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. 2021 Aug 18:374:n1868.
doi: 10.1136/bmj.n1868.

Associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 in nursing homes and healthcare workers in Catalonia: prospective cohort study

Carmen Cabezas  1 , Ermengol Coma  2 , Nuria Mora-Fernandez  2 , Xintong Li  3 , Montse Martinez-Marcos  1 , Francesc Fina  2 , Mireia Fabregas  2 , Eduardo Hermosilla  4 , Angel Jover  2 , Juan Carlos Contel  5 , Yolanda Lejardi  6 , Belen Enfedaque  2 , Josep Maria Argimon  7 , Manuel Medina-Peralta  2 , Daniel Prieto-Alhambra  3   8
Affiliations

Associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 in nursing homes and healthcare workers in Catalonia: prospective cohort study

Carmen Cabezas et al. BMJ. .

Abstract

Objective: To determine associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 among nursing home residents, nursing home staff, and healthcare workers.

Design: Prospective cohort study.

Setting: Nursing homes and linked electronic medical record, test, and mortality data in Catalonia on 27 December 2020.

Participants: 28 456 nursing home residents, 26 170 nursing home staff, and 61 791 healthcare workers.

Main outcome measures: Participants were followed until the earliest outcome (confirmed SARS-CoV-2 infection, hospital admission or death with covid-19) or 26 May 2021. Vaccination status was introduced as a time varying exposure, with a 14 day run-in after the first dose. Mixed effects Cox models were fitted to estimate hazard ratios with index month as a fixed effect and adjusted for confounders including sociodemographics, comorbidity, and previous medicine use.

Results: Among the nursing home residents, SARS-CoV-2 infection was found in 2482, 411 were admitted to hospital with covid-19, and 450 died with covid-19 during the study period. In parallel, 1828 nursing home staff and 2968 healthcare workers were found to have SARS-CoV-2 infection, but fewer than five were admitted or died with covid-19. The adjusted hazard ratio for SARS-CoV-2 infection after two doses of vaccine was 0.09 (95% confidence interval 0.08 to 0.11) for nursing home residents, 0.20 (0.17 to 0.24) for nursing home staff, and 0.13 (0.11 to 0.16) for healthcare workers. Adjusted hazard ratios for hospital admission and mortality after two doses of vaccine were 0.05 (0.04 to 0.07) and 0.03 (0.02 to 0.04), respectively, for nursing home residents. Nursing home staff and healthcare workers recorded insufficient events for mortality analysis.

Conclusions: Vaccination was associated with 80-91% reduction in SARS-CoV-2 infection in all three cohorts and greater reductions in hospital admissions and mortality among nursing home residents for up to five months. More data are needed on longer term effects of covid-19 vaccines.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work other than that detailed above; DPA’s research group has received grants and advisory or speaker fees from Amgen, Astellas, Astra-Zeneca, Chiesi-Taylor, Johnson and Johnson, and UCB; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Population flowchart. EMR=electronic medical records
Fig 2
Fig 2
Covid-19 vaccine uptake expressed as percentage with at least one dose (y axis) over time (x axis) in nursing home residents, nursing home staff, and healthcare workers
Fig 3
Fig 3
Kaplan-Meier estimates of SARS-CoV-2 infection according to vaccination status in nursing home residents (top left), staff (bottom left), and healthcare workers (top right)
Fig 4
Fig 4
Kaplan-Meier estimates of hospital admission (left) and mortality with covid-19 (right) according to vaccination status in nursing home residents
See this image and copyright information in PMC

References

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