以色列奥米克隆波期间患有严重COVID-19的住院患者-第四剂疫苗的益处

Tal Brosh-Nissimov, K. Hussein, Y. Wiener‐Well, E. Orenbuch-Harroch, Meital Elbaz, Shelly Lipman-Arens, Y. Maor, Y. Yagel, B. Chazan, M. Hershman-Sarafov, G. Rahav, O. Zimhony, Adi Zaidman Shimshovitz, M. Chowers
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引用次数: 13

摘要

重要性:在Omicron爆发期间,对COVID-19的免疫力下降,同时发病率增加,导致以色列卫生部向高危人群推荐第二剂BNT162b2(辉瑞)加强剂。以色列是第一个提出这一建议的国家,它允许评估第四剂疫苗对住院重症患者的额外保护作用。目的:评价新冠肺炎重症/危重型突破住院患者第四次用药的效果。设计:对2022年1月15日至2022年1月31日住院的成年人进行队列研究。环境:以色列14个医疗中心的多中心研究。参与者:经pcr确诊的重症/危重型COVID-19住院成人患者。排除了缺乏疫苗接种状况数据的患者。暴露:根据诊断前7天内接受的疫苗剂量总数对病例进行分类。未接种疫苗的成年人和单次接种者被分为未接种组。主要转归:机械通气或院内死亡的组合被定义为不良转归。比较了3剂和4剂疫苗接种者的结果。结果:纳入重症/危重型COVID-19患者1049例,中位年龄80岁(IQR 69 ~ 87),男性占51%。其中未接种者360人,接种1剂、2剂、3剂、4剂者分别为34人、172人、386人、88人。接种3次疫苗的患者年龄较大,男性较多,免疫抑制较多,但与未接种疫苗的患者相比,结果相似,分别为49%和51% (p=0.72)。接种4次疫苗的患者同样年龄较大且免疫抑制,但与未接种疫苗的患者相比,结果有所改善,34% vs. 51% (p<0.01)。我们进一步检查了完全接种疫苗的患者预后不良的独立预测因素,这些患者在诊断前3次接种的中位数为161 (IQR 147-168)天,或4次接种的中位数为14 (IQR 10-18)天。接受第四剂具有显著的保护作用:OR 0.51 (95%CI 0.30.87)。结论和相关性:在COVID-19重症/危重突破住院患者人群中,与完全接种单次疫苗的个体相比,最近接种的第四剂疫苗与防止机械通气或死亡的显着保护相关。
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Hospitalized patients with severe COVID-19 during the Omicron wave in Israel – benefits of a fourth vaccine dose
Importance: Waning immunity against COVID-19 in parallel with an increased incidence during the Omicron outbreak led the Israeli Ministry of Health to recommend a second booster dose of BNT162b2 (Pfizer) to high-risk individuals. Israel was the first country to recommend this, allowing evaluation of the added protection of a fourth vaccine dose to hospitalized patients with severe diseases. Objective: To assess the effect of a fourth dose for hospitalized patients with severe/critical breakthrough COVID-19. Design: A cohort study of hospitalized adults from 01/15/2022-01/31/2022. Settings: A multi center study of 14 medical centers in Israel. Participants: Hospitalized adult patients with PCR-confirmed severe/critical COVID-19. Excluded were patients lacking data on vaccination status. Exposure: Cases were divided according to the total number of vaccine doses received up to 7 days before diagnosis. Unvaccinated adults and single-dose recipients were grouped into an unvaccinated group. Main Outcome: A composite of mechanical ventilation or in-hospital death was defined as poor outcome. Outcomes were compared between 3- and 4-dose vaccinees. Results: Included were 1,049 patients with severe/critical COVID-19, median age 80 (IQR 69-87), 51% males. Among them, 360 unvaccinated, 34, 172, 386 and 88 were after 1, 2, 3 or 4 doses, respectively. Patients after 3 doses were older, had more males and immunosuppression, but with similar outcomes, 49% vs. 51% compared to unvaccinated patients (p=0.72). Patients after 4 doses were similarly older and immunosuppressed, but had improved outcomes compared to unvaccinated patients, 34% vs. 51% (p<0.01). We proceeded to examine independent predictors for poor outcome in fully-vaccinated patients with either 3 doses given a median of 161 (IQR 147-168) days earlier, or 4 doses given a median of 14 (IQR 10-18) days before diagnoses. Receipt of the fourth dose conferred significant protection: OR 0.51 (95%CI 0.30.87). Conclusion and Relevance: Within a population of hospitalized patients with severe/critical breakthrough COVID-19, a recent fourth dose was associated with significant protection against mechanical ventilation or death, compared to fully-vaccinated single boosted individuals.
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