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COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study

Stuart Bedston, Emily Lowthian, Christopher I Jarvis, Ashley Akbari Orcid Logo, Jillian Beggs, Declan Bradley, Simon de Lusignan, Rowena Griffiths, Laura Herbert Orcid Logo, Richard Hobbs, Steven Kerr, Jane Lyons, Will Midgley Orcid Logo, Rhiannon Owen Orcid Logo, Jennifer K Quint, Ruby Tsang, Fatemeh Torabi Orcid Logo, Aziz Sheikh, Ronan Lyons Orcid Logo

Vaccine, Volume: 41, Issue: 7, Pages: 1378 - 1389

Swansea University Authors: Stuart Bedston, Emily Lowthian, Ashley Akbari Orcid Logo, Rowena Griffiths, Laura Herbert Orcid Logo, Jane Lyons, Will Midgley Orcid Logo, Rhiannon Owen Orcid Logo, Fatemeh Torabi Orcid Logo, Ronan Lyons Orcid Logo

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DOI (Published version): 10.1016/j.vaccine.2023.01.023

Abstract

BackgroundFrom September 2021, Health Care Workers (HCWs) in Wales began receiving a COVID-19 booster vaccination. This is the first dose beyond the primary vaccination schedule. Given the emergence of new variants, vaccine waning vaccine, and increasing vaccination hesitancy, there is a need to und...

