Effectiveness of COVID-19 vaccines against Omicron and Delta hospitalisation, a test negative case-control study

Julia Stowe; Nick Andrews; Freja Kirsebom; Mary Ramsay; Jamie Lopez Bernal

doi:10.1038/s41467-022-33378-7

Effectiveness of COVID-19 vaccines against Omicron and Delta hospitalisation, a test negative case-control study

Julia Stowe^*
, Nick Andrews
, Freja Kirsebom
, Mary Ramsay
, Jamie Lopez Bernal

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

103 Citations (Scopus)

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Abstract

The Omicron variant has been associated with reduced vaccine effectiveness (VE) against mild disease with rapid waning. Meanwhile Omicron has also been associated with milder disease. Protection against severe disease has been substantially higher than protection against infection with previous variants. We used a test-negative case-control design to estimate VE against hospitalisation with the Omicron and Delta variants using PCR testing linked to hospital records. We investigated the impact of increasing the specificity and severity of hospitalisation definitions on VE. Among 18–64-year-olds using cases admitted via emergency care, VE after a 3rd dose peaked at 82.4% and dropped to 53.6% by 15+ weeks after the 3rd dose; using all admissions for > = 2 days stay with a respiratory code in the primary diagnostic field VE ranged from 90.9% to 67.4%; further restricting to those on oxygen/ventilated/intensive care VE ranged from 97.1% to 75.9%. Among 65+ year olds the equivalent VE estimates were 92.4% to 76.9%; 91.3% to 85.3% and 95.8% to 86.8%. Here we show that with milder Omicron disease contamination of hospitalisations with incidental cases is likely to reduce VE estimates. VE estimates increase, and waning is reduced, when specific hospitalisation definitions are used.

Original language	English
Article number	5736
Journal	Nature Communications
Volume	13
Issue number	1
Early online date	30 Sept 2022
DOIs	https://doi.org/10.1038/s41467-022-33378-7
Publication status	Published - Dec 2022

Bibliographical note

Funding Information: No funding information.

Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not
included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Publisher Copyright: © Crown 2022

Citation: Stowe, J., Andrews, N., Kirsebom, F. et al. Effectiveness of COVID-19 vaccines against Omicron and Delta hospitalisation, a test negative case-control study. Nat Commun 13, 5736 (2022). https://doi.org/10.1038/s41467-022-33378-7

DOI: https://doi.org/10.1038/s41467-022-33378-7

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Stowe2022EffectivenessOfCOVID-19VaccinesAgainstOmicronAndDeltaHospitalisationATestNegativeCase-ControlStudyNatCommunFinal published version, 801 KBLicence: CC BY

Cite this

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title = "Effectiveness of COVID-19 vaccines against Omicron and Delta hospitalisation, a test negative case-control study",

abstract = "The Omicron variant has been associated with reduced vaccine effectiveness (VE) against mild disease with rapid waning. Meanwhile Omicron has also been associated with milder disease. Protection against severe disease has been substantially higher than protection against infection with previous variants. We used a test-negative case-control design to estimate VE against hospitalisation with the Omicron and Delta variants using PCR testing linked to hospital records. We investigated the impact of increasing the specificity and severity of hospitalisation definitions on VE. Among 18–64-year-olds using cases admitted via emergency care, VE after a 3rd dose peaked at 82.4\% and dropped to 53.6\% by 15+ weeks after the 3rd dose; using all admissions for > = 2 days stay with a respiratory code in the primary diagnostic field VE ranged from 90.9\% to 67.4\%; further restricting to those on oxygen/ventilated/intensive care VE ranged from 97.1\% to 75.9\%. Among 65+ year olds the equivalent VE estimates were 92.4\% to 76.9\%; 91.3\% to 85.3\% and 95.8\% to 86.8\%. Here we show that with milder Omicron disease contamination of hospitalisations with incidental cases is likely to reduce VE estimates. VE estimates increase, and waning is reduced, when specific hospitalisation definitions are used.",

author = "Julia Stowe and Nick Andrews and Freja Kirsebom and Mary Ramsay and Bernal, \{Jamie Lopez\}",

note = "Funding Information: No funding information. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article{\textquoteright}s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article{\textquoteright}s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. Publisher Copyright: {\textcopyright} Crown 2022 Citation: Stowe, J., Andrews, N., Kirsebom, F. et al. Effectiveness of COVID-19 vaccines against Omicron and Delta hospitalisation, a test negative case-control study. Nat Commun 13, 5736 (2022). https://doi.org/10.1038/s41467-022-33378-7 DOI: https://doi.org/10.1038/s41467-022-33378-7",

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AU - Bernal, Jamie Lopez

N1 - Funding Information: No funding information. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. Publisher Copyright: © Crown 2022 Citation: Stowe, J., Andrews, N., Kirsebom, F. et al. Effectiveness of COVID-19 vaccines against Omicron and Delta hospitalisation, a test negative case-control study. Nat Commun 13, 5736 (2022). https://doi.org/10.1038/s41467-022-33378-7 DOI: https://doi.org/10.1038/s41467-022-33378-7

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N2 - The Omicron variant has been associated with reduced vaccine effectiveness (VE) against mild disease with rapid waning. Meanwhile Omicron has also been associated with milder disease. Protection against severe disease has been substantially higher than protection against infection with previous variants. We used a test-negative case-control design to estimate VE against hospitalisation with the Omicron and Delta variants using PCR testing linked to hospital records. We investigated the impact of increasing the specificity and severity of hospitalisation definitions on VE. Among 18–64-year-olds using cases admitted via emergency care, VE after a 3rd dose peaked at 82.4% and dropped to 53.6% by 15+ weeks after the 3rd dose; using all admissions for > = 2 days stay with a respiratory code in the primary diagnostic field VE ranged from 90.9% to 67.4%; further restricting to those on oxygen/ventilated/intensive care VE ranged from 97.1% to 75.9%. Among 65+ year olds the equivalent VE estimates were 92.4% to 76.9%; 91.3% to 85.3% and 95.8% to 86.8%. Here we show that with milder Omicron disease contamination of hospitalisations with incidental cases is likely to reduce VE estimates. VE estimates increase, and waning is reduced, when specific hospitalisation definitions are used.

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Effectiveness of COVID-19 vaccines against Omicron and Delta hospitalisation, a test negative case-control study

Abstract

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