Clinical Effectiveness of SARS-CoV-2 Booster Vaccine Against Omicron Infection in Residents and Staff of Long-term Care Facilities: A Prospective Cohort Study (VIVALDI)

Oliver Stirrup; Madhumita Shrotri; Natalie L Adams; Maria Krutikov; Hadjer Nacer-Laidi; Borscha Azmi; Tom Palmer; Christopher Fuller; Aidan Irwin-Singer; Verity Baynton; Gokhan Tut; Paul Moss; Andrew Hayward; Andrew Copas; Laura Shallcross

doi:10.1093/ofid/ofac694

Clinical Effectiveness of SARS-CoV-2 Booster Vaccine Against Omicron Infection in Residents and Staff of Long-term Care Facilities: A Prospective Cohort Study (VIVALDI)

Oliver Stirrup^*, Madhumita Shrotri, Natalie L Adams, Maria Krutikov, Hadjer Nacer-Laidi, Borscha Azmi, Tom Palmer, Christopher Fuller, Aidan Irwin-Singer, Verity Baynton, Gokhan Tut, Paul Moss, Andrew Hayward, Andrew Copas, Laura Shallcross

^*Corresponding author for this work

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Abstract

BACKGROUND: Successive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants have caused severe disease in long-term care facility (LTCF) residents. Primary vaccination provides strong short-term protection, but data are limited on duration of protection following booster vaccines, particularly against the Omicron variant. We investigated the effectiveness of booster vaccination against infections, hospitalizations, and deaths among LTCF residents and staff in England.

METHODS: We included residents and staff of LTCFs within the VIVALDI study (ISRCTN 14447421) who underwent routine, asymptomatic testing (December 12, 2021-March 31, 2022). Cox regression was used to estimate relative hazards of SARS-CoV-2 infection, and associated hospitalization and death at 0-13, 14-48, 49-83, 84-111, 112-139, and 140+ days after dose 3 of SARS-CoV-2 vaccination compared with 2 doses (after 84+ days), stratified by previous SARS-CoV-2 infection and adjusting for age, sex, LTCF capacity, and local SARS-CoV-2 incidence.

RESULTS: A total of 14 175 residents and 19 793 staff were included. In residents without prior SARS-CoV-2 infection, infection risk was reduced 0-111 days after the first booster, but no protection was apparent after 112 days. Additional protection following booster vaccination waned but was still present at 140+ days for COVID-associated hospitalization (adjusted hazard ratio [aHR], 0.20; 95% CI, 0.06-0.63) and death (aHR, 0.50; 95% CI, 0.20-1.27). Most residents (64.4%) had received primary course vaccine of AstraZeneca, but this did not impact pre- or postbooster risk. Staff showed a similar pattern of waning booster effectiveness against infection, with few hospitalizations and no deaths.

CONCLUSIONS: Our findings suggest that booster vaccination provided sustained protection against severe outcomes following infection with the Omicron variant, but no protection against infection from 4 months onwards. Ongoing surveillance for SARS-CoV-2 in LTCFs is crucial.

Original language	English
Article number	ofac694
Number of pages	10
Journal	Open Forum Infectious Diseases
Volume	10
Issue number	1
Early online date	29 Dec 2022
DOIs	https://doi.org/10.1093/ofid/ofac694
Publication status	Published - Jan 2023

Bibliographical note

Financial support:
This work is independent research funded by the Department of Health and Social Care (COVID-19 surveillance studies). M.K. is funded by a Wellcome Trust Clinical PhD Fellowship (222907/Z/21/Z). L.S. is funded by a National Institute for Health Research Clinician Scientist Award (CS-2016-007). A.H. is supported by Health Data Research UK (LOND1), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust.

© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Keywords

COVID-19
SARS-CoV-2
long-term care facilities
Omicron
vaccine effectiveness

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Stirrup, O., Shrotri, M., Adams, N. L., Krutikov, M., Nacer-Laidi, H., Azmi, B., Palmer, T., Fuller, C., Irwin-Singer, A., Baynton, V., Tut, G., Moss, P., Hayward, A., Copas, A., & Shallcross, L. (2023). Clinical Effectiveness of SARS-CoV-2 Booster Vaccine Against Omicron Infection in Residents and Staff of Long-term Care Facilities: A Prospective Cohort Study (VIVALDI). Open Forum Infectious Diseases, 10(1), Article ofac694. https://doi.org/10.1093/ofid/ofac694