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Published in: Vaccine
ISSN: 0264-410X
Published: Elsevier BV 2023
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2023-03-30T14:27:04.9237613</datestamp><bib-version>v2</bib-version><id>62336</id><entry>2023-01-16</entry><title>COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study</title><swanseaauthors><author><sid>c79d07eaba5c9515c0df82b372b76a41</sid><firstname>Stuart</firstname><surname>Bedston</surname><name>Stuart Bedston</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>db5bc529b8a9dfca2b4a268d14e03479</sid><firstname>Emily</firstname><surname>Lowthian</surname><name>Emily Lowthian</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>381464f639f98bd388c29326ca7f862c</sid><firstname>Rowena</firstname><surname>Griffiths</surname><name>Rowena Griffiths</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>0d5765f5486b80e173366af9a61ee200</sid><ORCID>0000-0001-7580-7413</ORCID><firstname>Laura</firstname><surname>Herbert</surname><name>Laura Herbert</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>1b74fa5125a88451c52c45bcf20e0b47</sid><ORCID/><firstname>Jane</firstname><surname>Lyons</surname><name>Jane Lyons</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>c5be705247fb78c27cb7924683c60406</sid><ORCID>0000-0001-7198-7613</ORCID><firstname>Will</firstname><surname>Midgley</surname><name>Will Midgley</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>0d30aa00eef6528f763a1e1589f703ec</sid><ORCID>0000-0001-5977-376X</ORCID><firstname>Rhiannon</firstname><surname>Owen</surname><name>Rhiannon Owen</name><active>true</active><ethesisStudent>false</ethesisStudent></author><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>83efcf2a9dfcf8b55586999d3d152ac6</sid><ORCID>0000-0001-5225-000X</ORCID><firstname>Ronan</firstname><surname>Lyons</surname><name>Ronan Lyons</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2023-01-16</date><deptcode>HDAT</deptcode><abstract>BackgroundFrom September 2021, Health Care Workers (HCWs) in Wales began receiving a COVID-19 booster vaccination. This is the first dose beyond the primary vaccination schedule. Given the emergence of new variants, vaccine waning vaccine, and increasing vaccination hesitancy, there is a need to understand booster vaccine uptake and subsequent breakthrough in this high-risk population.MethodsWe conducted a prospective, national-scale, observational cohort study of HCWs in Wales using anonymised, linked data from the SAIL Databank. We analysed uptake of COVID-19 booster vaccinations from September 2021 to February 2022, with comparisons against uptake of the initial primary vaccination schedule. We also analysed booster breakthrough, in the form of PCR-confirmed SARS-Cov-2 infection, comparing to the second primary dose. Cox proportional hazard models were used to estimate associations for vaccination uptake and breakthrough regarding staff roles, socio-demographics, household composition, and other factors.ResultsWe derived a cohort of 73,030 HCWs living in Wales (78% female, 60% 18-49 years old). Uptake was quickest amongst HCWs aged 60+ years old (aHR 2.54, 95%CI 2.45&#x2014;2.63), compared with those aged 18-29. Asian HCWs had quicker uptake (aHR 1.18, 95%CI 1.14&#x2014;1.22), whilst Black HCWs had slower uptake (aHR 0.67, 95%CI 0.61&#x2014;0.74), compared to white HCWs. HCWs residing in the least deprived areas were slightly quicker to have received a booster dose (aHR 1.12, 95%CI 1.09&#x2014;1.16), compared with those in the most deprived areas. Strongest associations with breakthrough infections were found for those living with children (aHR 1.52, 95%CI 1.41&#x2014;1.63), compared to two-adult only households. HCWs aged 60+ years old were less likely to get breakthrough infections, compared to those aged 18-29 (aHR 0.42, 95%CI 0.38&#x2014;0.47).ConclusionVaccination uptake was consistently lower among black HCWs, as well as those from deprived areas. Whilst breakthrough infections were highest in households with children.</abstract><type>Journal Article</type><journal>Vaccine</journal><volume>41</volume><journalNumber>7</journalNumber><paginationStart>1378</paginationStart><paginationEnd>1389</paginationEnd><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0264-410X</issnPrint><issnElectronic/><keywords>COVID-19; Health care workers; Booster; Vaccination; Uptake; Breakthrough</keywords><publishedDay>13</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-01-13</publishedDate><doi>10.1016/j.vaccine.2023.01.023</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>This research used data assets made available as part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant ref MC_PC_20029). Data and Connectivity: COVID-19 Vaccines Pharmacovigilance National Core Study (DaC-VaP; MR/R008345/1) is a partnership between The University of Edinburgh, University of Oxford, University of Strathclyde, Queen&#x2019;s University Belfast and Swansea University. The authors would like to acknowledge all other DaC-VaP collaborators not involved in these analyses but contributing to wider discussions and preceding outputs. We also need to acknowledge the support of BREATHE - The Health Data Research Hub for Respiratory Health [MC_PC_19004], which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. This work was supported by the Con-COV team funded by the Medical Research Council (grant number: MR/V028367/1). This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work was supported by the ADR Wales programme of work. The ADR Wales programme of work is aligned to the priority themes as identified in the Welsh Government&#x2019;s national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyse anonymised data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1). This work was supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales.