Comparative effectiveness of ChAdOx1 versus BNT162b2 covid-19 vaccines in health and social care workers in England: cohort study using OpenSAFELY.
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Hulme William J, Williamson Elizabeth J, Green Amelia C A, Bhaskaran Krishnan, McDonald Helen I, Rentsch Christopher T, Schultze Anna, Tazare John, Curtis Helen J, Walker Alex J, Tomlinson Laurie A, Palmer Tom, Horne Elsie M F, MacKenna Brian, Morton Caroline E, Mehrkar Amir, Morley Jessica, Fisher Louis, Bacon Sebastian C J, Evans David, Inglesby Peter, Hickman George, Davy Simon, Ward Tom, Croker Richard, Eggo Rosalind M, Wong Angel Y S, Mathur Rohini, Wing Kevin, Forbes Harriet, Grint Daniel J, Douglas Ian J, Evans Stephen J W, Smeeth Liam, Bates Chris, Cockburn Jonathan, Parry John, Hester Frank, Harper Sam, Sterne Jonathan A C, Hernán Miguel A, Goldacre Ben
Аннотация
DESIGN: Cohort study, emulating a comparative effectiveness trial, on behalf of NHS England.
SETTING: Linked primary care, hospital, and covid-19 surveillance records available within the OpenSAFELY-TPP research platform, covering a period when the SARS-CoV-2 Alpha variant was dominant.
PARTICIPANTS: 317 341 health and social care workers vaccinated between 4 January and 28 February 2021, registered with a general practice using the TPP SystmOne clinical information system in England, and not clinically extremely vulnerable.
INTERVENTIONS: Vaccination with either BNT162b2 or ChAdOx1 administered as part of the national covid-19 vaccine roll-out.
MAIN OUTCOME MEASURES: Recorded SARS-CoV-2 positive test, or covid-19 related attendance at an accident and emergency (A&E) department or hospital admission occurring within 20 weeks of receipt of the first vaccine dose.
RESULTS: Over the duration of 118 771 person-years of follow-up there were 6962 positive SARS-CoV-2 tests, 282 covid-19 related A&E attendances, and 166 covid-19 related hospital admissions. The cumulative incidence of each outcome was similar for both vaccines during the first 20 weeks after vaccination. The cumulative incidence of recorded SARS-CoV-2 infection 20 weeks after first-dose vaccination with BNT162b2 was 21.7 per 1000 people (95% confidence interval 20.9 to 22.4) and with ChAdOx1 was 23.7 (21.8 to 25.6), representing a difference of 2.04 per 1000 people (0.04 to 4.04). The difference in the cumulative incidence per 1000 people of covid-19 related A&E attendance at 20 weeks was 0.06 per 1000 people (95% CI -0.31 to 0.43). For covid-19 related hospital admission, this difference was 0.11 per 1000 people (-0.22 to 0.44).
CONCLUSIONS: In this cohort of healthcare workers where we would not anticipate vaccine type to be related to health status, we found no substantial differences in the incidence of SARS-CoV-2 infection or covid-19 disease up to 20 weeks after vaccination. Incidence dropped sharply at 3-4 weeks after vaccination, and there were few covid-19 related hospital attendance and admission events after this period. This is in line with expected onset of vaccine induced immunity and suggests strong protection against Alpha variant covid-19 disease for both vaccines in this relatively young and healthy population of healthcare workers.