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title = "Clinical Effectiveness of SARS-CoV-2 Booster Vaccine Against Omicron Infection in Residents and Staff of Long-term Care Facilities: A Prospective Cohort Study (VIVALDI)",

abstract = "BACKGROUND: Successive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants have caused severe disease in long-term care facility (LTCF) residents. Primary vaccination provides strong short-term protection, but data are limited on duration of protection following booster vaccines, particularly against the Omicron variant. We investigated the effectiveness of booster vaccination against infections, hospitalizations, and deaths among LTCF residents and staff in England.METHODS: We included residents and staff of LTCFs within the VIVALDI study (ISRCTN 14447421) who underwent routine, asymptomatic testing (December 12, 2021-March 31, 2022). Cox regression was used to estimate relative hazards of SARS-CoV-2 infection, and associated hospitalization and death at 0-13, 14-48, 49-83, 84-111, 112-139, and 140+ days after dose 3 of SARS-CoV-2 vaccination compared with 2 doses (after 84+ days), stratified by previous SARS-CoV-2 infection and adjusting for age, sex, LTCF capacity, and local SARS-CoV-2 incidence.RESULTS: A total of 14 175 residents and 19 793 staff were included. In residents without prior SARS-CoV-2 infection, infection risk was reduced 0-111 days after the first booster, but no protection was apparent after 112 days. Additional protection following booster vaccination waned but was still present at 140+ days for COVID-associated hospitalization (adjusted hazard ratio [aHR], 0.20; 95% CI, 0.06-0.63) and death (aHR, 0.50; 95% CI, 0.20-1.27). Most residents (64.4%) had received primary course vaccine of AstraZeneca, but this did not impact pre- or postbooster risk. Staff showed a similar pattern of waning booster effectiveness against infection, with few hospitalizations and no deaths.CONCLUSIONS: Our findings suggest that booster vaccination provided sustained protection against severe outcomes following infection with the Omicron variant, but no protection against infection from 4 months onwards. Ongoing surveillance for SARS-CoV-2 in LTCFs is crucial.",

keywords = "COVID-19, SARS-CoV-2, long-term care facilities, Omicron, vaccine effectiveness",

author = "Oliver Stirrup and Madhumita Shrotri and Adams, {Natalie L} and Maria Krutikov and Hadjer Nacer-Laidi and Borscha Azmi and Tom Palmer and Christopher Fuller and Aidan Irwin-Singer and Verity Baynton and Gokhan Tut and Paul Moss and Andrew Hayward and Andrew Copas and Laura Shallcross",

note = "Financial support: This work is independent research funded by the Department of Health and Social Care (COVID-19 surveillance studies). M.K. is funded by a Wellcome Trust Clinical PhD Fellowship (222907/Z/21/Z). L.S. is funded by a National Institute for Health Research Clinician Scientist Award (CS-2016-007). A.H. is supported by Health Data Research UK (LOND1), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. {\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.",

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Stirrup, O, Shrotri, M, Adams, NL, Krutikov, M, Nacer-Laidi, H, Azmi, B, Palmer, T, Fuller, C, Irwin-Singer, A, Baynton, V, Tut, G , Moss, P, Hayward, A, Copas, A & Shallcross, L 2023, 'Clinical Effectiveness of SARS-CoV-2 Booster Vaccine Against Omicron Infection in Residents and Staff of Long-term Care Facilities: A Prospective Cohort Study (VIVALDI)', Open Forum Infectious Diseases, vol. 10, no. 1, ofac694. https://doi.org/10.1093/ofid/ofac694

Clinical Effectiveness of SARS-CoV-2 Booster Vaccine Against Omicron Infection in Residents and Staff of Long-term Care Facilities: A Prospective Cohort Study (VIVALDI). / Stirrup, Oliver; Shrotri, Madhumita; Adams, Natalie L et al.
In: Open Forum Infectious Diseases, Vol. 10, No. 1, ofac694, 01.2023.

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

TY - JOUR

T1 - Clinical Effectiveness of SARS-CoV-2 Booster Vaccine Against Omicron Infection in Residents and Staff of Long-term Care Facilities

T2 - A Prospective Cohort Study (VIVALDI)

AU - Stirrup, Oliver

AU - Shrotri, Madhumita

AU - Adams, Natalie L

AU - Krutikov, Maria

AU - Nacer-Laidi, Hadjer

AU - Azmi, Borscha

AU - Palmer, Tom

AU - Fuller, Christopher

AU - Irwin-Singer, Aidan

AU - Baynton, Verity

AU - Tut, Gokhan

AU - Moss, Paul

AU - Hayward, Andrew

AU - Copas, Andrew

AU - Shallcross, Laura

N1 - Financial support: This work is independent research funded by the Department of Health and Social Care (COVID-19 surveillance studies). M.K. is funded by a Wellcome Trust Clinical PhD Fellowship (222907/Z/21/Z). L.S. is funded by a National Institute for Health Research Clinician Scientist Award (CS-2016-007). A.H. is supported by Health Data Research UK (LOND1), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

