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沪上疫情回溯分析-累计重症数、疫苗接种率及保护效力

微博 伊洛牧 伊洛 2022-09-18

千呼万唤始出来,沪上终于以文献形式披露了疫情、疫苗、感染者状况等更多数据。发布者为上海疾控中心副主任孙晓冬、复旦公卫学院王伟炳教授等作者,数据可靠、权威。

文章分析了202112-2022513日大于3岁的新冠感染者数据,获得样本量61.26万人(系统阳性感染者61.8万人,剔除5402人年龄小于3岁;可供参考的是实际3月份-5月份上海全口径累计报告感染62.7万人)。
1、首次知晓大致的累计危重症人数

分析样本中,披露了累计危重症患者人数1485人,加上568例死亡,早先沪上只披露当天在治疗的危重症人数,此次累计值应为首次向公众公开。

那么累计危重、死亡患者数量达到了2053人,重症或死亡率达到了3.35‰。这个千分之三数值和早先吉林、长春数万病例情况经验基本一致。考虑到养老院的混乱,考虑到沪上老年人口较低的接种率,能压低到这个程度已经是全国数万医护驰援的结果了。

但疫情早期,舆情一度认为上海重症极为罕见;疫情中后期,上海披露口径又是当日在治疗的危重症,从未主动披露累计值,导致危重症最高数值仅停留在5月5日的621人,也造成一定误导
2、首次知晓不同年龄段疫苗接种情况

上海是直到全城静默半个多月后的4月17日,才在新闻发布会披露,“上海60岁及以上人群新冠疫苗全程接种率只有62%,加强针的完成接种率大概是38%”。

如果早点披露,可能也根本不会造成初期对于清零政策的动摇。参考早先文章4.17疫情小结-疫苗接种率极低,沪上无资格讨论共存

此篇论文披露分年龄段的疫苗接种数据,60-79岁大致约3成、80岁以上大致约8成未接种疫苗。最为高危的人群,接种率却最差。若非及时阻断更大范围传播、全国及时援助数万医护前来,死亡人数毫无疑问会进一步上升。

3、灭活疫苗预防奥密克戎感染能力较差,但可预防重症及死亡
灭活疫苗对感染的有效性为16.3%(95% CI:15.4%-17.2%),
对严重/危重COVID-19的有效性为88.6%(95% CI:85.8%-90.9%),
对COVID-19死亡的有效性为91.7%(95% CI:86.9%-94.7%)。
这个结果跟mRNA疫苗基本类似,期待后续双价疫苗能有更好结果吧。
文献摘要如下(中文为机翻):
Methods 
A matched case-control study was conducted among people aged ≥3 years between 2 December 2021 through 13 May 2022.
Cases were SARS-CoV-2 infected individuals, individuals with severe/critical COVID-19, or COVID-19-related deaths.
Controls were selected from consecutively test negative individuals at the same time as cases were diagnosed and were exact-matched on year-of-age, gender, birthplace, illness onset date, and residency district in ratios of 1:1 with infected individuals and 4:1 with severe/critical COVID-19 and COVID-19-related deaths.
方法
在2021年12月2日至2022年5月13日期间,在年龄≥3岁的人群中进行了一项匹配的病例对照研究。
病例是SARS-CoV-2感染者、COVID-19严重/危重患者或COVID-19相关死亡者。
对照组是在诊断病例的同时,从连续检测阴性的人中选取的,并根据年龄、性别、出生地、发病日期和居住地进行精确匹配,与感染者的比例为1:1,与严重/临界COVID-19和COVID-19相关死亡的比例为4:1。
Results 
Our study included 612597 documented SARS-CoV-2 infections, among which 1485 progressed to severe or critical illness and 568 died.
Inactivated vaccine was 16.3% (95% CI: 15.4%-17.2%) effective against infection, 88.6% (95% CI: 85.8%-90.9%) effective against severe/critical COVIID-19 and 91.7% (95% CI: 86.9%-94.7%) against COVID-19 death.
Ad5-vectored vaccine was 13.2% (95% CI: 10.9%-15.5%) effective against infection and 77.9% (95% CI: 15.6%-94.2%) effective against severe/critical COVIID-19. Booster vaccination with inactivated vaccines enhanced protection against severe COVID-19 (92.7%, 95% CI: 90.1%-94.6%) and COVID-19 death (95.9%, 95% CI: 91.4%-98.1%).
Inactivated VE against infection began to wane 12 weeks after the last dose but two- and three-dose sustained high protection levels (>80%) against severe/critical illness and death.
研究结果
我们的研究包括612597例有记录的SARS-CoV-2感染者,其中1485例发展为重症或危重症,568例死亡。
灭活疫苗对感染的有效性为16.3%(95% CI:15.4%-17.2%),对严重/危重COVIID-19的有效性为88.6%(95% CI:85.8%-90.9%),对COVID-19死亡的有效性为91.7%(95% CI:86.9%-94.7%)。
Ad5-vectored疫苗对感染有13.2%(95% CI:10.9%-15.5%)的效果,对严重/危重的COVIID-19有77.9%(95% CI:15.6%-94.2%)效果。灭活疫苗的强化接种加强了对严重COVID-19(92.7%,95% CI:90.1%-94.6%)和COVID-19死亡(95.9%,95% CI:91.4%-98.1%)的保护。
灭活疫苗对感染的保护在最后一剂后的12周开始减弱,但两剂和三剂对严重/危重疾病和死亡的保护水平持续很高(>80%)。
Conclusions 
Our real-world study found high and durable two- and three-dose inactivated VE against Omicron-associated severe/critical illness and death across all age groups, but lower effectiveness against Omicron infection.
High direct protection from severe/fatal Omicron COVID-19 provided by inactivated vaccines, and a consequent potential reduction in health-care utilization, reinforces the critical importance of full-series vaccination and timely booster dose administration for all eligible individuals.
结论
我们的真实世界研究发现,两剂和三剂灭活VE对所有年龄组的Omicron相关的严重/危重疾病和死亡都有较高和持久的保护作用,但对Omicron感染的有效性较低。
灭活疫苗对严重/致命的Omicron COVID-19提供了高度的直接保护,并因此有可能减少医疗服务的使用,这加强了对所有符合条件的人进行全系列疫苗接种和及时加强剂量管理的极端重要性。

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