COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study br

Background: From September 2021, Health Care Workers (HCWs) in Wales began eceiving a COVID-19 booster vaccination. This is the first dose beyond the primary vaccination schedule. Given the emergence o. new variants, vaccine waning vaccine, and increasing vaccination hesitancy, there is a need to understand booster vaccine uptake and subsequent breakthrough in this high-risk population. Methods: We conducted a prospective, national-scale, observational cohort study of HCWs in Wales using anonymised, linked data from the SAIL Databank. We analysed uptake of COVID-19 booster vaccinations from September 2021 to Februari 2022, with comparisons against uptake of the initial primary vaccination schedule. We also analysed booster breakthrough, in the form of PCR-confirmed SARS-Cov-2 infection, comparing to the second primarJ dose. Cox proportional hazard models were used to estimate associations for vaccination uptake and breakthrough regarding staff roles, socio-demographics, household composition, and other factors. Results: We derived a cohort of 73,030 HCWs living in Wales (78% female, 60% 18-49 years old). Uptake was quickest amongst HCWs aged 60 + years old (aHR 2.54, 95%Cl 2.45-2.63), compared with those aged 18-29. Asian HCWs had quicker uptake (aHR 1.18, 95%Cl 1.14-1.22), whilst Black HCWs had slower uptake (aHR 0.67, 95%Cl 0.61-0.74), compared to white HCWs. HCWs residing in the least deprived areas were slightly quicker to have received a booster dose (aHR 1.12, 95%Cl 1.09-1.15), compared with those in the most deprived areas. Strongest associations with breakthrough infections were found for those living with children (aHR 1.52, 95%Cl 1.41-1.63), compared to two-adult only households. HCWs aged 60+ years old were less likely to get breakthrough infections, compared to those aged 18-29 (aHR 0.42,<br />95%CI 0.38-0.47). Conclusion: Vaccination uptake was consistently lower among black HCWs, as well as those from deprived areas. Whilst breakthrough infections were highest in households with children. creativecommons.org/licenses/by/4.0/).<br />(c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license

A Novel Ontological Approach to Track Social Determinants of Health in Primary Care

The associated morbidity and mortality from COVID-19 and the public health response to prevent the spread of the virus has repeatedly demonstrated the significant impact of social determinants of health (SDoH) and social inequities on health outcomes. Social prescriptions are interventions aimed at tackling SDoH. In 2019, NHS-England committed to support the use of social prescribing across England. NHS-England commissioned the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network to monitor the distribution of social prescribing services within English primary care and, within that, monitor the impact of the COVID-19 pandemic response on SDoH. To track incidence of people presenting to primary care with SDoH-related issues, we implemented an ontological approach to curate SDoH indicators in computerised medical records (CMR) using the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT). These indicators were then extracted from the RCGP-RSC sentinel network database to present weekly incidence rates per 10,000 people to assess the impact of the pandemic on these SDoH. Pre- versus peri-pandemic, we observed an increase in the recording of several of our SDoH indicators;namely issues related to homelessness, unemployment, mental health, harmful substance use and financial difficulties. As far as we are aware, this is the first time that routinely collected primary care CMR data has been utilised for the monitoring and surveillance of SDoH and demonstrates the feasibility of this approach for future surveillance. © 2022, Springer Nature Switzerland AG.

A Novel Ontological Approach to Estimate Inequalities and Underuse of Social Prescriptions for Mental Health in Primary Care in England

