COVID-19 vaccine effectiveness and uptake in a national cohort of English children and young people with life-limiting neurodisability

Joana Cruz; Rachel Harwood; Simon Kenny; Matthew Clark; Peter J Davis; Elizabeth S Draper; Dougal Hargreaves; Shamez N Ladhani; Karen Luyt; Stephen W Turner; Elizabeth Whittaker; Pia Hardelid; Lorna K Fraser; Russell M Viner; Joseph Lloyd Ward

doi:10.1136/archdischild-2024-327293

COVID-19 vaccine effectiveness and uptake in a national cohort of English children and young people with life-limiting neurodisability

Joana Cruz, Rachel Harwood, Simon Kenny, Matthew Clark, Peter J Davis, Elizabeth S Draper, Dougal Hargreaves, Shamez N Ladhani, Karen Luyt, Stephen W Turner, Elizabeth Whittaker, Pia Hardelid, Lorna K Fraser, Russell M Viner, Joseph Lloyd Ward

Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation

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

Abstract

Objective: To investigate SARS-CoV-2 vaccine uptake and effectiveness in children and young people (CYP) with life-limiting neurodisability. Design: We undertook a retrospective cohort study using national hospital data in England from 21 December 2020 to 2 September 2022 to describe SARS-CoV-2 vaccination uptake, and then examined COVID-19 hospitalisation, paediatric intensive care unit (PICU) admission and death following SARS-CoV-2 infection by vaccination status using Cox regression models. Patients: CYP aged 5-17 with life-limiting neurodisability. Results: We identified 38 067 CYP with life-limiting neurodisability; 13 311 (35.0%) received at least one SARS-CoV-2 vaccine, with uptake higher among older, white CYP, from less deprived neighbourhoods. Of 8134 CYP followed up after a positive SARS-CoV-2 test, 1547 (19%) were vaccinated. Within 28 days of infection, 309 (4.7%) unvaccinated CYP were hospitalised with COVID-19 compared with 75 (4.8%) vaccinated CYP. Of 46 (0.7%) unvaccinated CYP were admitted to PICU compared with 10 (0.6%) vaccinated CYP. Of 20 CYP died within 28 days of SARS-CoV-2 infection, of which 13 were unvaccinated. Overall, adjusted hazard of hospitalisation for COVID-19 or admission to PICU did not vary by vaccination status. When the Alpha-Delta SARS-CoV-2 variants were dominant, hazard of hospitalisation with COVID-19 was significantly lower among vaccinated CYP (HR 0.26 (0.09 to 0.74)), with no difference seen during Omicron (HR 1.16 (0.74 to 1.81)). Conclusions: SARS-CoV-2 vaccination was protective of COVID-19 hospitalisation among CYP with life-limiting neurodisability during Alpha-Delta, but not for other SARS-CoV-2 variants. Vaccine uptake was low and varied by ethnicity and deprivation.

Original language	English
Article number	archdischild-2024-327293
Journal	Archives of Disease in Childhood
DOIs	https://doi.org/10.1136/archdischild-2024-327293
Publication status	E-pub ahead of print - 17 Oct 2024

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Cruz, J., Harwood, R., Kenny, S., Clark, M., Davis, P. J., Draper, E. S., Hargreaves, D., Ladhani, S. N., Luyt, K., Turner, S. W., Whittaker, E., Hardelid, P., Fraser, L. K., Viner, R. M., & Ward, J. L. (2024). COVID-19 vaccine effectiveness and uptake in a national cohort of English children and young people with life-limiting neurodisability. Archives of Disease in Childhood, Article archdischild-2024-327293. Advance online publication. https://doi.org/10.1136/archdischild-2024-327293

