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COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study

Utkarsh Agrawal, Srinivasa Vittal Katikireddi, Colin McCowan, Rachel H Mulholland, Amaya Azcoaga-Lorenzo, Sarah Amele, Adeniyi Francis Fagbamigbe, Eleftheria Vasileiou, Zoe Grange, Ting Shi, Steven Kerr, Emily Moore, Josephine L K Murray, Syed Ahmar Shah, Lewis Ritchie, Dermot O'Reilly, Sarah J Stock, Jillian Beggs, Antony Chuter, Fatemeh Torabi Orcid Logo, Ashley Akbari Orcid Logo, Stuart Bedston, Jim McMenamin, Rachael Wood, Ruby S M Tang, Simon de Lusignan, F D Richard Hobbs, Mark Woolhouse, Colin R Simpson, Chris Robertson, Aziz Sheikh

The Lancet Respiratory Medicine

Swansea University Authors: Fatemeh Torabi Orcid Logo, Ashley Akbari Orcid Logo, Stuart Bedston

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DOI (Published version): 10.1016/s2213-2600(21)00380-5

Abstract

BackgroundThe UK COVID-19 vaccination programme has prioritised vaccination of those at the highest risk of COVID-19 mortality and hospitalisation. The programme was rolled out in Scotland during winter 2020–21, when SARS-CoV-2 infection rates were at their highest since the pandemic started, despit...

