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Comparative effectiveness of ChAdOx1 versus BNT162b2 covid-19 vaccines in health and social care workers in England: cohort study using OpenSAFELY.
Hulme, William J; Williamson, Elizabeth J; Green, Amelia C A; Bhaskaran, Krishnan; McDonald, Helen I; Rentsch, Christopher T; Schultze, Anna; Tazare, John; Curtis, Helen J; Walker, Alex J; Tomlinson, Laurie A; Palmer, Tom; Horne, Elsie M F; MacKenna, Brian; Morton, Caroline E; Mehrkar, Amir; Morley, Jessica; Fisher, Louis; Bacon, Sebastian C J; Evans, David; Inglesby, Peter; Hickman, George; Davy, Simon; Ward, Tom; Croker, Richard; Eggo, Rosalind M; Wong, Angel Y S; Mathur, Rohini; Wing, Kevin; Forbes, Harriet; Grint, Daniel J; Douglas, Ian J; Evans, Stephen J W; Smeeth, Liam; Bates, Chris; Cockburn, Jonathan; Parry, John; Hester, Frank; Harper, Sam; Sterne, Jonathan A C; Hernán, Miguel A; Goldacre, Ben.
  • Hulme WJ; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Williamson EJ; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Green ACA; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Bhaskaran K; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • McDonald HI; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Rentsch CT; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Schultze A; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Tazare J; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Curtis HJ; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Walker AJ; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Tomlinson LA; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Palmer T; MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK.
  • Horne EMF; Population Health Sciences, University of Bristol, Bristol BS8 2BN, UK.
  • MacKenna B; Population Health Sciences, University of Bristol, Bristol BS8 2BN, UK.
  • Morton CE; NIHR Bristol, Biomedical Research Centre, Bristol BS8 2BN, UK.
  • Mehrkar A; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Morley J; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Fisher L; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Bacon SCJ; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Evans D; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Inglesby P; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Hickman G; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Davy S; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Ward T; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Croker R; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Eggo RM; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Wong AYS; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
  • Mathur R; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Wing K; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Forbes H; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Grint DJ; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Douglas IJ; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Evans SJW; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Smeeth L; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Bates C; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Cockburn J; London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
  • Parry J; TPP, TPP House, Horsforth, Leeds LS18 5PX, UK.
  • Hester F; TPP, TPP House, Horsforth, Leeds LS18 5PX, UK.
  • Harper S; TPP, TPP House, Horsforth, Leeds LS18 5PX, UK.
  • Sterne JAC; TPP, TPP House, Horsforth, Leeds LS18 5PX, UK.
  • Hernán MA; TPP, TPP House, Horsforth, Leeds LS18 5PX, UK.
  • Goldacre B; Population Health Sciences, University of Bristol, Bristol BS8 2BN, UK.
BMJ ; 378: e068946, 2022 07 20.
Article in English | MEDLINE | ID: covidwho-1950077
ABSTRACT

OBJECTIVE:

To compare the effectiveness of the BNT162b2 mRNA (Pfizer-BioNTech) and the ChAdOx1 (Oxford-AstraZeneca) covid-19 vaccines against infection and covid-19 disease in health and social care workers.

DESIGN:

Cohort study, emulating a comparative effectiveness trial, on behalf of NHS England.

SETTING:

Linked primary care, hospital, and covid-19 surveillance records available within the OpenSAFELY-TPP research platform, covering a period when the SARS-CoV-2 Alpha variant was dominant.

PARTICIPANTS:

317 341 health and social care workers vaccinated between 4 January and 28 February 2021, registered with a general practice using the TPP SystmOne clinical information system in England, and not clinically extremely vulnerable.

INTERVENTIONS:

Vaccination with either BNT162b2 or ChAdOx1 administered as part of the national covid-19 vaccine roll-out. MAIN OUTCOME

MEASURES:

Recorded SARS-CoV-2 positive test, or covid-19 related attendance at an accident and emergency (A&E) department or hospital admission occurring within 20 weeks of receipt of the first vaccine dose.

RESULTS:

Over the duration of 118 771 person-years of follow-up there were 6962 positive SARS-CoV-2 tests, 282 covid-19 related A&E attendances, and 166 covid-19 related hospital admissions. The cumulative incidence of each outcome was similar for both vaccines during the first 20 weeks after vaccination. The cumulative incidence of recorded SARS-CoV-2 infection 20 weeks after first-dose vaccination with BNT162b2 was 21.7 per 1000 people (95% confidence interval 20.9 to 22.4) and with ChAdOx1 was 23.7 (21.8 to 25.6), representing a difference of 2.04 per 1000 people (0.04 to 4.04). The difference in the cumulative incidence per 1000 people of covid-19 related A&E attendance at 20 weeks was 0.06 per 1000 people (95% CI -0.31 to 0.43). For covid-19 related hospital admission, this difference was 0.11 per 1000 people (-0.22 to 0.44).

CONCLUSIONS:

In this cohort of healthcare workers where we would not anticipate vaccine type to be related to health status, we found no substantial differences in the incidence of SARS-CoV-2 infection or covid-19 disease up to 20 weeks after vaccination. Incidence dropped sharply at 3-4 weeks after vaccination, and there were few covid-19 related hospital attendance and admission events after this period. This is in line with expected onset of vaccine induced immunity and suggests strong protection against Alpha variant covid-19 disease for both vaccines in this relatively young and healthy population of healthcare workers.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Viral Vaccines / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Vaccines / Variants Limits: Humans Language: English Journal: BMJ Journal subject: Medicine Year: 2022 Document Type: Article Affiliation country: Bmj-2021-068946

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Viral Vaccines / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Vaccines / Variants Limits: Humans Language: English Journal: BMJ Journal subject: Medicine Year: 2022 Document Type: Article Affiliation country: Bmj-2021-068946