Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study

Eleftheria Vasileiou; Colin R Simpson; Ting Shi; Steven Kerr; Utkarsh Agrawal; Ashley Akbari; Stuart Bedston; Jillian Beggs; Declan Bradley; Antony Chuter; Simon de Lusignan; Annemarie B Docherty; David Ford; Fd Richard Hobbs; Mark Joy; Srinivasa Vittal Katikireddi; James Marple; Colin McCowan; Dylan McGagh; Jim McMenamin; Emily Moore; Josephine Lk Murray; Jiafeng Pan; Lewis Ritchie; Syed Ahmar Shah; Sarah Stock; Fatemeh Torabi; Ruby Sm Tsang; Rachael Wood; Mark Woolhouse; Chris Robertson; Aziz Sheikh

doi:10.1016/S0140-6736(21)00677-2

Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study

Eleftheria Vasileiou, Colin R Simpson, Ting Shi, Steven Kerr, Utkarsh Agrawal, Ashley Akbari, Stuart Bedston, Jillian Beggs, Declan Bradley, Antony Chuter, Simon de Lusignan, Annemarie B Docherty, David Ford, Fd Richard Hobbs, Mark Joy, Srinivasa Vittal Katikireddi, James Marple, Colin McCowan, Dylan McGagh, Jim McMenaminEmily Moore, Josephine Lk Murray, Jiafeng Pan, Lewis Ritchie, Syed Ahmar Shah, Sarah Stock, Fatemeh Torabi, Ruby Sm Tsang, Rachael Wood, Mark Woolhouse, Chris Robertson, Aziz Sheikh^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: The BNT162b2 mRNA (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) COVID-19 vaccines have shown high efficacy against disease in phase 3 clinical trials and are now being used in national vaccination programmes in the UK and several other countries. Studying the real-world effects of these vaccines is an urgent requirement. The aim of our study was to investigate the association between the mass roll-out of the first doses of these COVID-19 vaccines and hospital admissions for COVID-19.

METHODS: We did a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19-EAVE II-database comprising linked vaccination, primary care, real-time reverse transcription-PCR testing, and hospital admission patient records for 5·4 million people in Scotland (about 99% of the population) registered at 940 general practices. Individuals who had previously tested positive were excluded from the analysis. A time-dependent Cox model and Poisson regression models with inverse propensity weights were fitted to estimate effectiveness against COVID-19 hospital admission (defined as 1-adjusted rate ratio) following the first dose of vaccine.

FINDINGS: Between Dec 8, 2020, and Feb 22, 2021, a total of 1 331 993 people were vaccinated over the study period. The mean age of those vaccinated was 65·0 years (SD 16·2). The first dose of the BNT162b2 mRNA vaccine was associated with a vaccine effect of 91% (95% CI 85-94) for reduced COVID-19 hospital admission at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 88% (95% CI 75-94). Results of combined vaccine effects against hospital admission due to COVID-19 were similar when restricting the analysis to those aged 80 years and older (83%, 95% CI 72-89 at 28-34 days post-vaccination).

INTERPRETATION: Mass roll-out of the first doses of the BNT162b2 mRNA and ChAdOx1 vaccines was associated with substantial reductions in the risk of hospital admission due to COVID-19 in Scotland. There remains the possibility that some of the observed effects might have been due to residual confounding.

FUNDING: UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK.

Original language	English
Pages (from-to)	1646-1657
Number of pages	12
Journal	The Lancet
Volume	397
Issue number	10285
Early online date	23 Apr 2021
DOIs	https://doi.org/10.1016/S0140-6736(21)00677-2
Publication status	Published - 1 May 2021

Bibliographical note

EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE—The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Additional support has been provided through Public Health Scotland and the Scottish Government's director-general of Health and Social Care. FDRH acknowledges part support from the National Institutes of Health Research (NIHR) School for Primary Care Research, the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford, and the NIHR Oxford Biomedical Research Centre. We thank Dave Kelly from Albasoft for his support with making primary care data available, and James Pickett, Wendy Inglis-Humphrey, Vicky Hammersley, Maria Georgiou, and Laura Gonzalez Rienda for their support with project management and administration. SVK acknowledges funding from an NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2), and Scottish Government Chief Scientist Office (SPHSU13).

