Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT1262b2 and after booster vaccination with BNT1262b2 or mRNA-1273: a population-based cohort study (COVIDENCE UK)

Abstract

Background: Little is known about the relative influence of demographic, behavioural, and vaccine-related factors on risk of post-vaccination SARS-CoV-2 infection. We aimed to identify risk factors for SARS-CoV-2 infection after primary and booster vaccinations. Methods: We undertook a prospective population-based study in UK adults (≥16 years) vaccinated against SARS-CoV-2, including data from Jan 12, 2021, to Feb 21, 2022. We modelled risk of post-vaccination SARS-CoV-2 infection separately for participants who had completed a primary course of vaccination (two-dose or, in the immunosuppressed, three-dose course of either ChAdOx1 nCoV-19 [ChAdOx1] or BNT1262b2) and for those who had additionally received a booster dose (BNT1262b2 or mRNA-1273). Cox regression models were used to explore associations between sociodemographic, behavioural, clinical, pharmacological, and nutritional factors and breakthrough infection, defined as a self-reported positive result on a lateral flow or reverse transcription PCR (RT-PCR) test for SARS-CoV-2. Models were further adjusted for weekly SARS-CoV-2 incidence at the local (lower tier local authority) level. Findings: 14,713 participants were included in the post-primary analysis and 10,665 in the post-booster analysis, with a median follow-up of 203 days (IQR 195-216) in the post-primary cohort and 85 days (66-103) in the post-booster cohort. 1051 (7.1%) participants in the post-primary cohort and 1009 (9.4%) participants in the post-booster cohort reported a breakthrough SARS-CoV-2 infection. A primary course of ChAdOx1 (vs BNT182b2) was associated with higher risk of infection, both in the post-primary cohort (adjusted hazard ratio 1.63, 95% CI 1.41-1.88) and in the post-booster cohort after boosting with mRNA-1273 (1.29 [1.03-1.61] vs BNT162b2 primary plus BNT162b2 booster). A lower risk of breakthrough infection was associated with older age (post-primary: 0.96 [0.96-0.97] per year; post-booster: 0.97 [0.96-0.98]), whereas a higher risk of breakthrough infection was associated with lower levels of education (post-primary: 1.66 [1.35-2.06] for primary or secondary vs postgraduate; post-booster: 1.36 [1.08-1.71]) and at least three weekly visits to indoor public places (post-primary: 1.38 [1.15-1.66] vs none; post-booster: 1.33 [1.10-1.60]). Conclusions: Vaccine type, socioeconomic status, age, and behaviours affect risk of breakthrough SARS-CoV-2 infection following a primary schedule and a booster dose.

Demographic, behavioural and occupational risk factors associated with SARS-CoV-2 infection in UK healthcare workers: a retrospective observational study

“…We think that the risk factors discussed within this paper are unlikely to be greatly affected by a change in the risk of infection in new variants and remain broadly generalisable as risk factors for HCW infection, although the widespread introduction of both population and HCW vaccination since this study is likely to have had a significant impact on these risk factors. 47 Our work identified a number of targetable risk factors for mitigation of the risk of HCW infection during the ongoing COVID-19 pandemic. Maintaining vigilance and providing adequate social distancing space for shift change handover are likely to reduce the risk of HCW infection.…”

Rebound in asthma exacerbations following relaxation of COVID-19 restrictions: a longitudinal population-based study (COVIDENCE UK)

“…Full details of study design have been reported previously. [10][11][12][13] Briefly, from 1st May 2020 to 6th October 2021, UK residents aged ≥16 years were invited via a national media campaign to complete a detailed online baseline questionnaire capturing self-reported information relating to their socio-demographic characteristics, occupation, lifestyle, quality of life, weight, height, longstanding medical conditions, medication use, vaccination status, diet and supplemental micronutrient intake. Follow-up on-line questionnaires capturing behaviours potentially influencing risk of acquiring or transmitting ARI, incident ARI symptoms, results of reverse transcription polymerase chain reaction (RT-PCR) and antigen testing for respiratory viruses, incident exacerbations of asthma and chronic obstructive pulmonary disease and doses of SARS-CoV-2 vaccine received were completed at monthly intervals.…”

Transmembrane Protease Serine 2 Proteolytic Cleavage of the SARS-CoV-2 Spike Protein: A Mechanistic Quantum Mechanics/Molecular Mechanics Study to Inspire the Design of New Drugs To Fight the COVID-19 Pandemic

“… 2 As a result, even some infected vaccinated patients still have an associated risk of significant morbidity and even mortality related to this viral infection. 3 It is thus urgent to understand the biological mechanisms underlying this disease and to discover alternative or novel therapeutic targets.…”

“…However, even though vaccination plans are now used all over the world, several factors, such as the slow pace of vaccination, the fraction of the population that does not develop immunity upon vaccination, and the very good but not total efficiency of vaccines in preventing infection, result in a high number of daily cases, for which effective drug treatment is still lacking . As a result, even some infected vaccinated patients still have an associated risk of significant morbidity and even mortality related to this viral infection . It is thus urgent to understand the biological mechanisms underlying this disease and to discover alternative or novel therapeutic targets.…”

“…2 As a result, even some infected vaccinated patients still have an associated risk of significant morbidity and even mortality related to this viral infection. 3 It is thus urgent to understand the biological mechanisms underlying this disease and to discover alternative or novel therapeutic targets. SARS-CoV-2 is an enveloped virus with a single-stranded positive-sense RNA genome that contains four key structural proteins, spike (S protein), envelope (E protein), membrane (M protein), and nucleocapsid (N protein), and 16 nonstructural proteins.…”