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Assessing the Effectiveness of BNT162b2 and ChAdOx1nCoV-19 COVID-19 Vaccination in Prevention of Hospitalisations in Elderly and Frail Adults: A Single Centre Test Negative Case-Control Study

32 Pages Posted: 3 Mar 2021

See all articles by Catherine Hyams

Catherine Hyams

University of Bristol - Population Health Sciences

Robin Marlow

University of Bristol - Population Health Sciences

Zandile Maseko

Southmead Hospital - Academic Respiratory Unit

Jade King

University Hospitals Bristol NHS Foundation Trust - Clinical Research and Imaging Centre

Lana Ward

Southmead Hospital - North Bristol NHS Trust

Kazminder Fox

University Hospitals Bristol NHS Foundation Trust - Clinical Research and Imaging Centre

Robyn Heath

University Hospitals Bristol NHS Foundation Trust - Clinical Research and Imaging Centre

Anabella Turner

University Hospitals Bristol NHS Foundation Trust - Clinical Research and Imaging Centre

Zsolt Friedrich

Southmead Hospital - North Bristol NHS Trust

Leigh Morrison

Southmead Hospital - North Bristol NHS Trust

Gabriella Ruffino

Southmead Hospital - North Bristol NHS Trust

Rupert Antico

University of Bristol - Population Health Sciences

David Adegbite

University of Bristol - Population Health Sciences

Zsuzsa Szasz-Benczur

University of Bristol - Population Health Sciences

Maria Garcia Gonzalez

University of Bristol - Population Health Sciences

Jennifer Oliver

University of Bristol - Population Health Sciences

Leon Danon

University of Bristol - Engineering Mathematics

Adam Finn

University Hospitals Bristol and Weston NHS Foundation Trust; University of Bristol - Cellular and Molecular Medicine

More...

Abstract

Background: On 8th December 2020, deployment of the first vaccine against SARS-CoV-2 authorised for UK use, the mRNA-based vaccine BNT162b2, began, followed by the adenoviral vector vaccine ChAdOx1nCoV-19 on 4th January 2021. Initially care home-residents and staff, frontline healthcare workers and adults from age 80 were targeted. In phase 3 trials, BNT162b2 and ChAdOx1nCoV-19 demonstrated 95% and 70% efficacy, respectively, after two doses against symptomatic SARS-CoV-2 infection. However, few data exist regarding the effectiveness of these vaccines in elderly frail people. Evaluation following implementation to determine the effectiveness of one dose in reducing hospitalisations due to SARS-CoV-2 infection in elderly adults is urgent.

Methods: A prospective single-centre test-negative design case-control study of adults aged ≥80 years hospitalised with COVID-19 disease or other acute respiratory disease. We conducted logistic regression controlling for time (week), gender, index of multiple deprivations (IMD), and care residency status (CRS), and sensitivity analyses matched for time and gender using a conditional logistic model adjusting for IMD and CRS.

Findings: First dose vaccine effectiveness of BNT162b2 was 71.4% (95% confidence interval [CI] 46.5-90.6). ChAdOx1nCoV-19 first dose vaccine effectiveness was 80.4% (95% CI 36.4-94.5). When effectiveness analysis for BNT162b2 was restricted to the period covered by ChAdOx1nCoV-19, the estimate was 79.3% (95% CI 47.0-92.5).

Interpretation: A single dose of either BNT162b2 or ChAdOx1nCoV-19 vaccine resulted in substantial reductions in the risk of COVID-19-related hospitalisation in elderly, frail patients with extensive co-morbid disease.

Funding: The AvonCAP study is an investigator-led project funded under a collaborative agreement by Pfizer.

Conflict of Interest: CH is Principal Investigator of the Avon CAP study which is an investigator-led University of Bristol study funded by Pfizer and has previously received support from the NIHR in an Academic Clinical Fellowship. JO is a Co-Investigator on the Avon CAP Study. AF is a member of the Joint Committee on Vaccination and Immunization (JCVI) and chair of the World Health Organization European Technical Advisory Group of Experts on Immunization (ETAGE) committee. In addition to receiving funding from Pfizer as Chief Investigator of this study, he leads another project investigating transmission of respiratory bacteria in families jointly funded by Pfizer and the Gates Foundation. The other authors have no relevant conflicts of interest to declare.

