Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)

Vivaldi, Giulia; Jolliffe, David A.; Holt, Hayley; Tydeman, Florence; Talaei, Mohammad; Davies, Gwyneth; Lyons, Ronan; Griffiths, Christopher J.; Kee, Frank; Sheikh, Aziz; Shaheen, Seif O.; Martineau, Adrian R.

doi:10.1016/j.lanepe.2022.100501

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Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)

Giulia Vivaldi

, David A. Jolliffe, Hayley Holt, Florence Tydeman, Mohammad Talaei, Gwyneth Davies

, Ronan Lyons, Christopher J. Griffiths, Frank Kee, Aziz Sheikh, Seif O. Shaheen, Adrian R. Martineau

The Lancet Regional Health - Europe, Volume: 22, Start page: 100501

Swansea University Authors: Gwyneth Davies , Ronan Lyons

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DOI (Published version): 10.1016/j.lanepe.2022.100501

Abstract

BackgroundLittle is known about how demographic, behavioural, and vaccine-related factors affect risk of post-vaccination SARS-CoV-2 infection. We aimed to identify risk factors for SARS-CoV-2 infection after primary and booster vaccinations.MethodsThis prospective, population-based, UK study in adu...

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Published in:	The Lancet Regional Health - Europe
ISSN:	2666-7762
Published:	Elsevier BV 2022
Online Access:	Check full text
URI:	https://cronfa.swan.ac.uk/Record/cronfa70390

