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Background: Little is known on the relative influence of demographic, behavioural, and vaccine-related factors on risk of post-vaccination SARS-CoV-2 infection. Aim(s): To determine risk factors for SARS-CoV-2 infection after primary and booster vaccinations. Method(s): We did a prospective population-based study in SARS-CoV-2-vaccinated UK adults, including data up to Feb 3, 2022. We built two Cox regression models to explore associations between sociodemographic, behavioural, clinical, pharmacological, and nutritional factors and incident SARS-CoV-2 infection after a primary course of vaccination and after a booster dose. Finding(s): 1017 (6.4%) of 15,804 fully vaccinated participants and 697 (6.1%) of 11,382 boosted participants reported breakthrough SARS-CoV-2 infection. A primary course of ChAdOx1 nCoV-19 (ChAdOx1) vs BNT162b2 was associated with higher risk of post-primary infection (adjusted HR 1.61, 95% CI 1.39-1.87). This effect remained after an mRNA booster dose (1.24 [1.04-1.49] for ChAdOx1 + BNT162b2 and 1.44 [1.07-1.92] for ChAdOx1 + mRNA1273, vs BNT162b2 + BNT162b2). Older age was associated with lower risk of infection after primary (0.96 [0.96- 0.97] per year) and booster (0.97 [0.96-0.98]) vaccinations, while lower educational level (1.71 [1.38-2.12] post primary and 1.47 [1.11-1.95] post booster for primary/secondary vs postgraduate) and at least three weekly visits to indoor public places (1.37 [1.15-1.64] post primary and 1.54 [1.21-1.96] post booster vs no visits) were associated with higher risk. Conclusion(s): Vaccine type, socioeconomic status, and behaviours affect risk of breakthrough SARS-CoV-2 infection following a primary schedule and a booster dose.
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Background: A robust correlate of vaccine-induced protection against SARS-CoV-2 infection has yet to be found. Aim(s): To explore whether post-vaccination combined IgG, IgA, and IgM responses to the SARS-CoV-2 trimeric spike glycoprotein (anti-S IgGAM) can predict protection against breakthrough SARS-CoV-2 infection. Method(s): In this prospective population-based study, we used dried blood spots to determine post-vaccination anti-S IgGAM responses in SARS-CoV-2-vaccinated UK adults. Using receiver operating characteristic (ROC) curve analysis, we assessed the ability of anti-S IgGAM titres (adjusted for days since vaccination) to predict postvaccination incident SARS-CoV-2 infection. After adjusting for household and behavioural factors reflecting risk of SARS-CoV-2 exposure, we compared the area under the ROC curve (AUROC) between minimally and fully adjusted models. Finding(s): Between Jan 12, 2021, and Jan 31, 2022, 300 (4.0%) of 7530 participants reported a breakthrough SARS-CoV-2 infection during 18 weeks of follow-up (220 [4.4%] ChAdOx1 nCoV-19 [ChadOx1] recipients and 75 [3.1%] BNT162b2 recipients). Anti-S IgGAM titres were modestly predictive of breakthrough infection (overall: AUROC 0.582 [95% CI 0.550-0.614];ChAdOx1: 0.564 [0.526-0.602];BNT162b2: 0.562 [0.488-0.636]). Adjustment for exposure factors significantly improved discrimination (overall: 0.666 [0.633-0.699], p<0.0001;ChAdOx1: 0.656 [0.617-0.695], p<0.0001;BNT162b1: 0.709 [0.649-0.769], p=0.0012). Conclusion(s): Anti-S IgGAM titres correlate with protection against SARS-CoV-2 infection in vaccinated adults, but exposure factors contribute significantly to risk.
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Background: Prospective population-based studies investigating multiple determinants of pre-vaccination antibody responses to SARS-CoV-2 are lacking. Aim(s): To study factors associated with SARS-CoV-2 seropositivity. Method(s): We did a prospective population-based study in SARS-CoV-2 vaccine-naive UK adults recruited from May to November 2020, without a positive swab test result for SARS-CoV-2 prior to enrolment. Information on 88 potential sociodemographic, behavioural, nutritional, clinical, and pharmacological risk factors was obtained through online questionnaires, and combined IgG/IgA/IgM responses to SARS-CoV-2 spike glycoprotein were determined in dried blood spots. Result(s): 1696 (15.2%) of 11,130 participants were seropositive. Factors independently associated with higher risk of seropositivity included frontline health/care occupation (adjusted OR 1.86, 95% CI 1.48-2.33), international travel (1.20, 1.07-1.35), number of visits to shops and other indoor public places (>=5 vs 0/week: 1.29, 1.06-1.57, Ptrend=0.01), BMI >=25 vs <25 kg/m2 (1.24, 1.11-1.39), South Asian vs White ethnicity (1.65, 1.10-2.49), alcohol consumption >=15 vs 0 units/week (1.23, 1.04-1.46), sex hormone therapy (1.25, 1.02-1.52), and use of vitamin D supplements (1.16, 1.03-1.30). Postgraduate degree (vs primary or secondary level: 0.82, 0.67-0.99), light physical exercise (0.80, 0.70-0.93, for >=10 vs 0-4 h/week), passive smoking (0.59, 0.37-0.95), and prescribed paracetamol use (0.70, 0.52-0.96) were independently associated with lower risk. Conclusion(s): Our findings confirm ethnic, occupational, and lifestyle determinants of SARS-CoV-2 seropositivity and identify additional risk factors.
