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.
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.
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DOI：
10.1016/s2213-2600(21)00380-5
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发表时间：
2021-12
期刊：
影响因子：
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通讯作者：
Sheikh A
中科院分区：
文献类型：
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作者：
Agrawal U;Katikireddi SV;McCowan C;Mulholland RH;Azcoaga-Lorenzo A;Amele S;Fagbamigbe AF;Vasileiou E;Grange Z;Shi T;Kerr S;Moore E;Murray JLK;Shah SA;Ritchie L;O'Reilly D;Stock SJ;Beggs J;Chuter A;Torabi F;Akbari A;Bedston S;McMenamin J;Wood R;Tang RSM;de Lusignan S;Hobbs FDR;Woolhouse M;Simpson CR;Robertson C;Sheikh A
英国COVID-19疫苗接种计划优先为COVID-19死亡率和住院风险最高的人接种疫苗。该计划于2020-21年冬季在苏格兰推出，当时尽管采取了社会距离措施，但SARS-CoV-2感染率达到了疫情开始以来的最高水平。我们的目的是估计至少接种了一剂疫苗的人的COVID-19住院或死亡的频率，并描述这些人的特征。我们使用COVID-19早期大流行评估和加强监测（EAVE II）国家监测平台进行了一项前瞻性队列研究，该平台包含苏格兰540万人（约占人口的99%）的相关疫苗接种、初级保健、RT-PCR检测、住院和死亡记录。从接受第一剂BNT162b2（辉瑞- biontech）或ChAdOx1 nCoV-19（牛津-阿斯利康）COVID-19疫苗开始，对个体进行随访，直到2021年4月18日因COVID-19入院、死亡或研究期结束。我们使用了一个时间依赖的泊松回归模型来估计与首次接种疫苗后14天或更长时间的COVID-19住院或死亡相关的人口学和临床因素的比率（rr），并按疫苗类型分层。在2020年12月8日至2021年4月18日期间，有2 572 008人接种了第一剂疫苗，其中841 090人（32.7%）接种了BNT162b2, 1 730 918人（67.3%）接种了ChAdOx1。在首次接种疫苗14天或更长时间后，1196人（< 0.1%）因COVID-19疾病入院或死亡（883人住院，其中228人死亡，313人因COVID-19死亡而未住院）。这些严重的COVID-19结局与年龄较大（≥80岁vs 18-64岁校正RR 4.75, 95% CI 3.85 - 5.87）、合共病（5个或以上风险组vs少于5个风险组4.24,3.34 - 5.39）、前4周住院（3.00,2.47 - 3.65）、高危职业（10次或以上既往COVID-19检测vs少于10次既往COVID-19检测2.14,1.62 - 2·81）、养老院居住（1.63,1.32 - 2.02）、社会经济剥夺（最贫困五分之一组vs最贫困五分之一组1.57,1.30 - 1.90），男性（1.27,1.13 - 1.43），以及戒烟者（戒烟者vs非吸烟者1.18,1.01 - 1.38）。接种疫苗前的COVID-19病史具有保护作用（0.40、0.29 - 0.54）。在这项国家分析中，在SARS-CoV-2感染背景发病率高且采取了广泛的社会距离措施的背景下，在首次接种疫苗后14天或更长时间内，COVID-19住院和死亡的情况并不常见。已知在未接种疫苗的人群中增加严重疾病风险的社会人口统计学和临床特征也与接受第一剂疫苗的人的严重后果有关，并可能有助于为病例管理和未来的疫苗政策制定提供信息。英国研究与创新（医学研究理事会）、研究与创新产业战略挑战基金、苏格兰政府和英国健康数据研究所。
The 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. We 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. Between 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). COVID-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. UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Scottish Government, and Health Data Research UK.