Vaccine effectiveness against COVID-19 breakthrough infections in patients with cancer (UKCCEP): a population-based test-negative case-control study

Lennard Y W Lee; Thomas Starkey; Maria C Ionescu; Martin Little; Michael Tilby; Arvind R Tripathy; Hayley S Mckenzie; Youssra Al-Hajji; Matthew Barnard; Liza Benny; Alexander Burnett; Emma L Cattell; Jackie Charman; James J Clark; Sam Khan; Qamar Ghafoor; George Illsley; Catherine Harper-Wynne; Rosie J Hattersley; Alvin J X Lee; Pauline C Leonard; Justin K H Liu; NCRI Consumer Forum; Matthew Pang; Jennifer S Pascoe; James R Platt; Vanessa A Potter; Amelia Randle; Anne S Rigg; Tim M Robinson; Tom W Roques; René L Roux; Stefan Rozmanowski; Mark H Tuthill; Isabella Watts; Sarah Williams; Tim Iveson; Siow Ming Lee; Gary Middleton; Mark Middleton; Andrew Protheroe; Matthew W Fittall; Tom Fowler; Peter Johnson

doi:10.1016/S1470-2045(22)00202-9

Vaccine effectiveness against COVID-19 breakthrough infections in patients with cancer (UKCCEP): a population-based test-negative case-control study

Lancet Oncol. 2022 Jun;23(6):748-757. doi: 10.1016/S1470-2045(22)00202-9. Epub 2022 May 23.

Authors

Lennard Y W Lee¹, Thomas Starkey², Maria C Ionescu³, Martin Little⁴, Michael Tilby⁵, Arvind R Tripathy⁵, Hayley S Mckenzie⁶, Youssra Al-Hajji⁷, Matthew Barnard³, Liza Benny³, Alexander Burnett⁸, Emma L Cattell⁹, Jackie Charman¹⁰, James J Clark¹¹, Sam Khan¹², Qamar Ghafoor⁵, George Illsley³, Catherine Harper-Wynne¹³, Rosie J Hattersley¹⁴, Alvin J X Lee¹⁵, Pauline C Leonard¹⁶, Justin K H Liu¹⁷; NCRI Consumer Forum; Matthew Pang¹⁸, Jennifer S Pascoe⁵, James R Platt¹⁷, Vanessa A Potter¹⁹, Amelia Randle²⁰, Anne S Rigg²¹, Tim M Robinson²², Tom W Roques²³, René L Roux⁴, Stefan Rozmanowski¹⁸, Mark H Tuthill⁴, Isabella Watts²⁴, Sarah Williams⁵, Tim Iveson²⁵, Siow Ming Lee²⁶, Gary Middleton²⁷, Mark Middleton²⁸, Andrew Protheroe⁴, Matthew W Fittall²⁹, Tom Fowler³, Peter Johnson³⁰

Collaborators

NCRI Consumer Forum:
Emma Kinloch, Emily Lam, Gillian Murphy, Malcolm Rhodes, Kate Robinson