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Background: Antibody responses to SARS-CoV-2 vaccines vary for reasons that are poorly understood. AIM: To determine factors modifying antibody responses to SARS-CoV-2 vaccination. Method(s): We tested for anti-Spike (S) antibodies before and after 2 doses of ChAdOx1 or BNT162b2 given to UK adults December 2020-July 2021. Participant characteristics and outcomes were captured by online questionnaires. Logistic regression was used to estimate odds of seronegativity after vaccination. For those who were seronegative after 2 vaccine doses, repeat testing was offered following a booster dose of BNT162b2 or mRNA-1273. Result(s): Anti-S antibodies were undetectable in 378/9101 (4.2%) participants after 2 vaccine doses. Increased risk of post-vaccination seronegativity associated with administration of ChAdOx1 vs BNT162b2 (aOR 7.0, 95% CI 4.411.2), shorter interval between vaccine doses (aOR 1.6, 1.2-2.1, 6-10 vs >10 weeks), poor vs excellent general health (aOR 3.3, 1.5-7.5), immunodeficiency (aOR 6.8, 2.6-17.4) and immunosuppressant use (aOR 3.8, 2.4-5.8). Odds of seronegativity were lower for participants who were SARS-CoV-2 seropositive pre-vaccination (aOR 0.2, 0.0-0.7) and for those taking vitamin D supplements (aOR 0.7, 0.5-0.9). Of 247 participants who were seronegative following 2 vaccine doses, 8 (3.2%) remained seronegative post-booster: all were immunosuppressed. Conclusion(s): We identify multiple determinants of antibody responses to SARS-CoV-2 vaccines, many of which are modifiable. Booster doses of BNT162b2 or mRNA-1273 were highly effective in achieving seroconversion in those who failed to mount anti-S responses following two doses of ChAdOx1 or BNT162b2.
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Background: The COVID-19 pandemic exacerbated health inequities among systematically marginalized populations. At the onset of the pandemic, routine cancer screenings were effectively halted;from March to May 2021, there was a deficit of 9.3 million screens. Early evidence suggests that non-White patients, compared to White, have experienced even greater declines in breast and cervical cancer screenings. Consequences of missed or late screenings include later stage diagnosis and poor outcomes. Community navigation programs have been used to promote engagement in cancer screenings in under-resourced communities, but these too were interrupted as restrictions were put in place to mitigate the spread of COVID-19. Objective(s): To use a mixed methods approach to describe the challenges, strengths, and lessons learned of implementing a community navigation program for breast and cervical cancer screening during the COVID-19 pandemic. Method(s): In 2019, The University of Illinois Cancer Screening, Access, Awareness, and Navigation (UI CAAN) intervention was established to address breast and cervical cancer disparities on Chicago's West side, an area with large Black and Latinx populations. The intervention included community navigators who worked in partnership with community-based safety net hospitals and organizations. Participants were recruited at community events and through clinical referrals and were eligible if they were overdue for a guideline concordant breast or cervical cancer screening. Quantitative navigation and screening data were collected by the navigators in a REDCap database. Qualitative data, four focus groups with participants and partners, were also collected to broaden our understanding of impact of COVID-19 on the community navigation intervention. For these analyses, we describe participants' navigation and screening outcomes and use content analysis methods for the focus groups. We then triangulate the findings to understand the challenges, strengths, and lessons learned of the UI CAAN. Result(s): From 2019-2022, a total of 366 individuals were navigated for breast and cervical cancer screenings. Of these, 68% (n = 248) received a breast and/or cervical cancer screening. Among those who were screened, 75% were Latinx and 23% were Black, 92% were uninsured, and 86% did not have a primary care provider. Concerning services received, 30% had a mammogram and a pap smear, 37% a pap smear only, and 33% a mammogram only. At the height of the pandemic, navigators coordinated with community and clinical partners to deliver 500 meals, held 9 PPE distribution events, distributed 3000 masks, and conducted 2 webinars about COVID-19. Conclusion(s): Despite the challenges of the COVID-19 pandemic, the UI CAAN community navigation program was able to shift its efforts at the height of the pandemic to assist its community and clinical partners. The continued collaboration allowed for a successful resumption of navigation and screening efforts once healthcare systems were able to re-engage patients in cancer screenings.