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Published in: The Lancet Respiratory Medicine
ISSN: 2213-2600
Published: Elsevier BV 2021
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2021-10-29T16:07:38.6855669</datestamp><bib-version>v2</bib-version><id>58261</id><entry>2021-10-07</entry><title>COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2&#xB7;57 million people in Scotland (EAVE II): a prospective cohort study</title><swanseaauthors><author><sid>f569591e1bfb0e405b8091f99fec45d3</sid><ORCID>0000-0002-5853-4625</ORCID><firstname>Fatemeh</firstname><surname>Torabi</surname><name>Fatemeh Torabi</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>aa1b025ec0243f708bb5eb0a93d6fb52</sid><ORCID>0000-0003-0814-0801</ORCID><firstname>Ashley</firstname><surname>Akbari</surname><name>Ashley Akbari</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>c79d07eaba5c9515c0df82b372b76a41</sid><firstname>Stuart</firstname><surname>Bedston</surname><name>Stuart Bedston</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2021-10-07</date><deptcode>HDAT</deptcode><abstract>BackgroundThe UK COVID-19 vaccination programme has prioritised vaccination of those at the highest risk of COVID-19 mortality and hospitalisation. The programme was rolled out in Scotland during winter 2020&#x2013;21, when SARS-CoV-2 infection rates were at their highest since the pandemic started, despite social distancing measures being in place. We aimed to estimate the frequency of COVID-19 hospitalisation or death in people who received at least one vaccine dose and characterise these individuals.MethodsWe conducted a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) national surveillance platform, which contained linked vaccination, primary care, RT-PCR testing, hospitalisation, and mortality records for 5&#xB7;4 million people (around 99% of the population) in Scotland. Individuals were followed up from receiving their first dose of the BNT162b2 (Pfizer&#x2013;BioNTech) or ChAdOx1 nCoV-19 (Oxford&#x2013;AstraZeneca) COVID-19 vaccines until admission to hospital for COVID-19, death, or the end of the study period on April 18, 2021. We used a time-dependent Poisson regression model to estimate rate ratios (RRs) for demographic and clinical factors associated with COVID-19 hospitalisation or death 14 days or more after the first vaccine dose, stratified by vaccine type.FindingsBetween Dec 8, 2020, and April 18, 2021, 2&#x2009;572&#x2009;008 individuals received their first dose of vaccine&#x2014;841&#x2009;090 (32&#xB7;7%) received BNT162b2 and 1&#x2009;730&#x2009;918 (67&#xB7;3%) received ChAdOx1. 1196 (&lt;0&#xB7;1%) individuals were admitted to hospital or died due to COVID-19 illness (883 hospitalised, of whom 228 died, and 313 who died due to COVID-19 without hospitalisation) 14 days or more after their first vaccine dose. These severe COVID-19 outcomes were associated with older age (&#x2265;80 years vs 18&#x2013;64 years adjusted RR 4&#xB7;75, 95% CI 3&#xB7;85&#x2013;5&#xB7;87), comorbidities (five or more risk groups vs less than five risk groups 4&#xB7;24, 3&#xB7;34&#x2013;5&#xB7;39), hospitalisation in the previous 4 weeks (3&#xB7;00, 2&#xB7;47&#x2013;3&#xB7;65), high-risk occupations (ten or more previous COVID-19 tests vs less than ten previous COVID-19 tests 2&#xB7;14, 1&#xB7;62&#x2013;2&#xB7;81), care home residence (1&#xB7;63, 1&#xB7;32&#x2013;2&#xB7;02), socioeconomic deprivation (most deprived quintile vs least deprived quintile 1&#xB7;57, 1&#xB7;30&#x2013;1&#xB7;90), being male (1&#xB7;27, 1&#xB7;13&#x2013;1&#xB7;43), and being an ex-smoker (ex-smoker vs non-smoker 1&#xB7;18, 1&#xB7;01&#x2013;1&#xB7;38). A history of COVID-19 before vaccination was protective (0&#xB7;40, 0&#xB7;29&#x2013;0&#xB7;54).InterpretationCOVID-19 hospitalisations and deaths were uncommon 14 days or more after the first vaccine dose in this national analysis in the context of a high background incidence of SARS-CoV-2 infection and with extensive social distancing measures in place. Sociodemographic and clinical features known to increase the risk of severe disease in unvaccinated populations were also associated with severe outcomes in people receiving their first dose of vaccine and could help inform case management and future vaccine policy formulation.</abstract><type>Journal Article</type><journal>The Lancet Respiratory Medicine</journal><volume>0</volume><journalNumber/><paginationStart/><paginationEnd/><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2213-2600</issnPrint><issnElectronic/><keywords/><publishedDay>29</publishedDay><publishedMonth>9</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-09-29</publishedDate><doi>10.1016/s2213-2600(21)00380-5</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Scottish Government, and Health Data Research UK</funders><lastEdited>2021-10-29T16:07:38.6855669</lastEdited><Created>2021-10-07T09:59:50.6888561</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Utkarsh</firstname><surname>Agrawal</surname><order>1</order></author><author><firstname>Srinivasa Vittal</firstname><surname>Katikireddi</surname><order>2</order></author><author><firstname>Colin</firstname><surname>McCowan</surname><order>3</order></author><author><firstname>Rachel H</firstname><surname>Mulholland</surname><order>4</order></author><author><firstname>Amaya</firstname><surname>Azcoaga-Lorenzo</surname><order>5</order></author><author><firstname>Sarah</firstname><surname>Amele</surname><order>6</order></author><author><firstname>Adeniyi