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英国医护人员新冠康复者再感染风险分析
作者:小柯机器人 发布时间:2021/4/14 14:08:59

英国公共卫生部Victoria Jane Hall团队比较了英国医护人员抗体阳性与抗体阴性的SARS-CoV-2感染率。2021年4月9日,该研究发表在《柳叶刀》杂志上。

从COVID-19中恢复的个体是否能免受未来SARS-CoV-2感染?人们迫切想了解该问题的答案。

为了探讨抗SARS-CoV-2抗体是否与降低有症状和无症状再感染的风险相关,研究组进行了一项大型、多中心、前瞻性队列研究,参与者来自英格兰所有地区的公立医院。参与者定期参加SARS-CoV-2 PCR和抗体检测(每2-4周一次),同时每2周完成一次症状和暴露的问卷调查。在登记时,参与者被分配到阳性队列(抗体阳性,或先前PCR阳性)或阴性队列(抗体阴性,无先前阳性PCR)。主要结局是阳性队列中的再感染或阴性队列中的原发感染,通过PCR检测确定。根据病例定义和症状状态对潜在再感染进行临床回顾和分类,比较两组人群的感染率。

2020年6月18日到2020年12月31日,共有30625名参与者被纳入研究。51名参与者退出研究,4913名被排除在外,25661名参与者(有抗体和PCR检测的相关数据)被纳入分析。研究组在8278名受试者的基线阳性队列中检测到155例感染,共随访了2047113人-日。相比之下,在17383名参与者的阴性队列中,有1704例新发PCR阳性感染,共随访了2971436人-日。

2020年6月至2021年1月,阳性队列的发病密度为每10万人-日7.6例再感染,而阴性队列的发病密度为每10万人-日57.3例原发感染。与PCR证实的原发感染相比,所有再感染的校正IRR为0.159。原发感染和再感染之间的中位间隔超过200天。

研究结果表明,既往SARS-CoV-2感染史与84%的感染风险降低相关,在原发性感染后7个月观察到中位保护效果。以前感染过SARS-CoV-2可诱导大多数人对未来感染产生有效的免疫。

附:英文原文

Title: SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN)

Author: Victoria Jane Hall, Sarah Foulkes, Andre Charlett, Ana Atti, Edward J Monk, Ruth Simmons, Edgar Wellington, Michelle J Cole, Ayoub Saei, Blanche Oguti, Katie Munro, Sarah Wallace, Peter D Kirwan, Madhumita Shrotri, Amoolya Vusirikala, Sakib Rokadiya, Meaghan Kall, Maria Zambon, Mary Ramsay, Tim Brooks, Colin S Brown, Meera A Chand, Susan Hopkins, N Andrews, A Atti, H Aziz, T Brooks, CS Brown, D Camero, C Carr, MA Chand, A Charlett, H Crawford, M Cole, J Conneely, S DArcangelo, J Ellis, S Evans, S Foulkes, N Gillson, R Gopal, L Hall, VJ Hall, P Harrington, S Hopkins, J Hewson, K Hoschler, D Ironmonger, J Islam, M Kall, I Karagiannis, O Kay, J Khawam, E King, P Kirwan, R Kyffin, A Lackenby, M Lattimore, E Linley, J Lopez-Bernal, L Mabey, R McGregor, S Miah, EMJ Monk, K Munro, Z Naheed, A Nissr, AM OConnell, B Oguti, H Okafor, S Organ, J Osbourne, A Otter, M Patel, S Platt, D Pople, K Potts, M Ramsay, J Robotham, S Rokadiya, C Rowe, A Saei, G Sebbage, A Semper, M Shrotri, R Simmons, A Soriano, P Staves, S Taylor, A Taylor, A Tengbe, S Tonge, A Vusirikala, S Wallace, E Wellington, M Zambon, D Corrigan, M Sartaj, L Cromey, S Campbell, K Braithwaite, L Price, L Haahr, S Stewart, ED Lacey, L Partridge, G Stevens, Y Ellis, H Hodgson, C Norman, B Larru, S Mcwilliam, S Winchester, P Cieciwa, A Pai, C Loughrey, A Watt, F Adair, A Hawkins

Issue&Volume: 2021-04-09

Abstract:

Background

Increased understanding of whether individuals who have recovered from COVID-19 are protected from future SARS-CoV-2 infection is an urgent requirement. We aimed to investigate whether antibodies against SARS-CoV-2 were associated with a decreased risk of symptomatic and asymptomatic reinfection.

Methods

A large, multicentre, prospective cohort study was done, with participants recruited from publicly funded hospitals in all regions of England. All health-care workers, support staff, and administrative staff working at hospitals who could remain engaged in follow-up for 12 months were eligible to join The SARS-CoV-2 Immunity and Reinfection Evaluation study. Participants were excluded if they had no PCR tests after enrolment, enrolled after Dec 31, 2020, or had insufficient PCR and antibody data for cohort assignment. Participants attended regular SARS-CoV-2 PCR and antibody testing (every 2–4 weeks) and completed questionnaires every 2 weeks on symptoms and exposures. At enrolment, participants were assigned to either the positive cohort (antibody positive, or previous positive PCR or antibody test) or negative cohort (antibody negative, no previous positive PCR or antibody test). The primary outcome was a reinfection in the positive cohort or a primary infection in the negative cohort, determined by PCR tests. Potential reinfections were clinically reviewed and classified according to case definitions (confirmed, probable, or possible) and symptom-status, depending on the hierarchy of evidence. Primary infections in the negative cohort were defined as a first positive PCR test and seroconversions were excluded when not associated with a positive PCR test. A proportional hazards frailty model using a Poisson distribution was used to estimate incidence rate ratios (IRR) to compare infection rates in the two cohorts.

Findings

From June 18, 2020, to Dec 31, 2020, 30625 participants were enrolled into the study. 51 participants withdrew from the study, 4913 were excluded, and 25661 participants (with linked data on antibody and PCR testing) were included in the analysis. Data were extracted from all sources on Feb 5, 2021, and include data up to and including Jan 11, 2021. 155 infections were detected in the baseline positive cohort of 8278 participants, collectively contributing 2047113 person-days of follow-up. This compares with 1704 new PCR positive infections in the negative cohort of 17383 participants, contributing 2971436 person-days of follow-up. The incidence density was 7·6 reinfections per 100000 person-days in the positive cohort, compared with 57·3 primary infections per 100000 person-days in the negative cohort, between June, 2020, and January, 2021. The adjusted IRR was 0·159 for all reinfections (95% CI 0·13–0·19) compared with PCR-confirmed primary infections. The median interval between primary infection and reinfection was more than 200 days.

Interpretation

A previous history of SARS-CoV-2 infection was associated with an 84% lower risk of infection, with median protective effect observed 7 months following primary infection. This time period is the minimum probable effect because seroconversions were not included. This study shows that previous infection with SARS-CoV-2 induces effective immunity to future infections in most individuals.

DOI: 10.1016/S0140-6736(21)00675-9

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00675-9/fulltext

期刊信息

LANCET:《柳叶刀》,创刊于1823年。隶属于爱思唯尔出版社,最新IF:59.102
官方网址:http://www.thelancet.com/
投稿链接:http://ees.elsevier.com/thelancet