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Introduction and ObjectivesLittle is known about how demographic, behavioural, and vaccine-related factors affect risk of post-vaccination SARS-CoV-2 infection. We aimed to identify risk factors for SARS-CoV-2 infection after primary and booster vaccinations.MethodsThis prospective, population-based, UK study in adults (≥16 years) vaccinated against SARS-CoV-2 assessed risk of breakthrough SARS-CoV-2 infection up to February, 2022, for participants who completed a primary vaccination course (ChAdOx1 nCoV-19 or BNT1262b2) and those who received a booster dose (BNT1262b2 or mRNA-1273). Cox regression models explored associations between sociodemographic, behavioural, clinical, pharmacological, and nutritional factors and test-positive breakthrough infection, adjusted for local weekly SARS-CoV-2 incidence and testing behaviours.Results1051 (7.1%) of 14,713 post-primary participants and 1009 (9.4%) of 10,665 post-booster participants reported breakthrough infection, over a median follow-up of 203 days (IQR 195–216) and 85 days (66–103), respectively. Primary vaccination with ChAdOx1 (vs BNT182b2) was associated with higher risk of infection in both post-primary analysis (adjusted hazard ratio 1.63, 95% CI 1.41–1.88) and after an mRNA-1273 booster (1.26 [1.00–1.57] vs BNT162b2 primary and booster). Lower risk of infection was associated with older age (post-primary: 0.97 [0.96–0.97] per year;post-booster: 0.97 [0.97–0.98]), whereas higher risk of infection was associated with lower educational attainment (post-primary: 1.78 [1.44–2.20] for primary or secondary vs postgraduate;post-booster: 1.46 [1.16–1.83]) and at least three weekly visits to indoor public places (post-primary: 1.36 [1.13–1.63] vs none;post-booster: 1.29 [1.07–1.56]).ConclusionsVaccine type, socioeconomic status, age, and behaviours affect risk of breakthrough infection after primary and booster vaccinations. These findings can inform public health messaging and prioritisation for future vaccinations.Please refer to page A208 for declarations of interest related to this .
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IntroductionVitamin D deficiency associates with susceptibility to COVID-19 and other acute respiratory infections (ARI).ObjectiveTo determine whether a ‘test-and-treat’ approach to vitamin D replacement in the general population reduces incidence of COVID-19 or other ARI.MethodsWe randomly assigned 6200 UK adults to receive an offer of a postal vitamin D test with postal provision of a 6-month supply of higher-dose vitamin D (3200 IU/d, n=1550) or lower-dose vitamin D (800 IU/d, n=1550) to those with 25(OH)D <75 nmol/L vs no offer of vitamin D testing or supplementation (n=3100). The primary outcome was the proportion of participants experiencing at least one test- or doctor-confirmed ARI of any cause at 6 months. Secondary outcomes included incidence of COVID-19.Results2958/3100 adults randomised to intervention accepted the offer of testing, of whom 2690 (90.9%) had 25(OH)D <75 nmol/L and received vitamin D supplements (1356 higher-dose, 1334 lower-dose). 72 adults in the higher-dose offer group, 86 in the lower-dose offer group and 132 in the no offer group experienced at least one ARI of any cause during follow-up (odds ratio [OR] for higher-dose vs. no offer 1.05, 95% CI 0.78–1.40;OR for lower-dose vs. no offer 1.27, 0.96–1.68). COVID-19 was diagnosed in 32 adults in the higher-dose offer group, 48 in the lower-dose offer group and 68 in the no offer group (OR for higher-dose vs. no offer 0.90, 0.59–1.37;OR for lower-dose vs. no offer 1.37, 0.94–1.99).ConclusionsIn adults with a high baseline prevalence of vitamin D insufficiency, a test-and-treat approach to vitamin D replacement did not reduce risk of all-cause ARI or COVID-19.Please refer to page A209 for declarations of interest related to this .