@article{b3bb8f15e96944daa19e90848d8e37ab,

title = "COVID-19 vaccine effectiveness and uptake in a national cohort of English children and young people with life-limiting neurodisability",

abstract = "Objective: To investigate SARS-CoV-2 vaccine uptake and effectiveness in children and young people (CYP) with life-limiting neurodisability. Design: We undertook a retrospective cohort study using national hospital data in England from 21 December 2020 to 2 September 2022 to describe SARS-CoV-2 vaccination uptake, and then examined COVID-19 hospitalisation, paediatric intensive care unit (PICU) admission and death following SARS-CoV-2 infection by vaccination status using Cox regression models. Patients: CYP aged 5-17 with life-limiting neurodisability. Results: We identified 38 067 CYP with life-limiting neurodisability; 13 311 (35.0%) received at least one SARS-CoV-2 vaccine, with uptake higher among older, white CYP, from less deprived neighbourhoods. Of 8134 CYP followed up after a positive SARS-CoV-2 test, 1547 (19%) were vaccinated. Within 28 days of infection, 309 (4.7%) unvaccinated CYP were hospitalised with COVID-19 compared with 75 (4.8%) vaccinated CYP. Of 46 (0.7%) unvaccinated CYP were admitted to PICU compared with 10 (0.6%) vaccinated CYP. Of 20 CYP died within 28 days of SARS-CoV-2 infection, of which 13 were unvaccinated. Overall, adjusted hazard of hospitalisation for COVID-19 or admission to PICU did not vary by vaccination status. When the Alpha-Delta SARS-CoV-2 variants were dominant, hazard of hospitalisation with COVID-19 was significantly lower among vaccinated CYP (HR 0.26 (0.09 to 0.74)), with no difference seen during Omicron (HR 1.16 (0.74 to 1.81)). Conclusions: SARS-CoV-2 vaccination was protective of COVID-19 hospitalisation among CYP with life-limiting neurodisability during Alpha-Delta, but not for other SARS-CoV-2 variants. Vaccine uptake was low and varied by ethnicity and deprivation.",

author = "Joana Cruz and Rachel Harwood and Simon Kenny and Matthew Clark and Davis, {Peter J} and Draper, {Elizabeth S} and Dougal Hargreaves and Ladhani, {Shamez N} and Karen Luyt and Turner, {Stephen W} and Elizabeth Whittaker and Pia Hardelid and Fraser, {Lorna K} and Viner, {Russell M} and Ward, {Joseph Lloyd}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2024",

month = oct,

day = "17",

doi = "10.1136/archdischild-2024-327293",

language = "English",

journal = "Archives of Disease in Childhood",

issn = "0003-9888",

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Cruz, J, Harwood, R, Kenny, S, Clark, M, Davis, PJ, Draper, ES, Hargreaves, D, Ladhani, SN, Luyt, K, Turner, SW, Whittaker, E, Hardelid, P, Fraser, LK, Viner, RM & Ward, JL 2024, 'COVID-19 vaccine effectiveness and uptake in a national cohort of English children and young people with life-limiting neurodisability', Archives of Disease in Childhood. https://doi.org/10.1136/archdischild-2024-327293

TY - JOUR

T1 - COVID-19 vaccine effectiveness and uptake in a national cohort of English children and young people with life-limiting neurodisability