Francis</firstname><surname>Fagbamigbe</surname><order>7</order></author><author><firstname>Eleftheria</firstname><surname>Vasileiou</surname><order>8</order></author><author><firstname>Zoe</firstname><surname>Grange</surname><order>9</order></author><author><firstname>Ting</firstname><surname>Shi</surname><order>10</order></author><author><firstname>Steven</firstname><surname>Kerr</surname><order>11</order></author><author><firstname>Emily</firstname><surname>Moore</surname><order>12</order></author><author><firstname>Josephine L K</firstname><surname>Murray</surname><order>13</order></author><author><firstname>Syed Ahmar</firstname><surname>Shah</surname><order>14</order></author><author><firstname>Lewis</firstname><surname>Ritchie</surname><order>15</order></author><author><firstname>Dermot</firstname><surname>O'Reilly</surname><order>16</order></author><author><firstname>Sarah J</firstname><surname>Stock</surname><order>17</order></author><author><firstname>Jillian</firstname><surname>Beggs</surname><order>18</order></author><author><firstname>Antony</firstname><surname>Chuter</surname><order>19</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>20</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>21</order></author><author><firstname>Stuart</firstname><surname>Bedston</surname><order>22</order></author><author><firstname>Jim</firstname><surname>McMenamin</surname><order>23</order></author><author><firstname>Rachael</firstname><surname>Wood</surname><order>24</order></author><author><firstname>Ruby S M</firstname><surname>Tang</surname><order>25</order></author><author><firstname>Simon de</firstname><surname>Lusignan</surname><order>26</order></author><author><firstname>F D Richard</firstname><surname>Hobbs</surname><order>27</order></author><author><firstname>Mark</firstname><surname>Woolhouse</surname><order>28</order></author><author><firstname>Colin R</firstname><surname>Simpson</surname><order>29</order></author><author><firstname>Chris</firstname><surname>Robertson</surname><order>30</order></author><author><firstname>Aziz</firstname><surname>Sheikh</surname><order>31</order></author></authors><documents><document><filename>58261__21372__b3281d007f2b4da5bf7a8b8f0efb1152.pdf</filename><originalFilename>58261.pdf</originalFilename><uploaded>2021-10-29T16:05:50.2745184</uploaded><type>Output</type><contentLength>632825</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2021 The Author(s). This is an Open Access article under the CC BY 4.0 license</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2021-10-29T16:07:38.6855669 v2 58261 2021-10-07 COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false c79d07eaba5c9515c0df82b372b76a41 Stuart Bedston Stuart Bedston true false 2021-10-07 HDAT BackgroundThe UK COVID-19 vaccination programme has prioritised vaccination of those at the highest risk of COVID-19 mortality and hospitalisation. The programme was rolled out in Scotland during winter 2020–21, when SARS-CoV-2 infection rates were at their highest since the pandemic started, despite social distancing measures being in place. We aimed to estimate the frequency of COVID-19 hospitalisation or death in people who received at least one vaccine dose and characterise these individuals.MethodsWe conducted a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) national surveillance platform, which contained linked vaccination, primary care, RT-PCR testing, hospitalisation, and mortality records for 5·4 million people (around 99% of the population) in Scotland. Individuals were followed up from receiving their first dose of the BNT162b2 (Pfizer–BioNTech) or ChAdOx1 nCoV-19 (Oxford–AstraZeneca) COVID-19 vaccines until admission to hospital for COVID-19, death, or the end of the study period on April 18, 2021. We used a time-dependent Poisson regression model to estimate rate ratios (RRs) for demographic and clinical factors associated with COVID-19 hospitalisation or death 14 days or more after the first vaccine dose, stratified by vaccine type.FindingsBetween Dec 8, 2020, and April 18, 2021, 2 572 008 individuals received their first dose of vaccine—841 090 (32·7%) received BNT162b2 and 1 730 918 (67·3%) received ChAdOx1. 1196 (<0·1%) individuals were admitted to hospital or died due to COVID-19 illness (883 hospitalised, of whom 228 died, and 313 who died due to COVID-19 without hospitalisation) 14 days or more after their first vaccine dose. These severe COVID-19 outcomes were associated with older age (≥80 years vs 18–64 years adjusted RR 4·75, 95% CI 3·85–5·87), comorbidities (five or more risk groups vs less than five risk groups 4·24, 3·34–5·39), hospitalisation in the previous 4 weeks (3·00, 2·47–3·65), high-risk occupations (ten or more previous COVID-19 tests vs less than ten previous COVID-19 tests 2·14, 1·62–2·81), care home residence (1·63, 1·32–2·02), socioeconomic deprivation (most deprived quintile vs least deprived quintile 1·57, 1·30–1·90), being male (1·27, 1·13–1·43), and being an ex-smoker (ex-smoker vs non-smoker 1·18, 1·01–1·38). A history of COVID-19 before vaccination was protective (0·40, 0·29–0·54).InterpretationCOVID-19 hospitalisations and deaths were uncommon 14 days or more after the first vaccine dose in this national analysis in the context of a high background incidence of SARS-CoV-2 infection and with extensive social distancing measures in place. Sociodemographic and clinical features known to increase the risk of severe disease in unvaccinated populations were also associated with severe outcomes in people receiving their first dose of vaccine and could help inform case management and future vaccine policy formulation. Journal Article The Lancet Respiratory Medicine 0 Elsevier BV 2213-2600 29 9 2021 2021-09-29 10.1016/s2213-2600(21)00380-5 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Scottish