Keywords

Adolescent
Adult
Aged
Aged, 80 and over
COVID-19/epidemiology
COVID-19 Vaccines
Female
Hospitalization/statistics & numerical data
Humans
Male
Mass Vaccination
Middle Aged
Pandemics/prevention & control
Prospective Studies
Risk Factors
Scotland/epidemiology
Social Class
Young Adult

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Vasileiou, E., Simpson, C. R., Shi, T., Kerr, S., Agrawal, U., Akbari, A., Bedston, S., Beggs, J., Bradley, D., Chuter, A., de Lusignan, S., Docherty, A. B., Ford, D., Hobbs, F. R., Joy, M., Katikireddi, S. V., Marple, J., McCowan, C., McGagh, D., ... Sheikh, A. (2021). Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study. The Lancet, 397(10285), 1646-1657. https://doi.org/10.1016/S0140-6736(21)00677-2

Vasileiou, E, Simpson, CR, Shi, T, Kerr, S, Agrawal, U, Akbari, A, Bedston, S, Beggs, J, Bradley, D, Chuter, A, de Lusignan, S, Docherty, AB, Ford, D, Hobbs, FR, Joy, M, Katikireddi, SV, Marple, J, McCowan, C, McGagh, D, McMenamin, J, Moore, E, Murray, JL, Pan, J, Ritchie, L, Shah, SA, Stock, S, Torabi, F, Tsang, RS, Wood, R, Woolhouse, M, Robertson, C & Sheikh, A 2021, 'Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study', The Lancet, vol. 397, no. 10285, pp. 1646-1657. https://doi.org/10.1016/S0140-6736(21)00677-2

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title = "Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study",

abstract = "BACKGROUND: The BNT162b2 mRNA (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) COVID-19 vaccines have shown high efficacy against disease in phase 3 clinical trials and are now being used in national vaccination programmes in the UK and several other countries. Studying the real-world effects of these vaccines is an urgent requirement. The aim of our study was to investigate the association between the mass roll-out of the first doses of these COVID-19 vaccines and hospital admissions for COVID-19.METHODS: We did a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19-EAVE II-database comprising linked vaccination, primary care, real-time reverse transcription-PCR testing, and hospital admission patient records for 5·4 million people in Scotland (about 99% of the population) registered at 940 general practices. Individuals who had previously tested positive were excluded from the analysis. A time-dependent Cox model and Poisson regression models with inverse propensity weights were fitted to estimate effectiveness against COVID-19 hospital admission (defined as 1-adjusted rate ratio) following the first dose of vaccine.FINDINGS: Between Dec 8, 2020, and Feb 22, 2021, a total of 1 331 993 people were vaccinated over the study period. The mean age of those vaccinated was 65·0 years (SD 16·2). The first dose of the BNT162b2 mRNA vaccine was associated with a vaccine effect of 91% (95% CI 85-94) for reduced COVID-19 hospital admission at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 88% (95% CI 75-94). Results of combined vaccine effects against hospital admission due to COVID-19 were similar when restricting the analysis to those aged 80 years and older (83%, 95% CI 72-89 at 28-34 days post-vaccination).INTERPRETATION: Mass roll-out of the first doses of the BNT162b2 mRNA and ChAdOx1 vaccines was associated with substantial reductions in the risk of hospital admission due to COVID-19 in Scotland. There remains the possibility that some of the observed effects might have been due to residual confounding.FUNDING: UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK.",

keywords = "Adolescent, Adult, Aged, Aged, 80 and over, COVID-19/epidemiology, COVID-19 Vaccines, Female, Hospitalization/statistics & numerical data, Humans, Male, Mass Vaccination, Middle Aged, Pandemics/prevention & control, Prospective Studies, Risk Factors, Scotland/epidemiology, Social Class, Young Adult",

