Background

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.

Methods

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.

Findings

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).

Interpretation

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.

Funding

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

中文翻译：

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苏格兰 2·5700 万人接种 BNT162b2 和 ChAdOx1 nCoV-19 疫苗后的 COVID-19 住院和死亡情况 (EAVE II)：一项前瞻性队列研究

 背景

英国 COVID-19 疫苗接种计划优先为那些 COVID-19 死亡和住院风险最高的人群进行疫苗接种。该计划于 2020-21 年冬季在苏格兰推出，尽管采取了社交距离措施，但当时 SARS-CoV-2 感染率仍处于大流行开始以来的最高水平。我们的目的是估计至少接受一剂疫苗的人中 COVID-19 住院或死亡的频率，并描述这些人的特征。

 方法

我们利用 COVID-19 早期流行病评估和加强监测 (EAVE II) 国家监测平台进行了一项前瞻性队列研究，其中包含 5·40 万人的疫苗接种、初级保健、RT-PCR 检测、住院和死亡记录。 （约 99% 的人口）在苏格兰。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，直至因 COVID-19 入院、死亡或研究期结束。 2021 年 4 月 18 日。我们使用时间依赖性泊松回归模型来估计与首次接种疫苗后 14 天或更长时间内的 COVID-19 住院或死亡相关的人口和临床因素的比率 (RR)，并按疫苗类型进行分层。

 发现

2020年12月8日至2021年4月18日期间，2 572 008人接种了第一剂疫苗——841 090人（32·7%）接种了BNT162b2，1 730 918人（67·3%）接种了ChAdOx1。 1196（<0 id=3>与 18–64 岁调整后 RR 4·75，95% CI 3·85–5·87），合并症（五个或更多风险组与少于五个风险组 4·24、3· 34–5·39)、过去 4 周内住院治疗 (3·00、2·47–3·65)、高风险职业（之前进行过 10 次或以上的 COVID-19 测试与之前进行过 10 次以下的 COVID-19 测试 2 ·14, 1·62–2·81)，疗养院居住 (1·63, 1·32–2·02)，社会经济剥夺（最贫困的五分之一与最不贫困的五分之一 1·57, 1·30–1·90 ）、男性（1·27、1·13–1·43）以及戒烟者（戒烟者与非吸烟者 1·18、1·01–1·38）。接种疫苗前有 COVID-19 病史具有保护作用（0·40、0·29–0·54）。

 解释

在本次全国分析中，在 SARS-CoV-2 感染背景发病率较高且采取了广泛的社交距离措施的情况下，在首次接种疫苗 14 天或更长时间后，COVID-19 住院和死亡的情况并不常见。已知会增加未接种疫苗人群患严重疾病风险的社会人口学和临床特征也与接受第一剂疫苗的人的严重后果有关，并且可以帮助为病例管理和未来的疫苗政策制定提供信息。

 资金

英国研究与创新（医学研究委员会）、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。