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last_indexed	2025-10-28T10:50:06Z
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We aimed to identify risk factors for SARS-CoV-2 infection after primary and booster vaccinations.MethodsThis prospective, population-based, UK study in adults (≥16 years) vaccinated against SARS-CoV-2 assessed risk of breakthrough SARS-CoV-2 infection up to February, 2022, for participants who completed a primary vaccination course (ChAdOx1 nCoV-19 or BNT162b2) and those who received a booster dose (BNT162b2 or mRNA-1273). Cox regression models explored associations between sociodemographic, behavioural, clinical, pharmacological, and nutritional factors and test-positive breakthrough infection, adjusted for local weekly SARS-CoV-2 incidence.Findings1051 (7·1%) of 14 713 post-primary participants and 1009 (9·5%) of 10 665 post-booster participants reported breakthrough infection, over a median follow-up of 203 days (IQR 195–216) and 85 days (66–103), respectively. Primary vaccination with ChAdOx1 (vs BNT162b2) was associated with higher risk of infection in both post-primary analysis (adjusted hazard ratio 1·63, 95% CI 1·41–1·88) and after an mRNA-1273 booster (1·26 [1·00–1·57] vs BNT162b2 primary and booster). Lower risk of infection was associated with older age (post-primary: 0·97 [0·96–0·97] per year; post-booster: 0·97 [0·97–0·98]), whereas higher risk of infection was associated with lower educational attainment (post-primary: 1·78 [1·44–2·20] for primary/secondary vs postgraduate; post-booster: 1·46 [1·16–1·83]) and at least three weekly visits to indoor public places (post-primary: 1·36 [1·13–1·63] vs none; post-booster: 1·29 [1·07–1·56]).</abstract><type>Journal Article</type><journal>The Lancet Regional Health - Europe</journal><volume>22</volume><journalNumber/><paginationStart>100501</paginationStart><paginationEnd/><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2666-7762</issnPrint><issnElectronic/><keywords>SARS-CoV-2; Vaccination; Breakthrough infection; ChAdOx1; BNT162b2; mRNA-1273</keywords><publishedDay>1</publishedDay><publishedMonth>11</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-11-01</publishedDate><doi>10.1016/j.lanepe.2022.100501</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>OVIDENCE UK has received support from Barts Charity (MGU0459, MGU0466), Pharma Nord, the Fischer Family Foundation, DSM Nutritional Products, the Exilarch’s Foundation, the Karl R Pfleger Foundation, the AIM Foundation, Synergy Biologics, Cytoplan, the UK National Institute for Health and Care Research Clinical Research Network (52255; 52257), the Health Data Research UK BREATHE Hub, the UK Research and Innovation Industrial Strategy Challenge Fund (MC_PC_19004), Thornton & Ross, Warburtons, Matthew Isaacs (personal donation), Barbara Boucher (personal donation), and Hyphens Pharma. M.T. was supported by a grant from the Rosetrees Trust and The Bloom Foundation (M771) until May, 2021, and has been supported by Barts Charity since (MGU0570). D.A.J. is supported by a Barts Charity Lectureship (MGU045). The views expressed are those of the authors and not necessarily those of the funders. We thank all participants of COVIDENCE UK, and the following organisations who supported study recruitment: Asthma UK/British Lung Foundation, the British Heart Foundation, the British Obesity Society, Cancer Research UK, Diabetes UK, Future Publishing, Kidney Care UK, Kidney Wales, Mumsnet, the National Kidney Federation, the National Rheumatoid Arthritis Society, the North West London Health Research Register (DISCOVER), Primary Immunodeficiency UK, the Race Equality Foundation, SWM Health, the Terence Higgins Trust, and Vasculitis UK.</funders><projectreference/><lastEdited>2025-10-27T15:46:30.4523319</lastEdited><Created>2025-09-18T11:30:14.5810607</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>Giulia</firstname><surname>Vivaldi</surname><orcid>0000-0003-0816-9276</orcid><order>1</order></author><author><firstname>David A.</firstname><surname>Jolliffe</surname><order>2</order></author><author><firstname>Hayley</firstname><surname>Holt</surname><order>3</order></author><author><firstname>Florence</firstname><surname>Tydeman</surname><order>4</order></author><author><firstname>Mohammad</firstname><surname>Talaei</surname><order>5</order></author><author><firstname>Gwyneth</firstname><surname>Davies</surname><orcid>0000-0003-1218-1008</orcid><order>6</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><order>7</order></author><author><firstname>Christopher J.</firstname><surname>Griffiths</surname><order>8</order></author><author><firstname>Frank</firstname><surname>Kee</surname><order>9</order></author><author><firstname>Aziz</firstname><surname>Sheikh</surname><order>10</order></author><author><firstname>Seif O.</firstname><surname>Shaheen</surname><order>11</order></author><author><firstname>Adrian R.</firstname><surname>Martineau</surname><order>12</order></author></authors><documents><document><filename>70390__35488__8a14110eaa3542baae7313f2d4f729c7.pdf</filename><originalFilename>70390.VoR.pdf</originalFilename><uploaded>2025-10-27T15:20:16.4224678</uploaded><type>Output</type><contentLength>759327</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Copyright 2022 The Authors. 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spelling	2025-10-27T15:46:30.4523319 v2 70390 2025-09-18 Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK) 92d69cf8519a334ced3f55142c811d95 0000-0003-1218-1008 Gwyneth Davies Gwyneth Davies true false 83efcf2a9dfcf8b55586999d3d152ac6 Ronan Lyons Ronan Lyons true false 2025-09-18 MEDS BackgroundLittle is known about how demographic, behavioural, and vaccine-related factors affect risk of post-vaccination SARS-CoV-2 infection. We aimed to identify risk factors for SARS-CoV-2 infection after primary and booster vaccinations.MethodsThis prospective, population-based, UK study in adults (≥16 years) vaccinated against SARS-CoV-2 assessed risk of breakthrough SARS-CoV-2 infection up to February, 2022, for participants who completed a primary vaccination course (ChAdOx1 nCoV-19 or BNT162b2) and those who received a booster dose (BNT162b2 or mRNA-1273). Cox regression models explored associations between sociodemographic, behavioural, clinical, pharmacological, and nutritional factors and test-positive breakthrough infection, adjusted for local weekly SARS-CoV-2 incidence.Findings1051 (7·1%) of 14 713 post-primary participants and 1009 (9·5%) of 10 