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BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health is still being unravelled. It is important to identify which individuals are at greatest risk of worsening symptoms. This study aimed to examine changes in depression, anxiety and post-traumatic stress disorder (PTSD) symptoms using prospective and retrospective symptom change assessments, and to find and examine the effect of key risk factors. METHOD: Online questionnaires were administered to 34 465 individuals (aged 16 years or above) in April/May 2020 in the UK, recruited from existing cohorts or via social media. Around one-third (n = 12 718) of included participants had prior diagnoses of depression or anxiety and had completed pre-pandemic mental health assessments (between September 2018 and February 2020), allowing prospective investigation of symptom change. RESULTS: Prospective symptom analyses showed small decreases in depression (PHQ-9: -0.43 points) and anxiety [generalised anxiety disorder scale - 7 items (GAD)-7: -0.33 points] and increases in PTSD (PCL-6: 0.22 points). Conversely, retrospective symptom analyses demonstrated significant large increases (PHQ-9: 2.40; GAD-7 = 1.97), with 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Across both prospective and retrospective measures of symptom change, worsening depression, anxiety and PTSD symptoms were associated with prior mental health diagnoses, female gender, young age and unemployed/student status. CONCLUSIONS: We highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias-related underestimation of prior symptom severity.
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Introduction and Objectives Identification of modifiable risk factors for COVID-19 can inform development of public health policies to improve disease control. The COVIDENCE UK study is a population-based 5-year longitudinal study investigating risk factors for, and impacts of, COVID-19 in the UK population. Methods UK residents aged-16 years were invited via a national media campaign to participate in the COVIDENCE UK study by completion of an on-line questionnaire capturing information about potential risk factors for COVID-19. Details of potential symptoms of COVID-19 occurring since 1st February 2020 were also captured, and used to identify those who had experienced probable COVID-19 using an algorithm validated against PCR-positivity for SARS-CoV-2 infection. Multivariable logistic regression was then applied to identify factors independently associated with risk of probable COVID-19, with adjustment for fifteen potential confounders including age, sex and ethnic origin. Results A total of 9,817 participants completed the COVIDENCE UK baseline questionnaire between 1st May and 12th August 2020, of whom 982 (10.0%) were classified as having had probable COVID-19. Increased risk of probable COVID-19 was independently associated with lower household income (adjusted odds ratio [aOR] 1.52, 95% confidence interval [CI] 1.23 to 1.87), being overweight (BMI 25-30 kg/m2, aOR 1.19, 95% CI 1.01 to 1.39), poorer self-reported general health (aOR 1.33, 95% CI 1.09 to 1.61) and employment as a 'frontline worker' (aOR 1.57, 95% CI 1.34 to 1.84). Taking at least one hour of vigorous physical exercise per week was associated with a lower risk (aOR 0.77, 95% CI 0.67 to 0.89). Conclusions Lack of vigorous exercise may be a potentially modifiable risk factor for COVID-19. Lower household income, higher BMI, poorer self-reported general health and employment as a frontline worker were also independently associated with increased risk of disease.
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Introduction and ObjectivesIdentification of modifiable risk factors for COVID-19 can inform development of public health policies to improve disease control. The COVIDENCE UK study is a population-based 5-year longitudinal study investigating risk factors for, and impacts of, COVID-19 in the UK population.MethodsUK residents aged ≥16 years were invited via a national media campaign to participate in the COVIDENCE UK study by completion of an on-line questionnaire capturing information about potential risk factors for COVID-19. Details of potential symptoms of COVID-19 occurring since 1st February 2020 were also captured, and used to identify those who had experienced probable COVID-19 using an algorithm validated against PCR-positivity for SARS-CoV-2 infection. Multivariable logistic regression was then applied to identify factors independently associated with risk of probable COVID-19, with adjustment for fifteen potential confounders including age, sex and ethnic origin.ResultsA total of 9,817 participants completed the COVIDENCE UK baseline questionnaire between 1st May and 12th August 2020, of whom 982 (10.0%) were classified as having had probable COVID-19. Increased risk of probable COVID-19 was independently associated with lower household income (adjusted odds ratio [aOR] 1.52, 95% confidence interval [CI] 1.23 to 1.87), being overweight (BMI 25–30 kg/m2, aOR 1.19, 95% CI 1.01 to 1.39), poorer self-reported general health (aOR 1.33, 95% CI 1.09 to 1.61) and employment as a ‘frontline worker’ (aOR 1.57, 95% CI 1.34 to 1.84). Taking at least one hour of vigorous physical exercise per week was associated with a lower risk (aOR 0.77, 95% CI 0.67 to 0.89).ConclusionsLack of vigorous exercise may be a potentially modifiable risk factor for COVID-19. Lower household income, higher BMI, poorer self-reported general health and employment as a frontline worker were also independently associated with increased risk of disease.