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Real-world Effectiveness of the Pfizer-BioNTech BNT162b2 and Oxford-AstraZeneca ChAdOx1-S Vaccines Against SARS-CoV-2 in Solid Organ and Islet Transplant Recipients.
Callaghan, Chris J; Mumford, Lisa; Curtis, Rebecca M K; Williams, Sarah V; Whitaker, Heather; Andrews, Nick; Lopez Bernal, Jamie; Ushiro-Lumb, Ines; Pettigrew, Gavin J; Thorburn, Douglas; Forsythe, John L R; Ravanan, Rommel.
  • Callaghan CJ; National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom.
  • Mumford L; National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom.
  • Curtis RMK; National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom.
  • Williams SV; UK Health Security Agency, London, United Kingdom.
  • Whitaker H; UK Health Security Agency, London, United Kingdom.
  • Andrews N; UK Health Security Agency, London, United Kingdom.
  • Lopez Bernal J; UK Health Security Agency, London, United Kingdom.
  • Ushiro-Lumb I; National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom.
  • Pettigrew GJ; National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom.
  • Thorburn D; National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom.
  • Forsythe JLR; National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom.
  • Ravanan R; National Health Service Blood and Transplant, Stoke Gifford, Bristol, United Kingdom.
Transplantation ; 106(3): 436-446, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1604080
ABSTRACT

BACKGROUND:

The clinical effectiveness of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in immunosuppressed solid organ and islet transplant (SOT) recipients is unclear.

METHODS:

We linked 4 national registries to retrospectively identify laboratory-confirmed SARS-CoV-2 infections and deaths within 28 d in England between September 1, 2020, and August 31, 2021, comparing unvaccinated adult SOT recipients and those who had received 2 doses of ChAdOx1-S or BNT162b2 vaccine. Infection incidence rate ratios were adjusted for recipient demographics and calendar month using a negative binomial regression model, with 95% confidence intervals. Case fatality rate ratios were adjusted using a Cox proportional hazards model to generate hazard ratio (95% confidence interval).

RESULTS:

On August 31, 2021, it was found that 3080 (7.1%) were unvaccinated, 1141 (2.6%) had 1 vaccine dose, and 39 260 (90.3%) had 2 vaccine doses. There were 4147 SARS-CoV-2 infections and 407 deaths (unadjusted case fatality rate 9.8%). The risk-adjusted infection incidence rate ratio was 1.29 (1.03-1.61), implying that vaccination was not associated with reduction in risk of testing positive for SARS-CoV-2 RNA. Overall, the hazard ratio for death within 28 d of SARS-CoV-2 infection was 0.80 (0.63-1.00), a 20% reduction in risk of death in vaccinated patients (P = 0.05). Two doses of ChAdOx1-S were associated with a significantly reduced risk of death (hazard ratio, 0.69; 0.52-0.92), whereas vaccination with BNT162b2 was not (0.97; 0.71-1.31).

CONCLUSIONS:

Vaccination of SOT recipients confers some protection against SARS-CoV-2-related mortality, but this protection is inferior to that achieved in the general population. SOT recipients require additional protective measures, including further vaccine doses, antiviral drugs, and nonpharmaceutical interventions.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Topics: Vaccines Limits: Adult / Humans Language: English Journal: Transplantation Year: 2022 Document Type: Article Affiliation country: TP.0000000000004059

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Topics: Vaccines Limits: Adult / Humans Language: English Journal: Transplantation Year: 2022 Document Type: Article Affiliation country: TP.0000000000004059