Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. Out of 5,150,310 individuals in England that received two COVID-19 vaccine doses, 81 patients passed away from COVID-19 and 71 were admitted to hospital for COVID-19, at least 14 days after their 2nd dose.

2. Factors that increased risk the most for a serious COVID-19 outcome in partially or fully vaccinated individuals included increased age and Townsend material deprivation score, as well as male sex, Pakistani or Indian ethnicity, and having Down Syndrome, a kidney transplant, sickle cell disease, residence in a care home facility, chemotherapy, and HIV or AIDS.

Evidence Rating Level: 2 (Good)

During the first few months of the COVID-19 pandemic, the QCovid risk assessment tool was effective in identifying those at higher risk of serious illness and death from COVID-19. With the introduction of COVID-19 vaccines, it is unclear what the risk factors are for a severe outcome from a breakthrough infection in vaccinated individuals. With data from the second wave of the pandemic in England, the QCovid 3 risk algorithm was created based on partially and fully vaccinated patients. The current prospective study examined COVID-19 associated mortality and hospitalization outcomes for 6,952,440 adults (aged 19-100 years), at least 14 days after their 1st dose COVID-19 vaccination in England. Of these, 57.9% received the Oxford-AstraZeneca vaccine and 42.1% received the Pfizer-BioNTech vaccine. In total, there were 2031 COVID-19 deaths and 1929 COVID-19 hospitalizations (23.1%, or 446 hospitalized patients, eventually died). There were 81 deaths (4.0% of total deaths) and 71 hospital admissions (3.7% of total hospitalizations) that occurred 14 days after the individual received their 2nd vaccine dose. The incidence of COVID-19 mortality increased with greater age and higher Townsend deprivation score (a score measuring material deprivation. It also increased with male sex (hazard ratio 1.31, 95% CI 1.20-1.44), and Pakistani or Indian ethnicity, compared to Caucasian ethnicity (HR 2.49, 95% CI 1.86-3.33 and HR 1.32, 95% CI 1.00-1.75 respectively). Furthermore, hazards ratios were greatest for individuals with Down Syndrome (12.7 times increase), a kidney transplant (8.1 times), sickle cell disease (7.7 times), residence in a care home (4.1 times), group B and group C chemotherapy (3.6 and 4.3 times respectively), and HIV or AIDS (3.3 times). Overall, this study identified populations at risk for severe outcomes from breakthrough COVID-19 infections following partial or full vaccination, which may have implications for interventions to bolster their immunity and further reduce their risk of coming into contact with COVID-19.

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