author = "Eleftheria Vasileiou and Simpson, {Colin R} and Ting Shi and Steven Kerr and Utkarsh Agrawal and Ashley Akbari and Stuart Bedston and Jillian Beggs and Declan Bradley and Antony Chuter and {de Lusignan}, Simon and Docherty, {Annemarie B} and David Ford and Hobbs, {Fd Richard} and Mark Joy and Katikireddi, {Srinivasa Vittal} and James Marple and Colin McCowan and Dylan McGagh and Jim McMenamin and Emily Moore and Murray, {Josephine Lk} and Jiafeng Pan and Lewis Ritchie and Shah, {Syed Ahmar} and Sarah Stock and Fatemeh Torabi and Tsang, {Ruby Sm} and Rachael Wood and Mark Woolhouse and Chris Robertson and Aziz Sheikh",

note = "EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE—The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Additional support has been provided through Public Health Scotland and the Scottish Government's director-general of Health and Social Care. FDRH acknowledges part support from the National Institutes of Health Research (NIHR) School for Primary Care Research, the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford, and the NIHR Oxford Biomedical Research Centre. We thank Dave Kelly from Albasoft for his support with making primary care data available, and James Pickett, Wendy Inglis-Humphrey, Vicky Hammersley, Maria Georgiou, and Laura Gonzalez Rienda for their support with project management and administration. SVK acknowledges funding from an NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2), and Scottish Government Chief Scientist Office (SPHSU13). ",

year = "2021",

month = may,

day = "1",

doi = "10.1016/S0140-6736(21)00677-2",

language = "English",

volume = "397",

pages = "1646--1657",

journal = "The Lancet",

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TY - JOUR

T1 - Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland

T2 - a national prospective cohort study

AU - Vasileiou, Eleftheria

AU - Simpson, Colin R

AU - Shi, Ting

AU - Kerr, Steven

AU - Agrawal, Utkarsh

AU - Akbari, Ashley

AU - Bedston, Stuart

AU - Beggs, Jillian

AU - Bradley, Declan

AU - Chuter, Antony

AU - de Lusignan, Simon

AU - Docherty, Annemarie B

AU - Ford, David

AU - Hobbs, Fd Richard

AU - Joy, Mark

AU - Katikireddi, Srinivasa Vittal

AU - Marple, James

AU - McCowan, Colin

AU - McGagh, Dylan

AU - McMenamin, Jim

AU - Moore, Emily

AU - Murray, Josephine Lk

AU - Pan, Jiafeng

AU - Ritchie, Lewis

AU - Shah, Syed Ahmar

AU - Stock, Sarah

AU - Torabi, Fatemeh

AU - Tsang, Ruby Sm

AU - Wood, Rachael

AU - Woolhouse, Mark

AU - Robertson, Chris

AU - Sheikh, Aziz

N1 - EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE—The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Additional support has been provided through Public Health Scotland and the Scottish Government's director-general of Health and Social Care. FDRH acknowledges part support from the National Institutes of Health Research (NIHR) School for Primary Care Research, the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford, and the NIHR Oxford Biomedical Research Centre. We thank Dave Kelly from Albasoft for his support with making primary care data available, and James Pickett, Wendy Inglis-Humphrey, Vicky Hammersley, Maria Georgiou, and Laura Gonzalez Rienda for their support with project management and administration. SVK acknowledges funding from an NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2), and Scottish Government Chief Scientist Office (SPHSU13).

