Two-dose ChAdOx1 nCoV-19 vaccine protection against COVID-19 hospital admissions and deaths over time : a retrospective, population-based cohort study in Scotland and Brazil

Katikireddi, Srinivasa Vittal and Cerqueira-Silva, Thiago and Vasileiou, Eleftheria and Robertson, Chris and Amele, Sarah and Pan, Jiafeng and Taylor, Bob and Boaventura, Viviane and Werneck, Guilherme Loureiro and Flores-Ortiz, Renzo and Agrawal, Utkarsh and Docherty, Annemarie B and McCowan, Colin and McMenamin, Jim and Moore, Emily and Ritchie, Lewis D and Rudan, Igor and Shah, Syed Ahmar and Shi, Ting and Simpson, Colin R and Barreto, Mauricio L and Oliveira, Vinicius de Araujo and Barral-Netto, Manoel and Sheikh, Aziz (2022) Two-dose ChAdOx1 nCoV-19 vaccine protection against COVID-19 hospital admissions and deaths over time : a retrospective, population-based cohort study in Scotland and Brazil. Lancet, 399 (10319). pp. 25-35. ISSN 0140-6736 (https://doi.org/10.1016/S0140-6736(21)02754-9)

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Abstract

Reports suggest that COVID-19 vaccine effectiveness is decreasing, but whether this reflects waning or new SARS-CoV-2 variants-especially delta (B.1.617.2)-is unclear. We investigated the association between time since two doses of ChAdOx1 nCoV-19 vaccine and risk of severe COVID-19 outcomes in Scotland (where delta was dominant), with comparative analyses in Brazil (where delta was uncommon). In this retrospective, population-based cohort study in Brazil and Scotland, we linked national databases from the EAVE II study in Scotland; and the COVID-19 Vaccination Campaign, Acute Respiratory Infection Suspected Cases, and Severe Acute Respiratory Infection/Illness datasets in Brazil) for vaccination, laboratory testing, clinical, and mortality data. We defined cohorts of adults (aged ≥18 years) who received two doses of ChAdOx1 nCoV-19 and compared rates of severe COVID-19 outcomes (ie, COVID-19 hospital admission or death) across fortnightly periods, relative to 2-3 weeks after the second dose. Entry to the Scotland cohort started from May 19, 2021, and entry to the Brazil cohort started from Jan 18, 2021. Follow-up in both cohorts was until Oct 25, 2021. Poisson regression was used to estimate rate ratios (RRs) and vaccine effectiveness, with 95% CIs. 1 972 454 adults received two doses of ChAdOx1 nCoV-19 in Scotland and 42 558 839 in Brazil, with longer follow-up in Scotland because two-dose vaccination began earlier in Scotland than in Brazil. In Scotland, RRs for severe COVID-19 increased to 2·01 (95% CI 1·54-2·62) at 10-11 weeks, 3·01 (2·26-3·99) at 14-15 weeks, and 5·43 (4·00-7·38) at 18-19 weeks after the second dose. The pattern of results was similar in Brazil, with RRs of 2·29 (2·01-2·61) at 10-11 weeks, 3·10 (2·63-3·64) at 14-15 weeks, and 4·71 (3·83-5·78) at 18-19 weeks after the second dose. In Scotland, vaccine effectiveness decreased from 83·7% (95% CI 79·7-87·0) at 2-3 weeks, to 75·9% (72·9-78·6) at 14-15 weeks, and 63·7% (59·6-67·4) at 18-19 weeks after the second dose. In Brazil, vaccine effectiveness decreased from 86·4% (85·4-87·3) at 2-3 weeks, to 59·7% (54·6-64·2) at 14-15 weeks, and 42·2% (32·4-50·6) at 18-19 weeks. We found waning vaccine protection of ChAdOx1 nCoV-19 against COVID-19 hospital admissions and deaths in both Scotland and Brazil, this becoming evident within three months of the second vaccine dose. Consideration needs to be given to providing booster vaccine doses for people who have received ChAdOx1 nCoV-19. UK Research and Innovation (Medical Research Council), Scottish Government, Research and Innovation Industrial Strategy Challenge Fund, Health Data Research UK, Fiocruz, Fazer o Bem Faz Bem Programme; Conselho Nacional de Desenvolvimento Científico e Tecnológico, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro. For the Portuguese translation of the abstract see Supplementary Materials section.

ORCID iDs

Katikireddi, Srinivasa Vittal, Cerqueira-Silva, Thiago, Vasileiou, Eleftheria, Robertson, Chris, Amele, Sarah, Pan, Jiafeng ORCID logoORCID: https://orcid.org/0000-0001-5993-3209, Taylor, Bob, Boaventura, Viviane, Werneck, Guilherme Loureiro, Flores-Ortiz, Renzo, Agrawal, Utkarsh, Docherty, Annemarie B, McCowan, Colin, McMenamin, Jim, Moore, Emily, Ritchie, Lewis D, Rudan, Igor, Shah, Syed Ahmar, Shi, Ting, Simpson, Colin R, Barreto, Mauricio L, Oliveira, Vinicius de Araujo, Barral-Netto, Manoel and Sheikh, Aziz;
CORE (COnnecting REpositories)