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Effectiveness of BNT162b2 and ChAdOx1 nCoV-19 COVID-19 vaccination at preventing hospitalisations in people aged at least 80 years: a test-negative, case-control study - 28/10/21

Doi : 10.1016/S1473-3099(21)00330-3 
Catherine Hyams, PhD a, d, Robin Marlow, PhD a, Zandile Maseko, BSc d, Jade King, MSc e, Lana Ward, NVQ f, Kazminder Fox, MSc e, Robyn Heath, MSc e, Anabella Tuner, MSc e, Zsolt Friedrich, HND f, Leigh Morrison, BSc f, Gabriella Ruffino, BMBS f, Rupert Antico, MSc a, David Adegbite, MPharm a, Zsuzsa Szasz-Benczur, MA a, Maria Garcia Gonzalez, MSc a, Jennifer Oliver, PhD a, Leon Danon, PhD b, Adam Finn, ProfPhD a, c,
a Population Health Sciences, University of Bristol, Bristol, UK 
b Engineering Mathematics, University of Bristol, Bristol, UK 
c Cellular and Molecular Medicine, University of Bristol, Bristol, UK 
d Academic Respiratory Unit, Southmead Hospital, Bristol, UK 
e Clinical Research and Imaging Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK 
f North Bristol NHS Trust, Southmead Hospital, Bristol, UK 

* Correspondence to: Prof Adam Finn, Population Health Sciences, University of Bristol, Bristol BS2 8AE, UK Population Health Sciences University of Bristol Bristol BS2 8AE UK

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Summary

Background

On Dec 8, 2020, deployment of the first SARS-CoV-2 vaccination authorised for UK use (BNT162b2 mRNA vaccine) began, followed by an adenoviral vector vaccine ChAdOx1 nCoV-19 on Jan 4, 2021. Care home residents and staff, frontline health-care workers, and adults aged 80 years and older were vaccinated first. However, few data exist regarding the effectiveness of these vaccines in older people with many comorbidities. In this post-implementation evaluation of two COVID-19 vaccines, we aimed to determine the effectiveness of one dose in reducing COVID-19-related admissions to hospital in people of advanced age.

Methods

This prospective test-negative case-control study included adults aged at least 80 years who were admitted to hospital in two NHS trusts in Bristol, UK with signs and symptoms of respiratory disease. Patients who developed symptoms before receiving their vaccine or those who received their vaccine after admission to hospital were excluded, as were those with symptoms that started more than 10 days before hospital admission. We did logistic regression analysis, controlling for time (week), sex, index of multiple deprivations, and care residency status, and sensitivity analyses matched for time and sex using a conditional logistic model adjusting for index of multiple deprivations and care residency status. This study is registered with ISRCTN, number 39557.

Findings

Between Dec 18, 2020, and Feb 26, 2021, 466 adults were eligible (144 test-positive and 322 test-negative). 18 (13%) of 135 people with SARS-CoV-2 infection and 90 (34%) of 269 controls received one dose of BNT162b2. The adjusted vaccine effectiveness was 71·4% (95% CI 46·5–90·6). Nine (25%) of 36 people with COVID-19 infection and 53 (59%) of 90 controls received one dose of ChAdOx1 nCoV-19. The adjusted vaccine effectiveness was 80·4% (95% CI 36·4–94·5). When BNT162b2 effectiveness analysis was restricted to the period covered by ChAdOx1 nCoV-19, the estimate was 79·3% (95% CI 47·0–92·5).

Interpretation

One dose of either BNT162b2 or ChAdOx1 nCoV-19 resulted in substantial risk reductions of COVID-19-related hospitalisation in people aged at least 80 years.

Funding

Pfizer.

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Vol 21 - N° 11

P. 1539-1548 - novembre 2021 Retour au numéro
Article précédent Article précédent
  • Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of long-term care facilities in England (VIVALDI): a prospective cohort study
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