Government, and Health Data Research UK 2021-10-29T16:07:38.6855669 2021-10-07T09:59:50.6888561 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Utkarsh Agrawal 1 Srinivasa Vittal Katikireddi 2 Colin McCowan 3 Rachel H Mulholland 4 Amaya Azcoaga-Lorenzo 5 Sarah Amele 6 Adeniyi Francis Fagbamigbe 7 Eleftheria Vasileiou 8 Zoe Grange 9 Ting Shi 10 Steven Kerr 11 Emily Moore 12 Josephine L K Murray 13 Syed Ahmar Shah 14 Lewis Ritchie 15 Dermot O'Reilly 16 Sarah J Stock 17 Jillian Beggs 18 Antony Chuter 19 Fatemeh Torabi 0000-0002-5853-4625 20 Ashley Akbari 0000-0003-0814-0801 21 Stuart Bedston 22 Jim McMenamin 23 Rachael Wood 24 Ruby S M Tang 25 Simon de Lusignan 26 F D Richard Hobbs 27 Mark Woolhouse 28 Colin R Simpson 29 Chris Robertson 30 Aziz Sheikh 31 58261__21372__b3281d007f2b4da5bf7a8b8f0efb1152.pdf 58261.pdf 2021-10-29T16:05:50.2745184 Output 632825 application/pdf Version of Record true © 2021 The Author(s). This is an Open Access article under the CC BY 4.0 license true eng http://creativecommons.org/licenses/by/4.0/
title COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study
spellingShingle COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study
Fatemeh Torabi
Ashley Akbari
Stuart Bedston
title_short COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study
title_full COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study
title_fullStr COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study
title_full_unstemmed COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study
title_sort COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II): a prospective cohort study
author_id_str_mv f569591e1bfb0e405b8091f99fec45d3
aa1b025ec0243f708bb5eb0a93d6fb52
c79d07eaba5c9515c0df82b372b76a41
author_id_fullname_str_mv f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
c79d07eaba5c9515c0df82b372b76a41_***_Stuart Bedston
author Fatemeh Torabi
Ashley Akbari
Stuart Bedston
author2 Utkarsh Agrawal
Srinivasa Vittal Katikireddi
Colin McCowan
Rachel H Mulholland
Amaya Azcoaga-Lorenzo
Sarah Amele
Adeniyi Francis Fagbamigbe
Eleftheria Vasileiou
Zoe Grange
Ting Shi
Steven Kerr
Emily Moore
Josephine L K Murray
Syed Ahmar Shah
Lewis Ritchie
Dermot O'Reilly
Sarah J Stock
Jillian Beggs
Antony Chuter
Fatemeh Torabi
Ashley Akbari
Stuart Bedston
Jim McMenamin
Rachael Wood
Ruby S M Tang
Simon de Lusignan
F D Richard Hobbs
Mark Woolhouse
Colin R Simpson
Chris Robertson
Aziz Sheikh
format Journal article
container_title The Lancet Respiratory Medicine
container_volume 0
publishDate 2021
institution Swansea University
issn 2213-2600
doi_str_mv 10.1016/s2213-2600(21)00380-5
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description BackgroundThe UK COVID-19 vaccination programme has prioritised vaccination of those at the highest risk of COVID-19 mortality and hospitalisation. The programme was rolled out in Scotland during winter 2020–21, when SARS-CoV-2 infection rates were at their highest since the pandemic started, despite social distancing measures being in place. We aimed to estimate the frequency of COVID-19 hospitalisation or death in people who received at least one vaccine dose and characterise these individuals.MethodsWe conducted a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) national surveillance platform, which contained linked vaccination, primary care, RT-PCR testing, hospitalisation, and mortality records for 5·4 million people (around 99% of the population) in Scotland. Individuals were followed up from receiving their first dose of the BNT162b2 (Pfizer–BioNTech) or ChAdOx1 nCoV-19 (Oxford–AstraZeneca) COVID-19 vaccines until admission to hospital for COVID-19, death, or the end of the study period on April 18, 2021. We used a time-dependent Poisson regression model to estimate rate ratios (RRs) for demographic and clinical factors associated with COVID-19 hospitalisation or death 14 days or more after the first vaccine dose, stratified by vaccine type.FindingsBetween Dec 8, 2020, and April 18, 2021, 2 572 008 individuals received their first dose of vaccine—841 090 (32·7%) received BNT162b2 and 1 730 918 (67·3%) received ChAdOx1. 1196 (<0·1%) individuals were admitted to hospital or died due to COVID-19 illness (883 hospitalised, of whom 228 died, and 313 who died due to COVID-19 without hospitalisation) 14 days or more after their first vaccine dose. These severe COVID-19 outcomes were associated with older age (≥80 years vs 18–64 years adjusted RR 4·75, 95% CI 3·85–5·87), comorbidities (five or more risk groups vs less than five risk groups 4·24, 3·34–5·39), hospitalisation in the previous 4 weeks (3·00, 2·47–3·65), high-risk occupations (ten or more previous COVID-19 tests vs less than ten previous COVID-19 tests 2·14, 1·62–2·81), care home residence (1·63, 1·32–2·02), socioeconomic deprivation (most deprived quintile vs least deprived quintile 1·57, 1·30–1·90), being male (1·27, 1·13–1·43), and being an ex-smoker (ex-smoker vs non-smoker 1·18, 1·01–1·38). A history of COVID-19 before vaccination was protective (0·40, 0·29–0·54).InterpretationCOVID-19 hospitalisations and deaths were uncommon 14 days or more after the first vaccine dose in this national analysis in the context of a high background incidence of SARS-CoV-2 infection and with extensive social distancing measures in place. Sociodemographic and clinical features known to increase the risk of severe disease in unvaccinated populations were also associated with severe outcomes in people receiving their first dose of vaccine and could help inform case management and future vaccine policy formulation.
published_date 2021-09-29T04:14:39Z
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