Ethical Approval: The study was approved by the Health Research Authority Research Ethics Committee (East of England, Essex), REC 20/EE/0157, including data collection under Section 251 of the 2006 NHS Act authorised by the Confidentiality Advisory Group.

Keywords: COVID-19, SARS-CoV-2, respiratory infection, vaccination

Suggested Citation

Hyams, Catherine and Marlow, Robin and Maseko, Zandile and King, Jade and Ward, Lana and Fox, Kazminder and Heath, Robyn and Turner, Anabella and Friedrich, Zsolt and Morrison, Leigh and Ruffino, Gabriella and Antico, Rupert and Adegbite, David and Szasz-Benczur, Zsuzsa and Garcia Gonzalez, Maria and Oliver, Jennifer and Danon, Leon and Finn, Adam, Assessing the Effectiveness of BNT162b2 and ChAdOx1nCoV-19 COVID-19 Vaccination in Prevention of Hospitalisations in Elderly and Frail Adults: A Single Centre Test Negative Case-Control Study. Available at SSRN: https://ssrn.com/abstract=3796835 or http://dx.doi.org/10.2139/ssrn.3796835

Catherine Hyams

University of Bristol - Population Health Sciences

University of Bristol,
Senate House, Tyndall Avenue
Bristol, BS8 ITH
United Kingdom

Robin Marlow

University of Bristol - Population Health Sciences

University of Bristol,
Senate House, Tyndall Avenue
Bristol, BS8 ITH
United Kingdom

Zandile Maseko

Southmead Hospital - Academic Respiratory Unit ( email )

Southmead Rd
Westbury-on-Trym
Bristol, BS10 5NB
United Kingdom

Jade King

University Hospitals Bristol NHS Foundation Trust - Clinical Research and Imaging Centre ( email )

Bristol
United Kingdom

Lana Ward

Southmead Hospital - North Bristol NHS Trust ( email )

Southmead Rd
Westbury-on-Trym
Bristol, BS10 5NB
United Kingdom

Kazminder Fox

University Hospitals Bristol NHS Foundation Trust - Clinical Research and Imaging Centre ( email )

Bristol
United Kingdom

Robyn Heath

University Hospitals Bristol NHS Foundation Trust - Clinical Research and Imaging Centre ( email )

Bristol
United Kingdom

Anabella Turner

University Hospitals Bristol NHS Foundation Trust - Clinical Research and Imaging Centre ( email )

Bristol
United Kingdom

Zsolt Friedrich

Southmead Hospital - North Bristol NHS Trust ( email )

Southmead Rd
Westbury-on-Trym
Bristol, BS10 5NB
United Kingdom

Leigh Morrison

Southmead Hospital - North Bristol NHS Trust ( email )

Southmead Rd
Westbury-on-Trym
Bristol, BS10 5NB
United Kingdom

Gabriella Ruffino

Southmead Hospital - North Bristol NHS Trust ( email )

Southmead Rd
Westbury-on-Trym
Bristol, BS10 5NB
United Kingdom

Rupert Antico

University of Bristol - Population Health Sciences

University of Bristol,
Senate House, Tyndall Avenue
Bristol, BS8 ITH
United Kingdom

David Adegbite

University of Bristol - Population Health Sciences

University of Bristol,
Senate House, Tyndall Avenue
Bristol, BS8 ITH
United Kingdom

Zsuzsa Szasz-Benczur

University of Bristol - Population Health Sciences

University of Bristol,
Senate House, Tyndall Avenue
Bristol, BS8 ITH
United Kingdom

Maria Garcia Gonzalez

University of Bristol - Population Health Sciences

University of Bristol,
Senate House, Tyndall Avenue
Bristol, BS8 ITH
United Kingdom

Jennifer Oliver

University of Bristol - Population Health Sciences

University of Bristol,
Senate House, Tyndall Avenue
Bristol, BS8 ITH
United Kingdom

Leon Danon

University of Bristol - Engineering Mathematics

University of Bristol,
Senate House, Tyndall Avenue
Bristol, BS8 ITH
United Kingdom

Adam Finn (Contact Author)

University Hospitals Bristol and Weston NHS Foundation Trust

University of Bristol,
Senate House, Tyndall Avenue
Bristol, BS8 ITH
United Kingdom

University of Bristol - Cellular and Molecular Medicine ( email )

United Kingdom

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