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Effectiveness of bivalent mRNA booster vaccination and previous infection in older adults during Omicron period: real-world evidence

医学 增强剂量 二价(发动机) 危险系数 队列 接种疫苗 助推器(火箭) 置信区间 比例危险模型 回顾性队列研究 内科学 免疫学 病毒 效价 化学 物理 有机化学 天文 金属
作者
Pedro Pablo España,Idoia Castillo-Sintes,María José Legarreta,Amaia Bilbao-González,Nere Larrea,María Gascón,Ane Uranga,Amaia Artaraz,Julia García-Asensio,José M. Quintana,Janire Portuondo,J.M. Aguado García,Amaia Bilbao González,Idoia Castillo Sintes,José M. Quintana,Susana García‐Gutiérrez,María José Legarreta,María Gascón,Nere Larrea,Nerea Gonzàlez,Josune Martín,Pedro Pablo España,Ane Uranga
出处
期刊:Age and Ageing [Oxford University Press]
卷期号:53 (11)
标识
DOI:10.1093/ageing/afae251
摘要

Abstract Background The effectiveness of booster bivalent vaccines against the Omicron variant, particularly amongst older patients, remains uncertain. Objective We sought to compare the relative effectiveness of a fourth dose of vaccine using bivalent messenger ribonucleic acid (mRNA), by comparing patients who had and had not received this dose. Methods We conducted a matched retrospective cohort study to assess the risk of COVID-19 infection, hospitalization and death of people aged >60 years with four doses as compared to those with only three doses. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). We adjusted by age, sex, nursing-home, comorbidities, primary care setting and previous episodes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We also investigated the impact of prior SARS-CoV-2 infection within each cohort, using the same methodology. Results The administration of a fourth bivalent mRNA vaccine dose conferred significant additional protection against COVID-19 infection (HR: 0.479; 95% CI: 0.454–0.506), hospitalization (HR: 0.393; 95% CI: 0.348–0.443) and 30-day mortality (HR: 0.234; 95% CI: 0.171–0.318), as compared to individuals who had received only a third monovalent vaccine dose. In both cohorts, a prior history of COVID-19 infection involves lower risk of COVID-infection, hospitalization and death. Conclusions During the period of Omicron predominance, receiving a bivalent booster vaccine as a fourth dose, as compared to receiving only three doses of a monovalent mRNA vaccine, provides significant extra protection against COVID-19 infection, hospitalization and mortality. Antecedents of SARS-CoV-2 prior to vaccination involves a notable reduction in the above COVID-19 outcomes.

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