AZD1222 effectiveness against severe COVID-19 in individuals with comorbidity or frailty: The RAVEN cohort study - 30/03/24

Doi : 10.1016/j.jinf.2024.106129

Wilhelmine Meeraus ^a, Mark Joy ^b, Mario Ouwens ^c, Kathryn S. Taylor ^b, Sudhir Venkatesan ^d, John Dennis ^e, Trung N. Tran ^f, Ashkan Dashtban ^g, Xuejuan Fan ^b, Robert Williams ^b, Tamsin Morris ^h, Lucy Carty ^d, Debasish Kar ^b, Uy Hoang ^b, Michael Feher ^b, Anna Forbes ^b, Gavin Jamie ^b, William Hinton ^b, Kornelia Sanecka ⁱ, Rachel Byford ^b, Sneha N. Anand ^b, F.D. Richard Hobbs ^b, David A. Clifton ^j, Andrew J. Pollard ^k,^l, Sylvia Taylor ^a, Simon de Lusignan ^b,^m,^⁎
^a Medical Evidence, Vaccines & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
^b Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
^c Medical & Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Mölndal, Sweden
^d Medical & Payer Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
^e Momentum Data, St Albans, UK
^f Biopharmaceutical Medicine Respiratory and Immunology, AstraZeneca, Gaithersburg, MD, USA
^g Institute of Health Informatics, University College London, London, UK
^h Medical and Scientific Affairs, BioPharmaceuticals Medical, AstraZeneca, London, UK
ⁱ Medical Evidence, Vaccines & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Warsaw, Poland
^j Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
^k Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
^l NIHR Oxford Biomedical Research Centre, Oxford, UK
^m Royal College of General Practitioners Research and Surveillance Centre, London, UK

^⁎Correspondence to: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Radcliffe Observatory QuarterWoodstock RoadOxfordOX2 6GGUK

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Summary

Objectives

Despite being prioritized during initial COVID-19 vaccine rollout, vulnerable individuals at high risk of severe COVID-19 (hospitalization, intensive care unit admission, or death) remain underrepresented in vaccine effectiveness (VE) studies. The RAVEN cohort study (NCT05047822) assessed AZD1222 (ChAdOx1 nCov-19) two-dose primary series VE in vulnerable populations.

Methods

Using the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub, linked to secondary care, death registration, and COVID-19 datasets in England, COVID-19 outcomes in 2021 were compared in vaccinated and unvaccinated individuals matched on age, sex, region, and multimorbidity.

Results

Over 4.5 million AZD1222 recipients were matched (mean follow-up ∼5 months); 68% were ≥50 years, 57% had high multimorbidity. Overall, high VE against severe COVID-19 was demonstrated, with lower VE observed in vulnerable populations. VE against hospitalization was higher in the lowest multimorbidity quartile (91.1%; 95% CI: 90.1, 92.0) than the highest quartile (80.4%; 79.7, 81.1), and among individuals ≥65 years, higher in the ‘fit’ (86.2%; 84.5, 87.6) than the frailest (71.8%; 69.3, 74.2). VE against hospitalization was lowest in immunosuppressed individuals (64.6%; 60.7, 68.1).

Conclusions

Based on integrated and comprehensive UK health data, overall population-level VE with AZD1222 was high. VEs were notably lower in vulnerable groups, particularly the immunosuppressed.

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Graphical abstract

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Highlights

•	AZD1222 (ChAdOx1 nCoV-19) real-world vaccine effectiveness (VE) in 2021 was studied.
•	Over 4.5 million vaccinated individuals were assessed with ∼5 months mean follow-up.
•	VE was 84.1%/90.7%/85.9% for hospitalization/intensive care admission/death.
•	People with higher comorbidity burden or more severe frailty had lower VE.
•	Immunosuppressed individuals had the lowest VE from primary series vaccination.

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Keywords : COVID-19, SARS-CoV-2, COVID-19 vaccines, ChAdOx1 nCoV-19

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Introduction

Methods

Study design, population, and eligibility

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Vaccine effectiveness

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Vol 88 - N° 4

Article 106129- avril 2024 Retour au numéro

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AZD1222 effectiveness against severe COVID-19 in individuals with comorbidity or frailty: The RAVEN cohort study - 30/03/24

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Methods

Results

Conclusions

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