</funders><projectreference/><lastEdited>2023-03-30T14:27:04.9237613</lastEdited><Created>2023-01-16T18:30:00.9821592</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Stuart</firstname><surname>Bedston</surname><order>1</order></author><author><firstname>Emily</firstname><surname>Lowthian</surname><order>2</order></author><author><firstname>Christopher I</firstname><surname>Jarvis</surname><order>3</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>4</order></author><author><firstname>Jillian</firstname><surname>Beggs</surname><order>5</order></author><author><firstname>Declan</firstname><surname>Bradley</surname><order>6</order></author><author><firstname>Simon de</firstname><surname>Lusignan</surname><order>7</order></author><author><firstname>Rowena</firstname><surname>Griffiths</surname><order>8</order></author><author><firstname>Laura</firstname><surname>Herbert</surname><orcid>0000-0001-7580-7413</orcid><order>9</order></author><author><firstname>Richard</firstname><surname>Hobbs</surname><order>10</order></author><author><firstname>Steven</firstname><surname>Kerr</surname><order>11</order></author><author><firstname>Jane</firstname><surname>Lyons</surname><orcid/><order>12</order></author><author><firstname>Will</firstname><surname>Midgley</surname><orcid>0000-0001-7198-7613</orcid><order>13</order></author><author><firstname>Rhiannon</firstname><surname>Owen</surname><orcid>0000-0001-5977-376X</orcid><order>14</order></author><author><firstname>Jennifer K</firstname><surname>Quint</surname><order>15</order></author><author><firstname>Ruby</firstname><surname>Tsang</surname><order>16</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>17</order></author><author><firstname>Aziz</firstname><surname>Sheikh</surname><order>18</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>19</order></author></authors><documents><document><filename>62336__26953__8b34b5c876e54234884d4e31f957d996.pdf</filename><originalFilename>62336.VOR.pdf</originalFilename><uploaded>2023-03-30T14:10:24.4720912</uploaded><type>Output</type><contentLength>2439112</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>This is an open access article under the CC BY license</documentNotes><copyrightCorrect>false</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2023-03-30T14:27:04.9237613 v2 62336 2023-01-16 COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study c79d07eaba5c9515c0df82b372b76a41 Stuart Bedston Stuart Bedston true false db5bc529b8a9dfca2b4a268d14e03479 Emily Lowthian Emily Lowthian true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 381464f639f98bd388c29326ca7f862c Rowena Griffiths Rowena Griffiths true false 0d5765f5486b80e173366af9a61ee200 0000-0001-7580-7413 Laura Herbert Laura Herbert true false 1b74fa5125a88451c52c45bcf20e0b47 Jane Lyons Jane Lyons true false c5be705247fb78c27cb7924683c60406 0000-0001-7198-7613 Will Midgley Will Midgley true false 0d30aa00eef6528f763a1e1589f703ec 0000-0001-5977-376X Rhiannon Owen Rhiannon Owen true false f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 2023-01-16 HDAT BackgroundFrom September 2021, Health Care Workers (HCWs) in Wales began receiving a COVID-19 booster vaccination. This is the first dose beyond the primary vaccination schedule. Given the emergence of new variants, vaccine waning vaccine, and increasing vaccination hesitancy, there is a need to understand booster vaccine uptake and subsequent breakthrough in this high-risk population.MethodsWe conducted a prospective, national-scale, observational cohort study of HCWs in Wales using anonymised, linked data from the SAIL Databank. We analysed uptake of COVID-19 booster vaccinations from September 2021 to February 2022, with comparisons against uptake of the initial primary vaccination schedule. We also analysed booster breakthrough, in the form of PCR-confirmed SARS-Cov-2 infection, comparing to the second primary dose. Cox proportional hazard models were used to estimate associations for vaccination uptake and breakthrough regarding staff roles, socio-demographics, household composition, and other factors.ResultsWe derived a cohort of 73,030 HCWs living in Wales (78% female, 60% 18-49 years old). Uptake was quickest amongst HCWs aged 60+ years old (aHR 2.54, 95%CI 2.45—2.63), compared with those aged 18-29. Asian HCWs had quicker uptake (aHR 1.18, 95%CI 1.14—1.22), whilst Black HCWs had slower uptake (aHR 0.67, 95%CI 0.61—0.74), compared to white HCWs. HCWs residing in the least deprived areas were slightly quicker to have received a booster dose (aHR 1.12, 95%CI 1.09—1.16), compared with those in the most deprived areas. Strongest associations with breakthrough infections were found for those living with children (aHR 1.52, 95%CI 1.41—1.63), compared to two-adult only households. HCWs aged 60+ years old were less likely to get breakthrough infections, compared to those aged 18-29 (aHR 0.42, 95%CI 0.38—0.47).ConclusionVaccination uptake was consistently lower among black HCWs, as well as those from deprived areas. Whilst breakthrough infections were highest in households with children. Journal Article Vaccine 41 7 1378 1389 Elsevier BV 0264-410X COVID-19; Health care workers; Booster; Vaccination; Uptake; Breakthrough 13 1 2023 2023-01-13 10.1016/j.vaccine.2023.01.023 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University SU Library paid the OA fee (TA Institutional Deal) This research used data assets made available as part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant ref MC_PC_20029). Data and Connectivity: COVID-19 Vaccines Pharmacovigilance National Core Study (DaC-VaP; MR/R008345/1) is a partnership between The University of Edinburgh, University of Oxford, University of Strathclyde, Queen’s University Belfast and Swansea University. The authors would like to acknowledge all other DaC-VaP collaborators not involved in these analyses but contributing to wider discussions and preceding outputs. We also need to acknowledge the support of BREATHE - The Health Data Research