Mental health conditions are a significant contributor to morbidity and mortality and cost an estimated £1.6 trillion per year globally. The COVID-19 pandemic and its associated lockdowns have contributed to increases in common mental health problems (CMHP) like depression. Bodies in the UK recommend the use of non-medical interventions like social prescriptions to support individuals suffering from CMHP. In 2019, NHS-England committed to support the use of social prescribing across England. Despite this commitment, the proportion of eligible individuals with a CMHP that actually receive a social prescription remains unknown. To overcome this knowledge gap, a novel ontological approach was used to estimate the proportion of individuals with a CMHP that received a social prescription, disaggregated by different attributes (region, ethnicity, socio-economic status, sex, age) across a four-year period from 2017–2020. We discovered two general trends. First, there was a 1.4-fold increase in the presentation of individuals, across all attributes, to primary care with a CMHP across the four-year period analysed. There was also marked variation in the presentation to primary care with a CMHP based on different attributes (2020 variation figures - regions: 2.8-fold;ethnicity: 1.8-fold;socio-economic status: 1.4-fold;sex: 1.7-fold;age: 3.9-fold). Second, despite an increase in the use of social prescribing for mental health, there was still substantial underuse of it across all attributes in England (the highest percentage seen across all attributes in 2020 was 14%). The general trends revealed through our analyses provide valuable insights that can help to inform both policy and practice to address variation, health inequalities as well as to proactively design and implement appropriate services. © 2022, Springer Nature Switzerland AG.

Investigating the association between COVID-19 vaccination and care home outbreak frequency and duration.

OBJECTIVES: At the end of 2020, many countries commenced a vaccination programme against SARS-CoV-2. Public health authorities aim to prevent and interrupt outbreaks of infectious disease in social care settings. We aimed to investigate the association between the introduction of the vaccination programme and the frequency and duration of COVID-19 outbreaks in Northern Ireland (NI). STUDY DESIGN: We undertook an ecological study using routinely available national data. METHODS: We used Poisson regression to measure the relationship between the number of RT-PCR confirmed COVID-19 outbreaks in care homes, and as a measure of community COVID-19 prevalence, the Office for National Statistics COVID-19 Infection Survey estimated the number of people testing positive for COVID-19 in NI. We estimated the change in this relationship and estimated the expected number of care home outbreaks in the absence of the vaccination programme. A Cox proportional hazards model estimated the hazard ratio of a confirmed COVID-19 care home outbreak closure. RESULTS: Care home outbreaks reduced by two-thirds compared to expected following the introduction of the vaccination programme, from a projected 1625 COVID-19 outbreaks (95% prediction interval 1553-1694) between 7 December 2020 and 28 October 2021 to an observed 501. We estimated an adjusted hazard ratio of 2.53 of the outbreak closure assuming a 21-day lag for immunity. CONCLUSIONS: These findings describe the association of the vaccination with a reduction in outbreak frequency and duration across NI care homes. This indicates probable reduced harm and disruption from COVID-19 in social care settings following vaccination. Future research using individual level data from care home residents will be needed to investigate the effectiveness of the vaccines and the duration of their effects.

First-dose ChAdOx1 and BNT162b2 COVID-19 vaccines and thrombocytopenic, thromboembolic and hemorrhagic events in Scotland.

Reports of ChAdOx1 vaccine-associated thrombocytopenia and vascular adverse events have led to some countries restricting its use. Using a national prospective cohort, we estimated associations between exposure to first-dose ChAdOx1 or BNT162b2 vaccination and hematological and vascular adverse events using a nested incident-matched case-control study and a confirmatory self-controlled case series (SCCS) analysis. An association was found between ChAdOx1 vaccination and idiopathic thrombocytopenic purpura (ITP) (0-27 d after vaccination; adjusted rate ratio (aRR) = 5.77, 95% confidence interval (CI), 2.41-13.83), with an estimated incidence of 1.13 (0.62-1.63) cases per 100,000 doses. An SCCS analysis confirmed that this was unlikely due to bias (RR = 1.98 (1.29-3.02)). There was also an increased risk for arterial thromboembolic events (aRR = 1.22, 1.12-1.34) 0-27 d after vaccination, with an SCCS RR of 0.97 (0.93-1.02). For hemorrhagic events 0-27 d after vaccination, the aRR was 1.48 (1.12-1.96), with an SCCS RR of 0.95 (0.82-1.11). A first dose of ChAdOx1 was found to be associated with small increased risks of ITP, with suggestive evidence of an increased risk of arterial thromboembolic and hemorrhagic events. The attenuation of effect found in the SCCS analysis means that there is the potential for overestimation of the reported results, which might indicate the presence of some residual confounding or confounding by indication. Public health authorities should inform their jurisdictions of these relatively small increased risks associated with ChAdOx1. No positive associations were seen between BNT162b2 and thrombocytopenic, thromboembolic and hemorrhagic events.

