Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)

Giulia Vivaldi^{1

2}, David A Jolliffe^{1

2}, Hayley Holt^{1

2

3}, Florence Tydeman^{1

2}, Mohammad Talaei², Gwyneth A Davies⁴, Ronan A Lyons⁴, Christopher J Griffiths^{2

3}, Frank Kee⁵, Aziz Sheikh⁶, Seif O Shaheen², Adrian R Martineau^{1

2

3}

Affiliations

¹ Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
² Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
³ Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK.
⁴ Population Data Science, Swansea University Medical School, Singleton Park, Swansea, UK.
⁵ Centre for Public Health Research (NI), Queen's University Belfast, Belfast, UK.
⁶ Usher Institute, University of Edinburgh, Edinburgh, UK.

PMID: 36168404
PMCID: PMC9499825
DOI: 10.1016/j.lanepe.2022.100501

Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)

Giulia Vivaldi et al. Lancet Reg Health Eur. 2022.

. 2022 Sep 23:22:100501.

doi: 10.1016/j.lanepe.2022.100501. eCollection 2022 Nov.

Authors

Affiliations

¹ Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
² Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
³ Asthma UK Centre for Applied Research, Queen Mary University of London, London, UK.
⁴ Population Data Science, Swansea University Medical School, Singleton Park, Swansea, UK.
⁵ Centre for Public Health Research (NI), Queen's University Belfast, Belfast, UK.
⁶ Usher Institute, University of Edinburgh, Edinburgh, UK.

PMID: 36168404
PMCID: PMC9499825
DOI: 10.1016/j.lanepe.2022.100501

Abstract

Background: Little is known about how demographic, behavioural, and vaccine-related factors affect 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: This prospective, population-based, UK study in adults (≥16 years) vaccinated against SARS-CoV-2 assessed risk of breakthrough SARS-CoV-2 infection up to February, 2022, for participants who completed a primary vaccination course (ChAdOx1 nCoV-19 or BNT162b2) and those who received a booster dose (BNT162b2 or mRNA-1273). Cox regression models explored associations between sociodemographic, behavioural, clinical, pharmacological, and nutritional factors and test-positive breakthrough infection, adjusted for local weekly SARS-CoV-2 incidence.

Findings: 1051 (7·1%) of 14 713 post-primary participants and 1009 (9·5%) of 10 665 post-booster participants reported breakthrough infection, over a median follow-up of 203 days (IQR 195-216) and 85 days (66-103), respectively. Primary vaccination with ChAdOx1 (vs BNT162b2) was associated with higher risk of infection in both post-primary analysis (adjusted hazard ratio 1·63, 95% CI 1·41-1·88) and after an mRNA-1273 booster (1·26 [1·00-1·57] vs BNT162b2 primary and booster). Lower risk of infection was associated with older age (post-primary: 0·97 [0·96-0·97] per year; post-booster: 0·97 [0·97-0·98]), whereas higher risk of infection was associated with lower educational attainment (post-primary: 1·78 [1·44-2·20] for primary/secondary vs postgraduate; post-booster: 1·46 [1·16-1·83]) and at least three weekly visits to indoor public places (post-primary: 1·36 [1·13-1·63] vs none; post-booster: 1·29 [1·07-1·56]).

Interpretation: Vaccine type, socioeconomic status, age, and behaviours affect risk of breakthrough infection after primary and booster vaccinations.

Funding: Barts Charity, UK Research and Innovation Industrial Strategy Challenge Fund.

Keywords: BNT162b2; Breakthrough infection; ChAdOx1; SARS-CoV-2; Vaccination; mRNA-1273.

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Conflict of interest statement

R.A.L. has received grants from UKRI Medical Research Council, UKRI Economic and Social Research Council, Health Data Research UK, and Health and Care Research Wales. R.A.L. is a member of the Welsh Government COVID-19 Technical Advisory group, in an unremunerated role. A.S. is a member of the Scottish Government's Standing Committee on Pandemics, the Scottish Science Advisory Council, the UK Government's New and Emerging Respiratory Virus Threats Risk Stratification Subgroup and the Department of Health and Social Care's COVID-19 Therapeutics Modelling Group. He was a member of the Scottish Government Chief Medical Officer's COVID-19 Advisory Group and AstraZeneca's Thrombotic Thrombocytopenic Taskforce. All of A.S.’ roles are unremunerated. A.R.M. declares receipt of funding to support vitamin D research from the following companies who manufacture or sell vitamin D supplements: Pharma Nord DSM Nutritional Products, Thornton & Ross, and Hyphens Pharma. A.R.M. also declares support for attending meetings from the following companies who manufacture or sell vitamin D supplements: Pharma Nord and Abiogen Pharma. A.R.M. also declares participation on the Data and Safety Monitoring Board for the Chair, DSMB, VITALITY trial (Vitamin D for Adolescents with HIV to reduce musculoskeletal morbidity and immunopathology). A.R.M. also declares unpaid work as a Programme Committee member for the Vitamin D Workshop. A.R.M. also declares receipt of vitamin D capsules for clinical trial use from Pharma Nord, Synergy Biologics, and Cytoplan. All other authors declare no competing interests.

Figures

Figure 1: — **Figure 1**
Study flow diagram. ChAdOx1 = ChAdOx1 nCoV-19.

Figure 2: — **Figure 2**
Cumulative hazard of breakthrough infection according to age, sharing a home with schoolchildren, vaccine type, and previous infection for the post-primary and post-booster cohorts. Cumulative hazards shown are from the fully adjusted models. ChAdOx1 = ChAdOx1 nCoV-19. *Aged 5–15 years.

See this image and copyright information in PMC

References

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Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)

Affiliations

Risk factors for SARS-CoV-2 infection after primary vaccination with ChAdOx1 nCoV-19 or BNT162b2 and after booster vaccination with BNT162b2 or mRNA-1273: A population-based cohort study (COVIDENCE UK)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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