PY - 2021/5/1

Y1 - 2021/5/1

N2 - BACKGROUND: The BNT162b2 mRNA (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) COVID-19 vaccines have shown high efficacy against disease in phase 3 clinical trials and are now being used in national vaccination programmes in the UK and several other countries. Studying the real-world effects of these vaccines is an urgent requirement. The aim of our study was to investigate the association between the mass roll-out of the first doses of these COVID-19 vaccines and hospital admissions for COVID-19.METHODS: We did a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19-EAVE II-database comprising linked vaccination, primary care, real-time reverse transcription-PCR testing, and hospital admission patient records for 5·4 million people in Scotland (about 99% of the population) registered at 940 general practices. Individuals who had previously tested positive were excluded from the analysis. A time-dependent Cox model and Poisson regression models with inverse propensity weights were fitted to estimate effectiveness against COVID-19 hospital admission (defined as 1-adjusted rate ratio) following the first dose of vaccine.FINDINGS: Between Dec 8, 2020, and Feb 22, 2021, a total of 1 331 993 people were vaccinated over the study period. The mean age of those vaccinated was 65·0 years (SD 16·2). The first dose of the BNT162b2 mRNA vaccine was associated with a vaccine effect of 91% (95% CI 85-94) for reduced COVID-19 hospital admission at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 88% (95% CI 75-94). Results of combined vaccine effects against hospital admission due to COVID-19 were similar when restricting the analysis to those aged 80 years and older (83%, 95% CI 72-89 at 28-34 days post-vaccination).INTERPRETATION: Mass roll-out of the first doses of the BNT162b2 mRNA and ChAdOx1 vaccines was associated with substantial reductions in the risk of hospital admission due to COVID-19 in Scotland. There remains the possibility that some of the observed effects might have been due to residual confounding.FUNDING: UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK.

AB - BACKGROUND: The BNT162b2 mRNA (Pfizer-BioNTech) and ChAdOx1 nCoV-19 (Oxford-AstraZeneca) COVID-19 vaccines have shown high efficacy against disease in phase 3 clinical trials and are now being used in national vaccination programmes in the UK and several other countries. Studying the real-world effects of these vaccines is an urgent requirement. The aim of our study was to investigate the association between the mass roll-out of the first doses of these COVID-19 vaccines and hospital admissions for COVID-19.METHODS: We did a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19-EAVE II-database comprising linked vaccination, primary care, real-time reverse transcription-PCR testing, and hospital admission patient records for 5·4 million people in Scotland (about 99% of the population) registered at 940 general practices. Individuals who had previously tested positive were excluded from the analysis. A time-dependent Cox model and Poisson regression models with inverse propensity weights were fitted to estimate effectiveness against COVID-19 hospital admission (defined as 1-adjusted rate ratio) following the first dose of vaccine.FINDINGS: Between Dec 8, 2020, and Feb 22, 2021, a total of 1 331 993 people were vaccinated over the study period. The mean age of those vaccinated was 65·0 years (SD 16·2). The first dose of the BNT162b2 mRNA vaccine was associated with a vaccine effect of 91% (95% CI 85-94) for reduced COVID-19 hospital admission at 28-34 days post-vaccination. Vaccine effect at the same time interval for the ChAdOx1 vaccine was 88% (95% CI 75-94). Results of combined vaccine effects against hospital admission due to COVID-19 were similar when restricting the analysis to those aged 80 years and older (83%, 95% CI 72-89 at 28-34 days post-vaccination).INTERPRETATION: Mass roll-out of the first doses of the BNT162b2 mRNA and ChAdOx1 vaccines was associated with substantial reductions in the risk of hospital admission due to COVID-19 in Scotland. There remains the possibility that some of the observed effects might have been due to residual confounding.FUNDING: UK Research and Innovation (Medical Research Council), Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - COVID-19/epidemiology

KW - COVID-19 Vaccines

KW - Female

KW - Hospitalization/statistics & numerical data

KW - Humans

KW - Male

KW - Mass Vaccination

KW - Middle Aged

KW - Pandemics/prevention & control

KW - Prospective Studies

KW - Risk Factors

KW - Scotland/epidemiology

KW - Social Class

KW - Young Adult

U2 - 10.1016/S0140-6736(21)00677-2

DO - 10.1016/S0140-6736(21)00677-2

M3 - Article

C2 - 33901420

SN - 0140-6736

VL - 397

SP - 1646

EP - 1657

JO - The Lancet

JF - The Lancet

IS - 10285

ER -

Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study

Abstract

Bibliographical note

Keywords

UN SDGs

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