Severe COVID-19 outcomes after full vaccination of primary schedule and initial boosters: pooled analysis of national prospective cohort studies of 30 million individuals in England, Northern Ireland, Scotland, and Wales

Current UK vaccination policy is to offer future COVID-19 booster doses to individuals at high risk of serious illness from COVID-19, but it is still uncertain which groups of the population could benefit most. In response to an urgent request from the UK Joint Committee on Vaccination and Immunisat...

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Bibliographic Details
Published in:The Lancet (British edition) 2022-10, Vol.400 (10360), p.1305-1320
Main Authors: Agrawal, Utkarsh, Bedston, Stuart, McCowan, Colin, Oke, Jason, Patterson, Lynsey, Robertson, Chris, Akbari, Ashley, Azcoaga-Lorenzo, Amaya, Bradley, Declan T, Fagbamigbe, Adeniyi Francis, Grange, Zoe, Hall, Elliott C R, Joy, Mark, Katikireddi, Srinivasa Vittal, Kerr, Steven, Ritchie, Lewis, Murphy, Siobhán, Owen, Rhiannon K, Rudan, Igor, Shah, Syed Ahmar, Simpson, Colin R, Torabi, Fatemeh, Tsang, Ruby S M, de Lusignan, Simon, Lyons, Ronan A, O'Reilly, Dermot, Sheikh, Aziz
Format: Article
Language:English
Subjects:
Aged
BNT162 Vaccine
ChAdOx1 nCoV-19
Cohort analysis
Comorbidity
Coronaviruses
COVID-19
COVID-19 - epidemiology
COVID-19 - prevention & control
COVID-19 Vaccines
Datasets
Death
England - epidemiology
Ethics
Female
Health care
Health risks
Hospitalization
Humans
Immunization
Immunization, Secondary
Immunosuppressive Agents
Infections
Kidney diseases
Male
Males
Medical innovations
Medical research
Mortality
mRNA
Nations
Northern Ireland
Older people
Pandemics
Population
Primary care
Prospective Studies
Regression analysis
Regression models
Risk analysis
Risk factors
Risk management
SARS-CoV-2
Schedules
Scotland
Severe acute respiratory syndrome coronavirus 2
Vaccination
Vaccines
Viral diseases
Wales - epidemiology
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Summary:Current UK vaccination policy is to offer future COVID-19 booster doses to individuals at high risk of serious illness from COVID-19, but it is still uncertain which groups of the population could benefit most. In response to an urgent request from the UK Joint Committee on Vaccination and Immunisation, we aimed to identify risk factors for severe COVID-19 outcomes (ie, COVID-19-related hospitalisation or death) in individuals who had completed their primary COVID-19 vaccination schedule and had received the first booster vaccine. We constructed prospective cohorts across all four UK nations through linkages of primary care, RT-PCR testing, vaccination, hospitalisation, and mortality data on 30 million people. We included individuals who received primary vaccine doses of BNT162b2 (tozinameran; Pfizer–BioNTech) or ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccines in our initial analyses. We then restricted analyses to those given a BNT162b2 or mRNA-1273 (elasomeran; Moderna) booster and had a severe COVID-19 outcome between Dec 20, 2021, and Feb 28, 2022 (when the omicron (B.1.1.529) variant was dominant). We fitted time-dependent Poisson regression models and calculated adjusted rate ratios (aRRs) and 95% CIs for the associations between risk factors and COVID-19-related hospitalisation or death. We adjusted for a range of potential covariates, including age, sex, comorbidities, and previous SARS-CoV-2 infection. Stratified analyses were conducted by vaccine type. We then did pooled analyses across UK nations using fixed-effect meta-analyses. Between Dec 8, 2020, and Feb 28, 2022, 17 337 580 individuals completed their primary vaccine schedule and 14 698 030 individuals received a booster dose. Between Dec 20, 2021, and Feb 28, 2022, 59 510 (0·3%) of the primary vaccine group and 26 100 (0·2%) of those who received their booster had severe COVID-19 outcomes. The risk of severe COVID-19 outcomes reduced after receiving the booster (rate change: 8·8 events per 1000 person-years to 7·6 events per 1000 person-years). Older adults (≥80 years vs 18–49 years; aRR 3·60 [95% CI 3·45–3·75]), those with comorbidities (≥5 comorbidities vs none; 9·51 [9·07–9·97]), being male (male vs female; 1·23 [1·20–1·26]), and those with certain underlying health conditions—in particular, individuals receiving immunosuppressants (yes vs no; 5·80 [5·53–6·09])—and those with chronic kidney disease (stage 5 vs no; 3·71 [2·90–4·74]) remained at high risk despite the initial booster. Indivi
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(22)01656-7