Clin Infect Dis:新加坡真实世界研究揭示mRNA疫苗与灭活疫苗在防止新冠病毒感染和重症风险中的作用

2022-04-15 网络 网络

一项新的新加坡研究比较了 Covid-19 疫苗对感染和严重疾病的有效性,于 2022 年 4 月 12 日在Clin Infect Dis上发表。 该研究旨在比较新加坡的四种可用疫苗,并调查其他研究

一项新的新加坡研究比较了 Covid-19 疫苗对新冠病毒感染和重症预防的效果,于 2022 年 4 月 12 日在Clin Infect Dis上发表。 该研究旨在比较新加坡的四种可用疫苗,并调查其他研究的结果,即 mRNA 疫苗比非 mRNA 疫苗具有更高的功效。

这四种疫苗是辉瑞-BioNTech/Comirnaty 疫苗和 Moderna 疫苗,它们是 mRNA 疫苗,以及 Sinovac-CoronaVacvaccine 和国药疫苗,它们是使用灭活病毒触发免疫反应的非 mRNA 疫苗。辉瑞疫苗被用作参考,因为它在新加坡最常用。

该研究调查了 2021 年 10 月 1 日至 11 月 21 日期间 Covid-19 感染和严重疾病的发生率,并利用了新加坡卫生部 (MOH) 维护的官方数据库。研究者将队列限制在完成两剂疫苗后的两周内,以产生足够的免疫反应,并且在我们分析后的 120 天内接受了第二剂疫苗以控制免疫减弱。另外, “严重疾病”被定义为需要在医院补充氧气、进入重症监护室或死亡。

在接种两剂疫苗后的 14 至 120 天内,有 2,709,899 人被纳入研究队列,其中 2,001,181 人(74%)接受辉瑞 BioNTech/Comirnaty,628,012 人(23%)接受 Moderna,60,407 人(2%)接受 Sinovac CoronaVac 和 20,299 (1%) 获得国药控股。 在研究期间,通过 PCR 确认 107,220 人感染了 COVID-19,其中 644 人发展为严重疾病。

在调整了年龄、性别、种族、居住状况、社会经济地位、自第二次接种后的时间和每日感染率后,接种了 Sinovac-CoronaVac 疫苗的个体更有可能被感染(调整后的 IRR 2.37;95% CI 2.29 – 2.46),并且 更有可能患上严重疾病(调整后的 IRR 4.59;95% CI 3.25 – 6.48); 与国药集团相比,接种国药的个体感染风险也较高(调整后的 IRR 1.62;95% CI 1.43 – 1.85),而接种 Moderna 的个体患严重疾病的风险较低(调整后的 IRR 0.42;95% CI 0.25 – 0.70) 与那些接受辉瑞-BioNTech/Comirnaty 的人(表 1)

换句话说,以辉瑞mRNA疫苗作为参照,接受 科兴灭活疫苗(Sinovac-CoronaVac)治疗的人:被感染的可能性是接受辉瑞公司治疗的人的 2.37 倍;接受国药灭活疫苗的人感染几率是接受辉瑞的人的1.62倍;而接受 Moderna 的人感染的可能性是接受辉瑞(Pfizer)的人的 0.84 倍。预防因 Covid-19 感染引起重症的结果显示,接受科兴灭活疫苗(Sinovac-CoronaVac)治疗的人,患严重疾病的可能性是接受辉瑞治疗的人的 4.59 倍;接受国药治疗的人,患重症的可能性是接受辉瑞药物治疗的人的 1.62 倍;接受 Moderna 的人,患严重疾病的可能性是接受辉瑞(Pfizer)的人的 0.42 倍。

总体而言,各个疫苗的效果对比为莫德纳>辉瑞>国药>科兴。

研究者认为,观察到接种 2 剂灭活全病毒疫苗的个体与接种 mRNA 疫苗的个体相比,对 COVID-19 感染的保护作用较低。 尽管如此,mRNA 疫苗和灭活的全病毒疫苗都能为 COVID-19 严重疾病提供足够的保护,疫苗接种仍然是应对大流行的关键策略。 UK COV-BOOST 等研究表明,第三剂可提供针对 COVID-19 的额外保护,未来的研究应继续监测这些疫苗的有效性并评估进一步加强剂量如何增强它们。

研究认为,“mRNA 疫苗和灭活的全病毒疫苗都提供了针对 Covid-19 严重疾病的充分保护”,并肯定了疫苗接种作为 Covid-19 大流行中“关键策略”的重要性。

该研究的作者在介绍中说:“我们的目标是比较同一人群中的 mRNA 和灭活的全病毒疫苗,因为这些发现将有助于指导政策建议以预防感染和减少医疗保健系统的压力。”

不过,梅斯医学也提醒到,这项研究虽然很严谨,且样本量大,但是,还有两个重要问题需要注意:

其一,研究在2021 年 10 月 1 日至 11 月 21 日期间,在这一期间,仍然是以Delta感染为主,而不是Omicron,今后有必要再针对Omicron感染进行综合评价。同时,最新智利一项研究在Omicron期间科兴疫苗对儿童的保护作用,见:智利研究报告科兴新冠病毒灭活疫苗在儿童感染奥密克戎期间的真实世界中效果-MedSci.cn,通过综合判断,才可能更为全面了解疫苗的作用。

其二,本研究主要评价两针疫苗的保护作用,三针的作用未进行比较。结合此前香港的最新的结果显示,三针灭活疫苗对老人的重症和死亡的保护作用,近似于mRNA疫苗(辉瑞),对于灭活疫苗而言,三针的效果远远优于两针;而对于mRNA疫苗而言,三针比两针的效果仅有限提高。因此,两针与三针的效果,同样有巨大的差异,未来也需要更多的数据进行评估。

原始出处:

Premikha M, Chiew CJ, Wei WE, Leo YS, Ong B, Lye DC, Lee VJ, Tan KB.Comparative Effectiveness of mRNA and Inactivated Whole Virus Vaccines against COVID-19 Infection and Severe Disease in Singapore.Clin Infect Dis. 2022 Apr 12:ciac288. doi: 10.1093/cid/ciac288

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    2022-09-17 小小医者

    新加坡#真实世界研究#揭示#mRNA疫苗##灭活疫苗#在防止#新冠病毒#感染和重症风险中的作用

    0

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