Risk of severe COVID-19 outcomes after autumn 2022 COVID-19 booster vaccinations: a pooled analysis of national prospective cohort studies involving 7.4 million adults in England, Northern Ireland, Scotland and Wales.

Autor:	Bedston S; Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK., Almaghrabi F; Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK., Patterson L; Centre for Public Health, Queen's University Belfast, Belfast, UK.; Public Health Agency, Belfast, UK., Agrawal U; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK., Woolford L; Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK., Anand SN; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK., Joy M; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK., Crawford A; Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK., Goudie R; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK., Byford R; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK., Abbasizanjani H; Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK., Smith D; Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK., Laidlaw L; Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK., Akbari A; Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK., Sullivan C; Public Health Scotland, Glasgow, Scotland, UK., Bradley DT; Centre for Public Health, Queen's University Belfast, Belfast, UK.; Public Health Agency, Belfast, UK., Lyons RA; Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK., de Lusignan S; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK., Hobbs FDR; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK., Robertson C; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK.; Public Health Scotland, Glasgow, Scotland, UK., Sheikh SA; Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK., Shi T; Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK.
Jazyk:	angličtina
Zdroj:	The Lancet regional health. Europe [Lancet Reg Health Eur] 2023 Dec 12; Vol. 37, pp. 100816. Date of Electronic Publication: 2023 Dec 12 (Print Publication: 2024).
DOI:	10.1016/j.lanepe.2023.100816
Abstrakt:	Background: UK COVID-19 vaccination policy has evolved to offering COVID-19 booster doses to individuals at increased risk of severe Illness from COVID-19. Building on our analyses of vaccine effectiveness of first, second and initial booster doses, we aimed to identify individuals at increased risk of severe outcomes (i.e., COVID-19 related hospitalisation or death) post the autumn 2022 booster dose. Methods: We undertook a national population-based cohort analysis across all four UK nations through linked primary care, vaccination, hospitalisation and mortality data. We included individuals who received autumn 2022 booster doses of BNT162b2 (Comirnaty) or mRNA-1273 (Spikevax) during the period September 1, 2022 to December 31, 2022 to investigate the risk of severe COVID-19 outcomes. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for the association between demographic and clinical factors and severe COVID-19 outcomes after the autumn booster dose. Analyses were adjusted for age, sex, body mass index (BMI), deprivation, urban/rural areas and comorbidities. Stratified analyses were conducted by vaccine type. We then conducted a fixed-effect meta-analysis to combine results across the four UK nations. Findings: Between September 1, 2022 and December 31, 2022, 7,451,890 individuals ≥18 years received an autumn booster dose. 3500 had severe COVID-19 outcomes (2.9 events per 1000 person-years). Being male (male vs female, aHR 1.41 (1.32-1.51)), older adults (≥80 years vs 18-49 years; 10.43 (8.06-13.50)), underweight (BMI <18.5 vs BMI 25.0-29.9; 2.94 (2.51-3.44)), those with comorbidities (≥5 comorbidities vs none; 9.45 (8.15-10.96)) had a higher risk of COVID-19 hospitalisation or death after the autumn booster dose. Those with a larger household size (≥11 people within household vs 2 people; 1.56 (1.23-1.98)) and from more deprived areas (most deprived vs least deprived quintile; 1.35 (1.21-1.51)) had modestly higher risks. We also observed at least a two-fold increase in risk for those with various chronic neurological conditions, including Down's syndrome, immunodeficiency, chronic kidney disease, cancer, chronic respiratory disease, or cardiovascular disease. Interpretation: Males, older individuals, underweight individuals, those with an increasing number of comorbidities, from a larger household or more deprived areas, and those with specific underlying health conditions remained at increased risk of COVID-19 hospitalisation and death after the autumn 2022 vaccine booster dose. There is now a need to focus on these risk groups for investigating immunogenicity and efficacy of further booster doses or therapeutics. Funding: National Core Studies-Immunity, UK Research and Innovation (Medical Research Council and Economic and Social Research Council), Health Data Research UK, the Scottish Government, and the University of Edinburgh. Competing Interests: AS and CR are members of the Scottish Government's CMO COVID-19 Advisory Group. AS and CR are members of NERVTAG's risk stratification subgroup. CR is a member of SPI-M. AS is a member of AstraZeneca's Thrombotic Thrombocytopenic Advisory Group and the Scottish Government's Standing Committee on Pandemics. All roles are unremunerated. RAL is a member of the Welsh Government COVID-19 Technical Advisory Group. All other co-authors report no conflict of interests. SdeL is Director of the RSC, through his university he has received vaccine related research funding from AstraZeneca, GSK, Sanofi, Seqirus, MSD and Takeda, and been member of advisory boards for AstraZeneca, GSK, Sanofi and Seqirus. (© 2023 The Authors.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu