ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
Background: Early surveillance of COVID-19 in Scotland included routine monitoring of positive test rates and COVID-19-related NHS 24 calls. The COVID Symptom Study (CSS) provides another surveillance source, collating self-reported symptoms in the general population and predictions of likely infection. Aim(s): To capture spatial patterns of COVID-19 infection using Spatio-temporal (ST) analyses on three data streams: positive test rates, NHS24 calls, and CSS predicted cases. These were compared to assess which was best for early disease surveillance. Method(s): Data streams recorded weekly counts of activity by postcode district (PCD) during the first wave of the pandemic. ST analyses assessed the relationship between COVID-19 testing, NHS 24 COVID-19 calls, and CSS predicted COVID-19 cases, applying a Leroux conditional auto-regression (CAR) spatial GLM, adjusting for spatial covariates. Result(s): Positive test rates were associated with the proportion of NHS 24 calls related to COVID-19 per PCD (OR=1.038, 95% credible interval, 1.024-1.052) and the proportion of CSS app users predicted as cases, (OR=1.014, 0.974-1.056). A temporal effect was seen between all streams, after adjusting for spatial covariates. Using both NHS24 and the CSS to model COVID-19 positive test rates accounted for more ST variability than with the separate models, implying that combining sources may improve surveillance accuracy. Conclusion(s): NHS 24 and the CSS can identify similar trends/clusters of COVID-19 and gold-standard testing data, particularly when used in parallel. In the early stages of a pandemic, when widespread testing might not be available, alternative sources of data may be used to inform outbreak management.
ABSTRACT
IntroductionSocio-economic deprivation is a well-recognised risk factor for COVID-19 and other respiratory infections. However, the impact of COVID-19 infection on economic vulnerability has not previously been characterised.ObjectivesTo determine whether COVID-19 has a significant impact on household income and work absence due to sickness, both at onset of illness (acutely) and subsequently (long-term).MethodsMultivariate regression analysis of self-reported data from monthly online questionnaires completed by participants in the COVIDENCE UK population-based longitudinal study (n=16,910) from 1st May 2020 to 28th October 2021, adjusting for baseline characteristics including age, sex, economic status and health.ResultsIncident COVID-19 was independently associated with increased odds of participants reporting household income as being inadequate to meet their basic needs acutely (adjusted odds ratio [aOR) 1.39, 95% confidence interval [CI] 1.12 to 1.73) though this did not persist in the long-term (aOR 1.00, 95% CI 0.86 to 1.16).Exploratory analysis revealed a stronger acute association amongst those who reported ‘long COVID’, defined as the presence of symptoms lasting more than 4 weeks after the acute episode, than those reporting COVID-19 without ‘long COVID’ (p for trend 0.002).Incident COVID-19 associated with increased odds of reporting sickness absence from work in the long-term (aOR 4.73, 95% CI 2.47 to 9.06) but not acutely (aOR 1.34, 95% CI 0.52 to 3.49).ConclusionsWe demonstrate an independent association between COVID-19 and increased risk of economic vulnerability amongst COVIDENCE participants, measured by both household income sufficiency and sickness absence from work.Since socio-economic deprivation also increases risk of COVID-19, our findings suggest a bidirectional relationship between COVID-19 and poverty. This may generate a ‘vicious cycle’ of increased vulnerability, impaired health, and poor economic outcomes.Please refer to page A208 for declarations of interest related to this .
ABSTRACT
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 .
ABSTRACT
P80 Figure 1Generalised additive models showing trends in behaviours and acute respiratory infections (ARI) from November 2020 to April 2022 in UK adults with asthma. A, visits to indoor public places. B, visits to other households. C, use of face coverings. D, RT-PCR or antigen test-confirmed COVID-19. E, ARI testing negative for SARS-CoV-2 by RT-PCR or antigen test. F, asthma exacerbations requiring treatment with systemic corticosteroids and/or hospitalisation. Dotted lines show 95% confidence intervals[Figure omitted. See PDF]ConclusionsRelaxation of COVID-19 restrictions coincided with decreased use of face coverings, increased social mixing and a rebound in ARI and asthma exacerbations. Associations between incident ARI and risk of exacerbation were similar for non-COVID ARI and COVID-19, both before and after emergence of the omicron variant of SARS-CoV-2.ReferenceThorax, 2021. 76(9): p. 867–873.Please refer to page A214 for declarations of interest related to this .