PY - 2023/1

Y1 - 2023/1

N2 - BACKGROUND: Successive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants have caused severe disease in long-term care facility (LTCF) residents. Primary vaccination provides strong short-term protection, but data are limited on duration of protection following booster vaccines, particularly against the Omicron variant. We investigated the effectiveness of booster vaccination against infections, hospitalizations, and deaths among LTCF residents and staff in England.METHODS: We included residents and staff of LTCFs within the VIVALDI study (ISRCTN 14447421) who underwent routine, asymptomatic testing (December 12, 2021-March 31, 2022). Cox regression was used to estimate relative hazards of SARS-CoV-2 infection, and associated hospitalization and death at 0-13, 14-48, 49-83, 84-111, 112-139, and 140+ days after dose 3 of SARS-CoV-2 vaccination compared with 2 doses (after 84+ days), stratified by previous SARS-CoV-2 infection and adjusting for age, sex, LTCF capacity, and local SARS-CoV-2 incidence.RESULTS: A total of 14 175 residents and 19 793 staff were included. In residents without prior SARS-CoV-2 infection, infection risk was reduced 0-111 days after the first booster, but no protection was apparent after 112 days. Additional protection following booster vaccination waned but was still present at 140+ days for COVID-associated hospitalization (adjusted hazard ratio [aHR], 0.20; 95% CI, 0.06-0.63) and death (aHR, 0.50; 95% CI, 0.20-1.27). Most residents (64.4%) had received primary course vaccine of AstraZeneca, but this did not impact pre- or postbooster risk. Staff showed a similar pattern of waning booster effectiveness against infection, with few hospitalizations and no deaths.CONCLUSIONS: Our findings suggest that booster vaccination provided sustained protection against severe outcomes following infection with the Omicron variant, but no protection against infection from 4 months onwards. Ongoing surveillance for SARS-CoV-2 in LTCFs is crucial.

AB - BACKGROUND: Successive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants have caused severe disease in long-term care facility (LTCF) residents. Primary vaccination provides strong short-term protection, but data are limited on duration of protection following booster vaccines, particularly against the Omicron variant. We investigated the effectiveness of booster vaccination against infections, hospitalizations, and deaths among LTCF residents and staff in England.METHODS: We included residents and staff of LTCFs within the VIVALDI study (ISRCTN 14447421) who underwent routine, asymptomatic testing (December 12, 2021-March 31, 2022). Cox regression was used to estimate relative hazards of SARS-CoV-2 infection, and associated hospitalization and death at 0-13, 14-48, 49-83, 84-111, 112-139, and 140+ days after dose 3 of SARS-CoV-2 vaccination compared with 2 doses (after 84+ days), stratified by previous SARS-CoV-2 infection and adjusting for age, sex, LTCF capacity, and local SARS-CoV-2 incidence.RESULTS: A total of 14 175 residents and 19 793 staff were included. In residents without prior SARS-CoV-2 infection, infection risk was reduced 0-111 days after the first booster, but no protection was apparent after 112 days. Additional protection following booster vaccination waned but was still present at 140+ days for COVID-associated hospitalization (adjusted hazard ratio [aHR], 0.20; 95% CI, 0.06-0.63) and death (aHR, 0.50; 95% CI, 0.20-1.27). Most residents (64.4%) had received primary course vaccine of AstraZeneca, but this did not impact pre- or postbooster risk. Staff showed a similar pattern of waning booster effectiveness against infection, with few hospitalizations and no deaths.CONCLUSIONS: Our findings suggest that booster vaccination provided sustained protection against severe outcomes following infection with the Omicron variant, but no protection against infection from 4 months onwards. Ongoing surveillance for SARS-CoV-2 in LTCFs is crucial.

KW - COVID-19

KW - SARS-CoV-2

KW - long-term care facilities

KW - Omicron

KW - vaccine effectiveness

U2 - 10.1093/ofid/ofac694

DO - 10.1093/ofid/ofac694

M3 - Article

C2 - 36713473

SN - 2328-8957

VL - 10

JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

IS - 1

M1 - ofac694

ER -

Clinical Effectiveness of SARS-CoV-2 Booster Vaccine Against Omicron Infection in Residents and Staff of Long-term Care Facilities: A Prospective Cohort Study (VIVALDI)

Abstract

Bibliographical note

Keywords

UN SDGs

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