in critical patients was 17 and 23 days in the sirukumab and placebo groups (HR, 1∙1; 95% CI, 0∙66–1∙88; p > 0∙05). At Day 28, 59∙4% versus 55∙0% of patients achieved clinical improvement with sirukumab versus placebo and rates of all-cause mortality were 24∙6% versus 30∙0%, respectively. Rates of grade ≥3 adverse events were comparable between the sirukumab and placebo groups (25∙9% vs 32∙9%; all patients).

Interpretation

In critical COVID-19 patients who received sirukumab, there was no statistically significant difference in time to sustained clinical improvement versus placebo despite objective sequestration of circulating IL-6, questioning IL-6 as a key therapeutic target in COVID-19.

背景:IL-6的上调与COVID-19患者的预后恶化有关。在IL-6受体拮抗剂试验中,对IL-6信号转导的影响大多仅限于临床结果:方法:我们对美国住院的成人患者进行了一项 2 期随机、双盲、安慰剂对照试验(NCT04380961):2020年5月至2021年3月,209名患者接受了随机治疗;基线时,112人患有危重症(72人使用sirukumab,40人使用安慰剂)。sirukumab组和安慰剂组危重患者临床症状持续改善的中位时间分别为17天和23天(HR,1∙1;95% CI,0∙66-1∙88;P >0∙05)。在第28天,使用sirukumab与安慰剂相比,分别有59.4%和55.0%的患者临床症状得到改善,全因死亡率分别为24.6%和30.0%。sirukumab组与安慰剂组的≥3级不良事件发生率相当(25∙9% vs 32∙9%; 所有患者):在接受sirukumab治疗的COVID-19危重患者中,尽管循环中的IL-6被客观阻滞,但持续临床改善的时间与安慰剂相比没有统计学意义上的显著差异,这质疑了IL-6是COVID-19的关键治疗靶点:资金来源:Janssen Research & Development, LLC.
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引用次数: 0
Children with hemoglobin C or S trait have low serologic responses to a subset of malaria variant surface antigens 有血红蛋白 C 或 S 特质的儿童对疟疾变体表面抗原的血清反应较低。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-08-30 DOI: 10.1016/j.jinf.2024.106257

Children with hemoglobin AC or AS have decreased susceptibility to clinical malaria. Parasite variant surface antigen (VSA) presentation on the surface of infected erythrocytes is altered in erythrocytes with hemoglobin C (Hb AC) or sickle trait (Hb AS) mutations in vitro. The protective role of incomplete or altered VSA presentation against clinical malaria in individuals with Hb AC or AS is unclear. Using a high-throughput protein microarray, we sought to use serological responses to VSAs as a measure of host exposure to VSAs among Malian children with Hb AC, Hb AS, or wildtype hemoglobin (Hb AA). In uncomplicated malaria, when compared to Hb AA children, Hb AC children had significantly lower serological responses to extracellular Plasmodium falciparum erythrocyte membrane protein-1 (PfEMP1) domains but did not differ in responses to intracellular PfEMP1 domains and other VSAs, including members of the repetitive interspersed family (RIFIN) and subtelomeric variable open reading frame (STEVOR) family. Healthy children with Hb AC and Hb AS genotypes recognized fewer extracellular PfEMP1s compared to children with Hb AA, especially CD36-binding PfEMP1s. These reduced serologic responses may reflect reduced VSA presentation or lower parasite exposure in children with Hb AC or AS and provide insights into mechanisms of protection.