Hub for Respiratory Health [MC_PC_19004], which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. This work was supported by the Con-COV team funded by the Medical Research Council (grant number: MR/V028367/1). This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. This work was supported by the ADR Wales programme of work. The ADR Wales programme of work is aligned to the priority themes as identified in the Welsh Government’s national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence which supports Prosperity for All by using the SAIL Databank at Swansea University, to link and analyse anonymised data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) funded ADR UK (grant ES/S007393/1). This work was supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales. 2023-03-30T14:27:04.9237613 2023-01-16T18:30:00.9821592 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Stuart Bedston 1 Emily Lowthian 2 Christopher I Jarvis 3 Ashley Akbari 0000-0003-0814-0801 4 Jillian Beggs 5 Declan Bradley 6 Simon de Lusignan 7 Rowena Griffiths 8 Laura Herbert 0000-0001-7580-7413 9 Richard Hobbs 10 Steven Kerr 11 Jane Lyons 12 Will Midgley 0000-0001-7198-7613 13 Rhiannon Owen 0000-0001-5977-376X 14 Jennifer K Quint 15 Ruby Tsang 16 Fatemeh Torabi 0000-0002-5853-4625 17 Aziz Sheikh 18 Ronan Lyons 0000-0001-5225-000X 19 62336__26953__8b34b5c876e54234884d4e31f957d996.pdf 62336.VOR.pdf 2023-03-30T14:10:24.4720912 Output 2439112 application/pdf Version of Record true This is an open access article under the CC BY license false eng http://creativecommons.org/licenses/by/4.0/
title COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study
spellingShingle COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study
Stuart Bedston
Emily Lowthian
Ashley Akbari
Rowena Griffiths
Laura Herbert
Jane Lyons
Will Midgley
Rhiannon Owen
Fatemeh Torabi
Ronan Lyons
title_short COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study
title_full COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study
title_fullStr COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study
title_full_unstemmed COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study
title_sort COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study
author_id_str_mv c79d07eaba5c9515c0df82b372b76a41
db5bc529b8a9dfca2b4a268d14e03479
aa1b025ec0243f708bb5eb0a93d6fb52
381464f639f98bd388c29326ca7f862c
0d5765f5486b80e173366af9a61ee200
1b74fa5125a88451c52c45bcf20e0b47
c5be705247fb78c27cb7924683c60406
0d30aa00eef6528f763a1e1589f703ec
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author_id_fullname_str_mv c79d07eaba5c9515c0df82b372b76a41_***_Stuart Bedston
db5bc529b8a9dfca2b4a268d14e03479_***_Emily Lowthian
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
381464f639f98bd388c29326ca7f862c_***_Rowena Griffiths
0d5765f5486b80e173366af9a61ee200_***_Laura Herbert
1b74fa5125a88451c52c45bcf20e0b47_***_Jane Lyons
c5be705247fb78c27cb7924683c60406_***_Will Midgley
0d30aa00eef6528f763a1e1589f703ec_***_Rhiannon Owen
f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
author Stuart Bedston
Emily Lowthian
Ashley Akbari
Rowena Griffiths
Laura Herbert
Jane Lyons
Will Midgley
Rhiannon Owen
Fatemeh Torabi
Ronan Lyons
author2 Stuart Bedston
Emily Lowthian
Christopher I Jarvis
Ashley Akbari
Jillian Beggs
Declan Bradley
Simon de Lusignan
Rowena Griffiths
Laura Herbert
Richard Hobbs
Steven Kerr
Jane Lyons
Will Midgley
Rhiannon Owen
Jennifer K Quint
Ruby Tsang
Fatemeh Torabi
Aziz Sheikh
Ronan Lyons
format Journal article
container_title Vaccine
container_volume 41
container_issue 7
container_start_page 1378
publishDate 2023
institution Swansea University
issn 0264-410X
doi_str_mv 10.1016/j.vaccine.2023.01.023
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 - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description BackgroundFrom September 2021, Health Care Workers (HCWs) in Wales began receiving a COVID-19 booster vaccination. This is the first dose beyond the primary vaccination schedule. Given the emergence of new variants, vaccine waning vaccine, and increasing vaccination hesitancy, there is a need to understand booster vaccine uptake and subsequent breakthrough in this high-risk population.MethodsWe conducted a prospective, national-scale, observational cohort study of HCWs in Wales using anonymised, linked data from the SAIL Databank. We analysed uptake of COVID-19 booster vaccinations from September 2021 to February 2022, with comparisons against uptake of the initial primary vaccination schedule. We also analysed booster breakthrough, in the form of PCR-confirmed SARS-Cov-2 infection, comparing to the second primary dose. Cox proportional hazard models were used to estimate associations for vaccination uptake and breakthrough regarding staff roles, socio-demographics, household composition, and other factors.ResultsWe derived a cohort of 73,030 HCWs living in Wales (78% female, 60% 18-49 years old). Uptake was quickest amongst HCWs aged 60+ years old (aHR 2.54, 95%CI 2.45—2.63), compared with those aged 18-29. Asian HCWs had quicker uptake (aHR 1.18, 95%CI 1.14—1.22), whilst Black HCWs had slower uptake (aHR 0.67, 95%CI 0.61—0.74), compared to white HCWs. HCWs residing in the least deprived areas were slightly quicker to have received a booster dose (aHR 1.12, 95%CI 1.09—1.16), compared with those in the most deprived areas. Strongest associations with breakthrough infections were found for those living with children (aHR 1.52, 95%CI 1.41—1.63), compared to two-adult only households. HCWs aged 60+ years old were less likely to get breakthrough infections, compared to those aged 18-29 (aHR 0.42, 95%CI 0.38—0.47).ConclusionVaccination uptake was consistently lower among black HCWs, as well as those from deprived areas. Whilst breakthrough infections were highest in households with children.
published_date 2023-01-13T04:21:52Z
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