TY - JOUR
T1 - 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
T2 - A population-based cohort study (COVIDENCE UK)
AU - Vivaldi, Giulia
AU - Jolliffe, David A
AU - Holt, Hayley
AU - Tydeman, Florence
AU - Talaei, Mohammad
AU - Davies, Gwyneth A
AU - Lyons, Ronan A
AU - Griffiths, Christopher J
AU - Kee, Frank
AU - Sheikh, Aziz
AU - Shaheen, Seif O
AU - Martineau, Adrian R
N1 - Funding Information:
R.A.L. has received grants from UKRI Medical Research Council, UKRI Economic and Social Research Council, Health Data Research UK, and Health and Care Research Wales. R.A.L. is a member of the Welsh Government COVID-19 Technical Advisory group, in an unremunerated role. A.S. is a member of the Scottish Government's Standing Committee on Pandemics, the Scottish Science Advisory Council, the UK Government's New and Emerging Respiratory Virus Threats Risk Stratification Subgroup and the Department of Health and Social Care's COVID-19 Therapeutics Modelling Group. He was a member of the Scottish Government Chief Medical Officer's COVID-19 Advisory Group and AstraZeneca's Thrombotic Thrombocytopenic Taskforce. All of A.S.’ roles are unremunerated. A.R.M. declares receipt of funding to support vitamin D research from the following companies who manufacture or sell vitamin D supplements: Pharma Nord DSM Nutritional Products, Thornton & Ross, and Hyphens Pharma. A.R.M. also declares support for attending meetings from the following companies who manufacture or sell vitamin D supplements: Pharma Nord and Abiogen Pharma. A.R.M. also declares participation on the Data and Safety Monitoring Board for the Chair, DSMB, VITALITY trial (Vitamin D for Adolescents with HIV to reduce musculoskeletal morbidity and immunopathology). A.R.M. also declares unpaid work as a Programme Committee member for the Vitamin D Workshop. A.R.M. also declares receipt of vitamin D capsules for clinical trial use from Pharma Nord, Synergy Biologics, and Cytoplan. All other authors declare no competing interests.
Funding Information:
COVIDENCE 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.
Publisher Copyright:
© 2022 The Authors
PY - 2022/11/1
Y1 - 2022/11/1
N2 - Background: Little 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.Methods: This 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.Findings: 1051 (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]).Interpretation: Vaccine type, socioeconomic status, age, and behaviours affect risk of breakthrough infection after primary and booster vaccinations.Funding: Barts Charity, UK Research and Innovation Industrial Strategy Challenge Fund.
AB - Background: Little 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.Methods: This 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.Findings: 1051 (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]).Interpretation: Vaccine type, socioeconomic status, age, and behaviours affect risk of breakthrough infection after primary and booster vaccinations.Funding: Barts Charity, UK Research and Innovation Industrial Strategy Challenge Fund.
KW - BNT162b2
KW - Breakthrough infection
KW - ChAdOx1
KW - SARS-CoV-2
KW - Vaccination
KW - mRNA-1273
U2 - 10.1016/j.lanepe.2022.100501
DO - 10.1016/j.lanepe.2022.100501
M3 - Article
C2 - 36168404
SN - 2666-7762
VL - 22
SP - 100501
JO - The Lancet Regional Health Europe
JF - The Lancet Regional Health Europe
M1 - 100501
ER -