P251 The induction of early, dynamic airway mucosal and systemic immune responses following recent SARS-CoV-2 household exposure

P251 Figure 1Symptom score, virology, serology and nasal & serum cytokine data in the index case and their two PCR-positive household contacts since day of symptom onset at 4 timepoints across 28 days of follow up. A. Symptom score was calculated by allocating values for each self-reported symptom, weighted by self-reported severity, from a daily tracker;B. virology was measured by oropharyngeal swab RT-PCR. Samples below the detectable level were assigned value of 1;C-F. concentrations of 2 of the cytokines (IFNA1 and IP-10) measured in nasal lining fluid (C & E) and serum (D & F), measured by Meso Scale Discoveries U-plex assay. Grey dashed line indicates mean of healthy control values (C&E: n=4;D&F: n=5). Serum values for the fourth timepoint were not reported due to delayed sample processing.[Figure omitted. See PDF]ConclusionThese data demonstrate the ability of the INSTINCT household contact study to capture early immune responses in mild SARS-CoV-2 infection, not captured by COVID-19 hospital cohort studies. Early nasal mucosal cytokine responses to SARS-CoV-2 infection are not reflected in serum. The correlations observed provide cogent hypotheses that will be tested in the larger INSTINCT cohort, with implications for COVID-19 risk stratification, therapeutics, prophylaxis and vaccinology.ReferenceVabret N, Britton GJ, Gruber C, et al. Immunology of COVID-19: Current State of the Science. Immunity. 2020;52(6):910–41.

Managing COVID-19 within and across health systems: why we need performance intelligence to coordinate a global response.

BACKGROUND: The COVID-19 pandemic is a complex global public health crisis presenting clinical, organisational and system-wide challenges. Different research perspectives on health are needed in order to manage and monitor this crisis. Performance intelligence is an approach that emphasises the need for different research perspectives in supporting health systems' decision-makers to determine policies based on well-informed choices. In this paper, we present the viewpoint of the Innovative Training Network for Healthcare Performance Intelligence Professionals (HealthPros) on how performance intelligence can be used during and after the COVID-19 pandemic. DISCUSSION: A lack of standardised information, paired with limited discussion and alignment between countries contribute to uncertainty in decision-making in all countries. Consequently, a plethora of different non-data-driven and uncoordinated approaches to address the outbreak are noted worldwide. Comparative health system research is needed to help countries shape their response models in social care, public health, primary care, hospital care and long-term care through the different phases of the pandemic. There is a need in each phase to compare context-specific bundles of measures where the impact on health outcomes can be modelled using targeted data and advanced statistical methods. Performance intelligence can be pursued to compare data, construct indicators and identify optimal strategies. Embracing a system perspective will allow countries to take coordinated strategic decisions while mitigating the risk of system collapse.A framework for the development and implementation of performance intelligence has been outlined by the HealthPros Network and is of pertinence. Health systems need better and more timely data to govern through a pandemic-induced transition period where tensions between care needs, demand and capacity are exceptionally high worldwide. Health systems are challenged to ensure essential levels of healthcare towards all patients, including those who need routine assistance. CONCLUSION: Performance intelligence plays an essential role as part of a broader public health strategy in guiding the decisions of health system actors on the implementation of contextualised measures to tackle COVID-19 or any future epidemic as well as their effect on the health system at large. This should be based on commonly agreed-upon standardised data and fit-for-purpose indicators, making optimal use of existing health information infrastructures. The HealthPros Network can make a meaningful contribution.