Vaccinated groups who are at highest risk of COVID-19 hospitalization
and death identified using new QCovid tool

Date:
September 20, 2021
Source:
University of Oxford
Summary:
Researchers report new findings on the vaccinated people who are
at greatest risk from severe COVID-19 leading to hospitalization
or death from 14 days post the second dose vaccination,
when substantial immunity should be expected. By updating the
QCovid tool, they are able to identify groups more at risk of
hospitalization or death from COVID-19.



FULL STORY ========================================================================== Researchers from the University of Oxford have today reported on findings
on the vaccinated people who are at greatest risk from severe Covid-19
leading to hospitalisation or death from 14 days post the second dose vaccination, when substantial immunity should be expected.


==========================================================================
In a paper published in the British Medical Journal,they write that by
updating the QCovid tool developed in 2020, which directly influenced UK
policy in February 2021, adding 1.5 million people in February 2021 to
list of those advised to shield, they are able to identify groups more
at risk of hospitalisation or death from Covid-19.

They used national linked datasets from general practice, national
immunisation and SARS-CoV-2 testing, death registry and hospital episode
data, in order to analyse a sample of over 6.9m vaccinated adults, of
whom 5.2m had both vaccines doses, which was representative of the UK population as a whole. This sample included 2,031 Covid-19 deaths and
1,929 Covid-19 related hospital admissions, of which 81 deaths and 71 admissions occurred 14 or more days after the second vaccine dose.

Based on this, the researchers have developed cumulative risk scores
to calculate people's risk of hospitalisation or death from Covid-19
following one, or two vaccination doses. These scores take into account
factors including age, sex, ethnic group and the background rate of
Covid infections, and in particular highlight an elevated risk to:
* Those who are immunosuppressed as a result of chemotherapy,
a recent bone
marrow or solid organ transplant, or HIV/AIDS
* People with neurological disorders, including dementia and
Parkinson's * Care home residents, and those with chronic disorders
including Down's
Syndrome
Julia Hippisley-Cox, Professor of Clinical Epidemiology and General
Practice at the University of Oxford, co-author of the paper, said: "The
UK was the first place to implement a vaccination programme and has some
of the best clinical research data in the world. We have developed this
new tool using the QResearch database, to help the NHS identify which
patients are at highest risk of serious outcomes despite vaccination
for targeted intervention. This new tool can also inform discussions
between doctors and patients about the level of risk to aid shared
decision making." The researchers report that there were relatively
few COVID-19 related hospitalisations or deaths in the group who had
received the second dose of any vaccine, meaning that the study lacked
the statistical power to determine if the groups listed above are more,
or less, at risk following a second vaccine dose compared with following
the first dose.



========================================================================== Furthermore, they did not distinguish between type of vaccination offered,
and acknowledge that their study may have been limited by factors such
as exposure, as occupation for example is not something that is often
recorded in general practice or hospital records.

Aziz Sheikh, Professor of Primary Care Research & Development and
Director of the Usher Institute at The University of Edinburgh and a
co-author of the paper, said: "This enormous national study of over 5
million people vaccinated with 2 doses across the UK has found that a
small minority of people remain at risk of Covid-19 hospitalisation and
death. Our risk calculator helps to identify those who remain most at
risk post-vaccination." "Our new QCovid tool, developed with the help
of experts from across the UK, has been designed to identify those at
high risk who may benefit from interventions such as vaccine booster
doses or new treatments such as monoclonal antibodies, which can help
reduce the risk of progression SARS-CoV- 2 infection to serious Covid-19 outcomes." The researchers hope that these data can be used in a variety
of health and care settings to inform those more likely to be at risk,
and potentially help to prioritise those identified for further trials
of vaccines, boosters or future preventative therapies.

Prof. Hippisley-Cox concludes: "Individual risk will always depend on individual choices as well as the current prevalence of the disease,
however we hope that this new tool will help shared decision making
and more personalised risk assessment." This study was funded by the
National Institute for Health Research.

========================================================================== Story Source: Materials provided by University_of_Oxford. Note: Content
may be edited for style and length.


========================================================================== Journal Reference:
1. Julia Hippisley-Cox, Carol AC Coupland, Nisha Mehta, Ruth H Keogh,
Karla
Diaz-Ordaz, Kamlesh Khunti, Ronan A Lyons, Frank Kee, Aziz Sheikh,
Shamim Rahman, Jonathan Valabhji, Ewen M Harrison, Peter Sellen,
Nazmus Haq, Malcolm G Semple, Peter W M Johnson, Andrew Hayward,
Jonathan S Nguyen- Van-Tam. Risk prediction of covid-19 related
death and hospital admission in adults after covid-19 vaccination:
national prospective cohort study.

BMJ, 2021; n2244 DOI: 10.1136/bmj.n2244 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/09/210918085828.htm

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