Uptake, effectiveness and safety of COVID-19 vaccines in the immunocompromised population: A population-based cohort study in England

Abstract Immunocompromised individuals face increased risks of severe COVID-19 outcomes, underscoring the importance of receiving COVID-19 vaccination. However, there's a lack of comprehensive real-world data on their COVID-19 vaccine uptake, effectiveness, and safety profile. We analysed data in the QResearch UK database from 01/12/2020 to 11/04/2022. We included 12,274,948 people aged ≥ 12 years in our analysis, of whom 583,541 (4.8%) were immunocompromised, defined as on immune-modifying drugs, chemotherapy, organ transplants, or dialysis. Overall, 93.7% of immunocompromised patients received at least one COVID-19 vaccine dose. Uptake reduced with increasing deprivation (Hazard Ratio [HR] 0.78 [95% CI 0.77–0.79] in the most deprived quintile compared to the least for the first dose). Using a nested case-control design, estimated vaccine effectiveness against COVID-19 hospitalisation 2–6 weeks after the second and third doses compared to the unvaccinated was 78% (95%CI 72–83) and 91% (95%CI 88–93) for the immunocompromised, versus 85% (95%CI 83–86) and 86% (95%CI 85–89) respectively for the general population. COVID-19 vaccines were protective against intensive care unit admission and death in both groups. There were no differing risks of adverse events during the first 28 days after each dose between the two populations. These findings underscore the importance of ongoing vaccination prioritisation for immunocompromised individuals to maximise protection against severe COVID-19-related outcomes.