COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study

Background

From September 2021, Health Care Workers (HCWs) in Wales began receiving a COVID-19 booster vaccination. This is the first dose beyond the primary vaccination schedule. Given the emergence of new variants, vaccine waning vaccine, and increasing vaccination hesitancy, there is a need to understand booster vaccine uptake and subsequent breakthrough in this high-risk population.

Methods

We conducted a prospective, national-scale, observational cohort study of HCWs in Wales using anonymised, linked data from the SAIL Databank. We analysed uptake of COVID-19 booster vaccinations from September 2021 to February 2022, with comparisons against uptake of the initial primary vaccination schedule. We also analysed booster breakthrough, in the form of PCR-confirmed SARS-Cov-2 infection, comparing to the second primary dose. Cox proportional hazard models were used to estimate associations for vaccination uptake and breakthrough regarding staff roles, socio-demographics, household composition, and other factors.

Results

We derived a cohort of 73,030 HCWs living in Wales (78% female, 60% 18–49 years old). Uptake was quickest amongst HCWs aged 60 + years old (aHR 2.54, 95%CI 2.45–2.63), compared with those aged 18–29. Asian HCWs had quicker uptake (aHR 1.18, 95%CI 1.14–1.22), whilst Black HCWs had slower uptake (aHR 0.67, 95%CI 0.61–0.74), compared to white HCWs. HCWs residing in the least deprived areas were slightly quicker to have received a booster dose (aHR 1.12, 95%CI 1.09–1.16), compared with those in the most deprived areas. Strongest associations with breakthrough infections were found for those living with children (aHR 1.52, 95%CI 1.41–1.63), compared to two-adult only households. HCWs aged 60 + years old were less likely to get breakthrough infections, compared to those aged 18–29 (aHR 0.42, 95%CI 0.38–0.47).

Conclusion

Vaccination uptake was consistently lower among black HCWs, as well as those from deprived areas. Whilst breakthrough infections were highest in households with children.

Author list

Affiliations:

  1. Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, UK
  2. Department of Education and Childhood Studies, School of Social Sciences, Swansea University, UK
  3. London School of Hygiene and Tropical Medicine, UK
  4. Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, UK
  5. Usher Institute, University of Edinburgh, UK
  6. Centre for Public Health, Queen’s University Belfast, Belfast, UK. And Public Health Agency, Belfast, UK
  7. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  8. Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, UK
  9. Usher Institute, The University of Edinburgh, Edinburgh, UK
  10. National Heart & Lung Institute, Faculty of Medicine, Imperial College London, UK
  11. Usher Institute and HDR UK BREATHE Hub, University of Edinburgh, UK

Authors:

StuartBedston1, EmilyLowthian2, Christopher I.Jarvis3, AshleyAkbari4, JillianBeggs5, DeclanBradley6, Simonde Lusignan7, RowenaGriffiths8, LauraHerbert8, RichardHobbs8, StevenKerr9, JaneLyons8, William Midgley8, Rhiannon K.Owen8, Jennifer K.Quint10, RubyTsang7, FatemehTorabi8, AzizSheikh11, Ronan A.Lyons8

Novel Coronavirus SARS-CoV-2

10.1016/j.vaccine.2023.01.023

Vaccine

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