Risk of death and cardiovascular events following COVID-19 vaccination or positive SARS-CoV-2 test amongst adult Singaporeans during omicron transmission.

Autor: Wee LE; National Centre for Infectious Diseases, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore. Electronic address: ian.wee.l.e@singhealth.com.sg., Malek MIBA; Ministry of Health, Singapore., Tan J; Ministry of Health, Singapore., Chiew C; National Centre for Infectious Diseases, Singapore; Ministry of Health, Singapore., Lee V; National Centre for Infectious Diseases, Singapore; Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore., Heng D; Ministry of Health, Singapore., Ong B; Ministry of Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Lye DC; National Centre for Infectious Diseases, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore., Tan KB; National Centre for Infectious Diseases, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore; Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Jazyk: angličtina
Zdroj: Vaccine [Vaccine] 2024 Sep 18; Vol. 42 (26), pp. 126356. Date of Electronic Publication: 2024 Sep 18.
DOI: 10.1016/j.vaccine.2024.126356
Abstrakt: Importance: Assessing population-wide risk-benefit ratio of COVID-19 vaccination remains relevant in the current era of Omicron endemicity and boosting. Assessments of mortality risk and cardiovascular events post-vaccination/infection were generally made prior to emergence of milder Omicron and booster rollout.
Methods: Retrospective cohort study from 6th January to 31st December 2022 (Omicron-predominant transmission), amongst adult Singaporeans aged ≥18 years. Cox regression models adjusted for demographics/comorbidities were used to estimate risk of all-cause mortality and cardiovascular events 0-180 days post-mRNA vaccination/SARS-CoV-2 infection, compared to >180 days post-mRNA vaccination. Risk periods post-vaccination were further stratified by presence/absence of SARS-CoV-2 infection in the preceding 180 days; similarly, risk periods post-infection were further stratified by vaccination in the 180 days preceding infection.
Results: 3,137,210 adults participated, with 2,047,008 vaccine doses administered (99 % being booster doses) and 1,189,846 infections. 23,028 deaths and 54,017 cardiac events were recorded. No elevated risk of all-cause mortality/cardiovascular events was observed across all age strata post-vaccination. Conversely, all-cause mortality post-infection remained elevated up to >180 days in older adults (≥60 years), compared to person-time > 180 days post-vaccination. For vaccine-breakthrough SARS-CoV-2 infection in older adults vaccinated <180 days prior, risk of mortality was only elevated up to 60 days post-infection, but not beyond. Elevated risk of cardiovascular events 1-2 months after any SARS-CoV-2 infection was observed across all age strata, with elevated risk observed in older adults >180 days post-infection (adjusted-hazards-ratio, aHR = 1.18, 95 %CI = 1.04-1.34). Preceding vaccination within 180 days prior to infection attenuated this risk, with no significantly elevated post-acute risk of cardiovascular events (>180 days: aHR = 1.10, 95 %CI = 0.95-1.07).
Conclusion: No increased risk of all-cause mortality or cardiovascular events was observed up to 180 days after any mRNA vaccination dose in the Omicron era; vaccination attenuated post-acute cardiovascular risk in older adults. The risk-benefit ratio of vaccination remained positive during Omicron.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors report no conflicts of interest.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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