665 post-booster participants reported breakthrough infection, over a median follow-up of 203 days (IQR 195–216) and 85 days (66–103), respectively. Primary vaccination with ChAdOx1 (vs BNT162b2) was associated with higher risk of infection in both post-primary analysis (adjusted hazard ratio 1·63, 95% CI 1·41–1·88) and after an mRNA-1273 booster (1·26 [1·00–1·57] vs BNT162b2 primary and booster). Lower risk of infection was associated with older age (post-primary: 0·97 [0·96–0·97] per year; post-booster: 0·97 [0·97–0·98]), whereas higher risk of infection was associated with lower educational attainment (post-primary: 1·78 [1·44–2·20] for primary/secondary vs postgraduate; post-booster: 1·46 [1·16–1·83]) and at least three weekly visits to indoor public places (post-primary: 1·36 [1·13–1·63] vs none; post-booster: 1·29 [1·07–1·56]). Journal Article The Lancet Regional Health - Europe 22 100501 Elsevier BV 2666-7762 SARS-CoV-2; Vaccination; Breakthrough infection; ChAdOx1; BNT162b2; mRNA-1273 1 11 2022 2022-11-01 10.1016/j.lanepe.2022.100501 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee OVIDENCE UK has received support from Barts Charity (MGU0459, MGU0466), Pharma Nord, the Fischer Family Foundation, DSM Nutritional Products, the Exilarch’s Foundation, the Karl R Pfleger Foundation, the AIM Foundation, Synergy Biologics, Cytoplan, the UK National Institute for Health and Care Research Clinical Research Network (52255; 52257), the Health Data Research UK BREATHE Hub, the UK Research and Innovation Industrial Strategy Challenge Fund (MC_PC_19004), Thornton & Ross, Warburtons, Matthew Isaacs (personal donation), Barbara Boucher (personal donation), and Hyphens Pharma. M.T. was supported by a grant from the Rosetrees Trust and The Bloom Foundation (M771) until May, 2021, and has been supported by Barts Charity since (MGU0570). D.A.J. is supported by a Barts Charity Lectureship (MGU045). The views expressed are those of the authors and not necessarily those of the funders. We thank all participants of COVIDENCE UK, and the following organisations who supported study recruitment: Asthma UK/British Lung Foundation, the British Heart Foundation, the British Obesity Society, Cancer Research UK, Diabetes UK, Future Publishing, Kidney Care UK, Kidney Wales, Mumsnet, the National Kidney Federation, the National Rheumatoid Arthritis Society, the North West London Health Research Register (DISCOVER), Primary Immunodeficiency UK, the Race Equality Foundation, SWM Health, the Terence Higgins Trust, and Vasculitis UK. 2025-10-27T15:46:30.4523319 2025-09-18T11:30:14.5810607 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Giulia Vivaldi 0000-0003-0816-9276 1 David A. Jolliffe 2 Hayley Holt 3 Florence Tydeman 4 Mohammad Talaei 5 Gwyneth Davies 0000-0003-1218-1008 6 Ronan Lyons 7 Christopher J. Griffiths 8 Frank Kee 9 Aziz Sheikh 10 Seif O. Shaheen 11 Adrian R. Martineau 12 70390__35488__8a14110eaa3542baae7313f2d4f729c7.pdf 70390.VoR.pdf 2025-10-27T15:20:16.4224678 Output 759327 application/pdf Version of Record true Copyright 2022 The Authors. This is an open access article under the CC BY license. true eng http://creativecommons.org/licenses/by/4.0/
title	Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)
spellingShingle	Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK) Gwyneth Davies Ronan Lyons
title_short	Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)
title_full	Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)
title_fullStr	Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)
title_full_unstemmed	Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)
title_sort	Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)
author_id_str_mv	92d69cf8519a334ced3f55142c811d95 83efcf2a9dfcf8b55586999d3d152ac6
author_id_fullname_str_mv	92d69cf8519a334ced3f55142c811d95_*_Gwyneth Davies 83efcf2a9dfcf8b55586999d3d152ac6_*_Ronan Lyons
author	Gwyneth Davies Ronan Lyons
author2	Giulia Vivaldi David A. Jolliffe Hayley Holt Florence Tydeman Mohammad Talaei Gwyneth Davies Ronan Lyons Christopher J. Griffiths Frank Kee Aziz Sheikh Seif O. Shaheen Adrian R. Martineau
format	Journal article
container_title	The Lancet Regional Health - Europe
container_volume	22
container_start_page	100501
publishDate	2022
institution	Swansea University
issn	2666-7762
doi_str_mv	10.1016/j.lanepe.2022.100501
publisher	Elsevier BV
college_str	Faculty of Medicine, Health and Life Sciences
hierarchytype
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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
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description	BackgroundLittle is known about how demographic, behavioural, and vaccine-related factors affect risk of post-vaccination SARS-CoV-2 infection. We aimed to identify risk factors for SARS-CoV-2 infection after primary and booster vaccinations.MethodsThis prospective, population-based, UK study in adults (≥16 years) vaccinated against SARS-CoV-2 assessed risk of breakthrough SARS-CoV-2 infection up to February, 2022, for participants who completed a primary vaccination course (ChAdOx1 nCoV-19 or BNT162b2) and those who received a booster dose (BNT162b2 or mRNA-1273). Cox regression models explored associations between sociodemographic, behavioural, clinical, pharmacological, and nutritional factors and test-positive breakthrough infection, adjusted for local weekly SARS-CoV-2 incidence.Findings1051 (7·1%) of 14 713 post-primary participants and 1009 (9·5%) of 10 665 post-booster participants reported breakthrough infection, over a median follow-up of 203 days (IQR 195–216) and 85 days (66–103), respectively. Primary vaccination with ChAdOx1 (vs BNT162b2) was associated with higher risk of infection in both post-primary analysis (adjusted hazard ratio 1·63, 95% CI 1·41–1·88) and after an mRNA-1273 booster (1·26 [1·00–1·57] vs BNT162b2 primary and booster). Lower risk of infection was associated with older age (post-primary: 0·97 [0·96–0·97] per year; post-booster: 0·97 [0·97–0·98]), whereas higher risk of infection was associated with lower educational attainment (post-primary: 1·78 [1·44–2·20] for primary/secondary vs postgraduate; post-booster: 1·46 [1·16–1·83]) and at least three weekly visits to indoor public places (post-primary: 1·36 [1·13–1·63] vs none; post-booster: 1·29 [1·07–1·56]).
published_date	2022-11-01T05:32:46Z
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Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)

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