Affiliations

¹ Department of Oncology, University of Oxford, Oxford, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK. Electronic address: [email protected].
² Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
³ UK Health Security Agency, London, UK.
⁴ Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁵ Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
⁶ Oncology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁷ Birmingham Medical School, University of Birmingham, Birmingham, UK.
⁸ NHS England, London, UK; NHS Improvement, London, UK.
⁹ Department of Cancer, Taunton and Somerset NHS Foundation Trust, Taunton, UK.
¹⁰ National Disease Registration Service, NHS Digital, London, UK.
¹¹ Department of Surgery and Cancer, Imperial College London, London, UK.
¹² Leicester Cancer Research Centre, University of Leicester, Leicester, UK.
¹³ Kent Oncology Centre, University of Kent and Kent and Medway Medical School, Maidstone, UK.
¹⁴ Department of Oncology, Torbay Hospital NHS Foundation Trust, Torquay, UK.
¹⁵ UCL Cancer Institute, University College London Hospitals NHS Trust and University College London, London, UK.
¹⁶ Cancer Services, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK.
¹⁷ Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
¹⁸ Department of Health and Social Care, London, UK.
¹⁹ Department of Oncology, University Hospital Coventry and Warwickshire, Coventry, UK.
²⁰ Royal College of Physicians, London, UK.
²¹ Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
²² Population Health Sciences, University of Bristol, Bristol, UK.
²³ Cancer Services, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
²⁴ Department of Academic Oncology, Royal Free Hospital, London, UK.
²⁵ Cancer Sciences, University of Southampton, Southampton, UK.
²⁶ UCL Cancer Institute, University College London Hospitals NHS Trust and University College London, London, UK; CRUK Lung Cancer Centre of Excellence, University College London Hospitals NHS Trust and University College London, London, UK.
²⁷ Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK; Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
²⁸ Department of Oncology, University of Oxford, Oxford, UK.
²⁹ Cancer Services, The Royal Marsden NHS Foundation Trust, London, UK.
³⁰ NHS England, London, UK; Cancer Sciences, University of Southampton, Southampton, UK.

Abstract

Background: People with cancer are at increased risk of hospitalisation and death following infection with SARS-CoV-2. Therefore, we aimed to conduct one of the first evaluations of vaccine effectiveness against breakthrough SARS-CoV-2 infections in patients with cancer at a population level.

Methods: In this population-based test-negative case-control study of the UK Coronavirus Cancer Evaluation Project (UKCCEP), we extracted data from the UKCCEP registry on all SARS-CoV-2 PCR test results (from the Second Generation Surveillance System), vaccination records (from the National Immunisation Management Service), patient demographics, and cancer records from England, UK, from Dec 8, 2020, to Oct 15, 2021. Adults (aged ≥18 years) with cancer in the UKCCEP registry were identified via Public Health England's Rapid Cancer Registration Dataset between Jan 1, 2018, and April 30, 2021, and comprised the cancer cohort. We constructed a control population cohort from adults with PCR tests in the UKCCEP registry who were not contained within the Rapid Cancer Registration Dataset. The coprimary endpoints were overall vaccine effectiveness against breakthrough infections after the second dose (positive PCR COVID-19 test) and vaccine effectiveness against breakthrough infections at 3-6 months after the second dose in the cancer cohort and control population.

Findings: The cancer cohort comprised 377 194 individuals, of whom 42 882 had breakthrough SARS-CoV-2 infections. The control population consisted of 28 010 955 individuals, of whom 5 748 708 had SARS-CoV-2 breakthrough infections. Overall vaccine effectiveness was 69·8% (95% CI 69·8-69·9) in the control population and 65·5% (65·1-65·9) in the cancer cohort. Vaccine effectiveness at 3-6 months was lower in the cancer cohort (47·0%, 46·3-47·6) than in the control population (61·4%, 61·4-61·5).

Interpretation: COVID-19 vaccination is effective for individuals with cancer, conferring varying levels of protection against breakthrough infections. However, vaccine effectiveness is lower in patients with cancer than in the general population. COVID-19 vaccination for patients with cancer should be used in conjunction with non-pharmacological strategies and community-based antiviral treatment programmes to reduce the risk that COVID-19 poses to patients with cancer.

Funding: University of Oxford, University of Southampton, University of Birmingham, Department of Health and Social Care, and Blood Cancer UK.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
COVID-19 Vaccines
COVID-19* / epidemiology
COVID-19* / prevention & control
Case-Control Studies
Humans
Neoplasms* / epidemiology
SARS-CoV-2
Vaccine Efficacy
Viral Vaccines*

Vaccine effectiveness against COVID-19 breakthrough infections in patients with cancer (UKCCEP): a population-based test-negative case-control study

Authors

Collaborators

Affiliations

Abstract

Publication types

MeSH terms

Substances

Supplementary concepts

Grants and funding