RESUMO
Among adults at risk for severe coronavirus disease 2019 (COVID-19), the lowest hospitalization rate was among those who received nirmatrelvir-ritonavir after 3 or more messenger RNA vaccine doses (adjusted hazard ratio, 0.22; 95% confidence interval, .19-.24). Eligible adults, including those previously vaccinated, should be considered for COVID-19 antiviral treatment.
Assuntos
Antivirais , Vacinas contra COVID-19 , COVID-19 , Hospitalização , Ritonavir , SARS-CoV-2 , Humanos , Ritonavir/uso terapêutico , Ritonavir/administração & dosagem , Hospitalização/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Feminino , COVID-19/prevenção & controle , COVID-19/epidemiologia , Adulto , SARS-CoV-2/imunologia , Antivirais/uso terapêutico , Antivirais/administração & dosagem , Vacinas contra COVID-19/administração & dosagem , Idoso , Vacinação/estatística & dados numéricos , Leucina/análogos & derivados , Leucina/uso terapêutico , Tratamento Farmacológico da COVID-19 , Lactamas , Nitrilas , ProlinaRESUMO
BACKGROUND: In the United States, more than 30,000 cases of mpox (formerly known as monkeypox) had occurred as of March 1, 2023, in an outbreak disproportionately affecting transgender persons and gay, bisexual, and other men who have sex with men. In 2019, the JYNNEOS vaccine was approved for subcutaneous administration (0.5 ml per dose) to prevent mpox infection. On August 9, 2022, an emergency use authorization was issued for intradermal administration (0.1 ml per dose); however, real-world effectiveness data are limited for either route. METHODS: We conducted a case-control study based on data from Cosmos, a nationwide Epic electronic health record (EHR) database, to assess the effectiveness of JYNNEOS vaccination in preventing medically attended mpox disease among adults. Case patients had an mpox diagnosis code or positive orthopoxvirus or mpox virus laboratory result, and control patients had an incident diagnosis of human immunodeficiency virus (HIV) infection or a new or refill order for preexposure prophylaxis against HIV infection between August 15, 2022, and November 19, 2022. Odds ratios and 95% confidence intervals were estimated from conditional logistic-regression models, adjusted for confounders; vaccine effectiveness was calculated as (1 - odds ratio for vaccination in case patients vs. controls) × 100. RESULTS: Among 2193 case patients and 8319 control patients, 25 case patients and 335 control patients received two doses (full vaccination), among whom the estimated adjusted vaccine effectiveness was 66.0% (95% confidence interval [CI], 47.4 to 78.1), and 146 case patients and 1000 control patients received one dose (partial vaccination), among whom the estimated adjusted vaccine effectiveness was 35.8% (95% CI, 22.1 to 47.1). CONCLUSIONS: In this study using nationwide EHR data, patients with mpox were less likely to have received one or two doses of JYNNEOS vaccine than control patients. The findings suggest that JYNNEOS vaccine was effective in preventing mpox disease, and a two-dose series appeared to provide better protection. (Funded by the Centers for Disease Control and Prevention and Epic Research.).
Assuntos
Mpox , Eficácia de Vacinas , Adulto , Humanos , Masculino , Estudos de Casos e Controles , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Mpox/epidemiologia , Mpox/prevenção & controle , Minorias Sexuais e de Gênero/estatística & dados numéricos , Estados Unidos/epidemiologia , Eficácia de Vacinas/estatística & dados numéricosAssuntos
COVID-19 , Adulto , Humanos , Estados Unidos/epidemiologia , COVID-19/epidemiologia , HospitalizaçãoRESUMO
Nirmatrelvir-ritonavir (Paxlovid), an oral antiviral treatment, is authorized for adults with mild-to-moderate COVID-19 who are at increased risk for progression to severe illness. However, real-world evidence on the benefit of Paxlovid, according to vaccination status, age group, and underlying health conditions, is limited. To examine the benefit of Paxlovid in adults aged ≥18 years in the United States, a large electronic health record (EHR) data set (Cosmos) was analyzed to assess the association between receiving a prescription for Paxlovid and hospitalization with a COVID-19 diagnosis in the ensuing 30 days. A Cox proportional hazards model was used to estimate this association, adjusted for demographic characteristics, geographic location, vaccination, previous infection, and number of underlying health conditions. Among 699,848 adults aged ≥18 years eligible for Paxlovid during April-August 2022, 28.4% received a Paxlovid prescription within 5 days of COVID-19 diagnosis. Being prescribed Paxlovid was associated with a lower hospitalization rate among the overall study population (adjusted hazard ratio [aHR] = 0.49), among those who had received ≥3 mRNA COVID-19 vaccines (aHR = 0.50), and across age groups (18-49 years: aHR = 0.59; 50-64 years: aHR = 0.40; and ≥65 years: aHR = 0.53). Paxlovid should be prescribed to eligible adults to reduce the risk of COVID-19-associated hospitalization.