血红蛋白为 AC 或 AS 的儿童对临床疟疾的易感性降低。血红蛋白 C(Hb AC)或镰刀型血红蛋白(Hb AS)变异的红细胞在体外受感染红细胞表面的寄生虫变异表面抗原(VSA)呈递发生了改变。对于血红蛋白 AC 或镰状血红蛋白 AS 患者,不完全或改变的 VSA 表达对临床疟疾的保护作用尚不清楚。我们利用高通量蛋白芯片,试图用血清对VSAs的反应来衡量宿主暴露于Hb AC、Hb AS或野生型血红蛋白(Hb AA)的马里儿童中的VSAs的情况。在无并发症的疟疾中,与血红蛋白AA儿童相比,血红蛋白AC儿童对细胞外恶性疟原虫红细胞膜蛋白-1(PfEMP1)结构域的血清反应明显较低,但对细胞内PfEMP1结构域和其他VSAs(包括重复穿插家族(RIFIN)和次同源变异开放阅读框(STEVOR)家族成员)的反应没有差异。与血红蛋白 AA 儿童相比,血红蛋白 AC 和血红蛋白 AS 基因型的健康儿童能识别的细胞外 PfEMP1s 较少,尤其是与 CD36 结合的 PfEMP1s。这些降低的血清反应可能反映了血红蛋白 AC 或血红蛋白 AS 儿童的 VSA 表达减少或寄生虫暴露减少,并为保护机制提供了启示。
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引用次数: 0
Comparative effectiveness of bivalent BA.4–5 or BA.1 mRNA booster vaccines among immunocompromised individuals across three Nordic countries: A nationwide cohort study 二价 BA.4.5 或 BA.1 mRNA 强化疫苗在三个北欧国家免疫力低下人群中的效果比较:一项全国性队列研究。
IF 14.3 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-08-30 DOI: 10.1016/j.jinf.2024.106261

Objectives

To estimate the effectiveness and waning of the bivalent BA.4–5 or BA.1 mRNA booster vaccine against Covid-19-related hospitalization and death in immunocompromised individuals.

Methods

Nationwide analyses across Nordic countries from 1 September 2022 to 31 October 2023 using a matched cohort design. Individuals boosted with a BA.4–5 or BA.1 vaccine were matched 1:1 with unboosted individuals. The outcomes of interest were country-combined vaccine effectiveness (VE) estimates against Covid-19-related hospitalization and death at day 270 of follow-up. Waning was assessed in 45-day intervals.

Results

A total of 352,762 BA.4–5 and 191,070 BA.1 booster vaccine doses were included. At day 270, the comparative VE against Covid-19-related hospitalization was 34.2% (95% CI, 7.1% to 61.3%) for the bivalent BA.4–5 vaccine and 42.6% (95% CI, 31.3% to 53.9%) for the BA.1 vaccine compared with matched unboosted. The comparative VE against Covid-19-related death was 53.9% (95% CI, 38.6% to 69.3%) for the bivalent BA.4–5 vaccine and 57.9% (95% CI, 48.5% to 67.4%) for the BA.1 vaccine.

Conclusions

In immunocompromised individuals, vaccination with bivalent BA.4–5 or BA.1 booster lowered the risk of Covid-19-related hospitalization and death over a follow-up period of 9 months. The effectiveness was highest during the first months since vaccination with subsequent gradual waning.

目的估计二价 BA.4-5 或 BA.1 mRNA 强化疫苗对免疫力低下者因 Covid-19 导致的住院和死亡的有效性和减弱情况:方法:采用匹配队列设计,对北欧国家 2022 年 9 月 1 日至 2023 年 10 月 31 日期间的全国情况进行分析。接种 BA.4-5 或 BA.1 疫苗的个体与未接种疫苗的个体进行 1:1 配对。关注的结果是在随访的第 270 天,针对与 Covid-19 相关的住院和死亡的国家综合疫苗有效性 (VE) 估计值。每隔 45 天对衰减情况进行评估:共纳入了 352,762 剂 BA.4-5 和 191,070 剂 BA.1 强化疫苗。在第270天,与匹配的未加强疫苗相比,二价BA.4-5疫苗预防Covid-19相关住院的比较VE为34.2%(95% CI,7.1%至61.3%),BA.1疫苗为42.6%(95% CI,31.3%至53.9%)。二价BA.4-5疫苗预防Covid-19相关死亡的比较VE为53.9%(95% CI,38.6%至69.3%),BA.1疫苗为57.9%(95% CI,48.5%至67.4%):结论:在免疫力低下的人群中,接种二价 BA.4-5 或 BA.1 强化疫苗可在 9 个月的随访期内降低与 Covid-19 相关的住院和死亡风险。接种后的头几个月效果最好,随后逐渐减弱。
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引用次数: 0
期刊
Journal of Infection
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