AU - Cruz, Joana

AU - Harwood, Rachel

AU - Kenny, Simon

AU - Clark, Matthew

AU - Davis, Peter J

AU - Draper, Elizabeth S

AU - Hargreaves, Dougal

AU - Ladhani, Shamez N

AU - Luyt, Karen

AU - Turner, Stephen W

AU - Whittaker, Elizabeth

AU - Hardelid, Pia

AU - Fraser, Lorna K

AU - Viner, Russell M

AU - Ward, Joseph Lloyd

PY - 2024/10/17

Y1 - 2024/10/17

N2 - Objective: To investigate SARS-CoV-2 vaccine uptake and effectiveness in children and young people (CYP) with life-limiting neurodisability. Design: We undertook a retrospective cohort study using national hospital data in England from 21 December 2020 to 2 September 2022 to describe SARS-CoV-2 vaccination uptake, and then examined COVID-19 hospitalisation, paediatric intensive care unit (PICU) admission and death following SARS-CoV-2 infection by vaccination status using Cox regression models. Patients: CYP aged 5-17 with life-limiting neurodisability. Results: We identified 38 067 CYP with life-limiting neurodisability; 13 311 (35.0%) received at least one SARS-CoV-2 vaccine, with uptake higher among older, white CYP, from less deprived neighbourhoods. Of 8134 CYP followed up after a positive SARS-CoV-2 test, 1547 (19%) were vaccinated. Within 28 days of infection, 309 (4.7%) unvaccinated CYP were hospitalised with COVID-19 compared with 75 (4.8%) vaccinated CYP. Of 46 (0.7%) unvaccinated CYP were admitted to PICU compared with 10 (0.6%) vaccinated CYP. Of 20 CYP died within 28 days of SARS-CoV-2 infection, of which 13 were unvaccinated. Overall, adjusted hazard of hospitalisation for COVID-19 or admission to PICU did not vary by vaccination status. When the Alpha-Delta SARS-CoV-2 variants were dominant, hazard of hospitalisation with COVID-19 was significantly lower among vaccinated CYP (HR 0.26 (0.09 to 0.74)), with no difference seen during Omicron (HR 1.16 (0.74 to 1.81)). Conclusions: SARS-CoV-2 vaccination was protective of COVID-19 hospitalisation among CYP with life-limiting neurodisability during Alpha-Delta, but not for other SARS-CoV-2 variants. Vaccine uptake was low and varied by ethnicity and deprivation.

AB - Objective: To investigate SARS-CoV-2 vaccine uptake and effectiveness in children and young people (CYP) with life-limiting neurodisability. Design: We undertook a retrospective cohort study using national hospital data in England from 21 December 2020 to 2 September 2022 to describe SARS-CoV-2 vaccination uptake, and then examined COVID-19 hospitalisation, paediatric intensive care unit (PICU) admission and death following SARS-CoV-2 infection by vaccination status using Cox regression models. Patients: CYP aged 5-17 with life-limiting neurodisability. Results: We identified 38 067 CYP with life-limiting neurodisability; 13 311 (35.0%) received at least one SARS-CoV-2 vaccine, with uptake higher among older, white CYP, from less deprived neighbourhoods. Of 8134 CYP followed up after a positive SARS-CoV-2 test, 1547 (19%) were vaccinated. Within 28 days of infection, 309 (4.7%) unvaccinated CYP were hospitalised with COVID-19 compared with 75 (4.8%) vaccinated CYP. Of 46 (0.7%) unvaccinated CYP were admitted to PICU compared with 10 (0.6%) vaccinated CYP. Of 20 CYP died within 28 days of SARS-CoV-2 infection, of which 13 were unvaccinated. Overall, adjusted hazard of hospitalisation for COVID-19 or admission to PICU did not vary by vaccination status. When the Alpha-Delta SARS-CoV-2 variants were dominant, hazard of hospitalisation with COVID-19 was significantly lower among vaccinated CYP (HR 0.26 (0.09 to 0.74)), with no difference seen during Omicron (HR 1.16 (0.74 to 1.81)). Conclusions: SARS-CoV-2 vaccination was protective of COVID-19 hospitalisation among CYP with life-limiting neurodisability during Alpha-Delta, but not for other SARS-CoV-2 variants. Vaccine uptake was low and varied by ethnicity and deprivation.

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U2 - 10.1136/archdischild-2024-327293

DO - 10.1136/archdischild-2024-327293

M3 - Article

C2 - 39406462

SN - 0003-9888

JO - Archives of Disease in Childhood

JF - Archives of Disease in Childhood

M1 - archdischild-2024-327293

ER -

COVID-19 vaccine effectiveness and uptake in a national cohort of English children and young people with life-limiting neurodisability

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