2021年11月首次在非洲南部发现的高传播性SARS-CoV-2的omicron变种，到2021年12月底成为美国的主要变种。该项研究旨在比较美国初级系列covid-19疫苗加强化剂量与单独初级系列疫苗在预防与欧米克隆相关的covid-19住院的有效性

该项研究纳入2385例患者，初级系列的疫苗有效性为36% (21% - 48%)(P＜0.001);mRNA-1273 (Moderna):初级系列加两个助推器68%(17% - 88%)，初级系列加一个助推器65%(55% - 73%)，初级系列单独使用41% (25% - 54%)(P=0.001)。在免疫功能低下的患者中，初级系列加上一种增强剂的疫苗有效性为69%(31% - 86%)，而单纯初级系列的疫苗有效性为49% (30% - 63%)(P=0.04)。

在美国，2022年的前6个月，在预防与欧米克隆相关的covid-19入院方面，covid-19疫苗强化剂量提供了比单一初级系列疫苗更多的好处。

Abstract

Objective: To compare the effectiveness of a primary covid-19 vaccine series plus booster doses with a primary series alone for the prevention of hospital admission with omicron related covid-19 in the United States.

Design: Multicenter observational case-control study with a test negative design.

Setting: Hospitals in 18 US states.

Participants: 4760 adults admitted to one of 21 hospitals with acute respiratory symptoms between 26 December 2021 and 30 June 2022, a period when the omicron variant was dominant. Participants included 2385 (50.1%) patients with laboratory confirmed covid-19 (cases) and 2375 (49.9%) patients who tested negative for SARS-CoV-2 (controls).

Main outcome measures: The main outcome was vaccine effectiveness against hospital admission with covid-19 for a primary series plus booster doses and a primary series alone by comparing the odds of being vaccinated with each of these regimens versus being unvaccinated among cases versus controls. Vaccine effectiveness analyses were stratified by immunosuppression status (immunocompetent, immunocompromised). The primary analysis evaluated all covid-19 vaccine types combined, and secondary analyses evaluated specific vaccine products.

Results: Overall, median age of participants was 64 years (interquartile range 52-75 years), 994 (20.8%) were immunocompromised, 85 (1.8%) were vaccinated with a primary series plus two boosters, 1367 (28.7%) with a primary series plus one booster, and 1875 (39.3%) with a primary series alone, and 1433 (30.1%) were unvaccinated. Among immunocompetent participants, vaccine effectiveness for prevention of hospital admission with omicron related covid-19 for a primary series plus two boosters was 63% (95% confidence interval 37% to 78%), a primary series plus one booster was 65% (58% to 71%), and for a primary series alone was 37% (25% to 47%) (P<0.001 for the pooled boosted regimens compared with a primary series alone). Vaccine effectiveness was higher for a boosted regimen than for a primary series alone for both mRNA vaccines (BNT162b2 (Pfizer-BioNTech): 73% (44% to 87%) for primary series plus two boosters, 64% (55% to 72%) for primary series plus one booster, and 36% (21% to 48%) for primary series alone (P<0.001); mRNA-1273 (Moderna): 68% (17% to 88%) for primary series plus two boosters, 65% (55% to 73%) for primary series plus one booster, and 41% (25% to 54%) for primary series alone (P=0.001)). Among immunocompromised patients, vaccine effectiveness for a primary series plus one booster was 69% (31% to 86%) and for a primary series alone was 49% (30% to 63%) (P=0.04).

Conclusion: During the first six months of 2022 in the US, booster doses of a covid-19 vaccine provided additional benefit beyond a primary vaccine series alone for preventing hospital admissions with omicron related covid-19.

文章连接：www.bmj.com/content/bmj/379/bmj-2022-072065.full.pdf

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