COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2.57 million people in Scotland (EAVE II): a prospective cohort study

Contextual research

Evidence before this study

We searched PubMed, medRxiv, and SSRN on May 27, 2021, for studies using free text and related MeSH terms for hospital admission after COVID-19 vaccination, using the terms’ breakthrough COVID-19 infections. “COVID-19 (MeSH) vaccines”, and “COVID-19 (MeSH)”. We only considered studies published in English. A study in Israel of 596,618 people who received the BNT162b2 vaccine ( Pfizer-BioNTech) reported that 110 vaccinated people were admitted to hospital and that there were nine deaths from COVID-19 up to 42 days after vaccination. However, almost all individuals (96%) study received a second dose of vaccination (95% of participants received the second dose by day 24). Public Health England reported that 9% of people aged 80 or older who tested positive for COVID -19 after a first dose of BNT162b2 vaccine and 7% of people who received a first dose of the vaccine ChAdOx1 (Oxford-AstraZeneca) were then admitted to hospital for COVID-19. A preprint study in northwest London followed 389,587 people for an average of 29 days after the first dose of vaccine, with 288 patients admitted to hospital (155 in the first 14 days after vaccination). A separate report from the ISARIC / CO-CIN study in the UK indicated that, since the start of the vaccination program, one in 25 people admitted to hospital with COVID-19 had received at least one dose of the vaccine. Of the 42,788 people recruited for this study since December 8, 2020, 4.2% had been vaccinated (1,685 with one dose and 27 with two doses), with a median time between vaccination and admission to the hospital. 10 days.

Added value of this study

This nationwide analysis found that at 14 days or more since the first dose of the vaccine, there had been 883 COVID-19 hospital admissions and 541 deaths in nearly 2.57 million people in Scotland. Old age, increasing number of underlying comorbidities, recent admission to hospital, high-risk occupation, residential care, being male, Being socioeconomically disadvantaged and being a former smoker were all associated with an increased risk of serious illness. COVID-19 post-vaccination events. In contrast, a previous infection with COVID-19 had a protective effect.

Implications of all available evidence

The rollout of the COVID-19 vaccination program has been associated with a low number of serious post-vaccination COVID-19 findings 14 days or more since vaccination. It remains to be seen whether the same degree of protection is maintained beyond the monitoring period analyzed and once the containment measures have been lifted. As the roll-out of immunization programs continues around the world, there is a need to identify those at increased risk of breakthrough infections and identify mechanisms to reduce these risks. The benefits of an accelerated second dose over a longer interval between vaccinations are unclear, as there is a potential longer-term gain in an enhanced immune response with a longer interval between doses.

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