Vaccine Surveillance Report - Week 5

COVID-19 vaccine surveillance report
Week 5
3 February 2022
COVID-19 vaccine surveillance report – week 5
Contents
Executive summary ...................................................................................................................... 3
Vaccine effectiveness ............................................................................................................... 3
Population impact ..................................................................................................................... 3
Vaccine effectiveness .................................................................................................................. 4
Effectiveness against symptomatic disease ............................................................................. 4
Effectiveness against hospitalisation ........................................................................................ 9
Effectiveness against mortality ............................................................................................... 10
Effectiveness against infection ............................................................................................... 13
Effectiveness against transmission ........................................................................................ 13
Population impact ...................................................................................................................... 19
Vaccine coverage ................................................................................................................... 19
Vaccination in immunosuppressed individuals ....................................................................... 23
Vaccination in pregnancy ....................................................................................................... 24
Vaccination status in cases, deaths and hospitalisations ....................................................... 39
Vaccine impact on proportion of population with antibodies to COVID-19.............................. 48
Summary of impact on hospitalisations, infections and mortality............................................ 55
References................................................................................................................................. 56
2
Executive summary
Four coronavirus (COVID-19) vaccines have now been approved for use in the UK. Rigorous
clinical trials have been undertaken to understand the immune response, safety profile and
efficacy of these vaccines as part of the regulatory process. Ongoing monitoring of the vaccines
as they are rolled out in the population is important to continually ensure that clinical and public
health guidance on the vaccination programme is built upon the best available evidence.
UK Health Security Agency (UKHSA), formerly Public Health England (PHE), works closely with
the Medicines and Healthcare Regulatory Agency (MHRA), NHS England, and other
government, devolved administration and academic partners to monitor the COVID-19
vaccination programme. Details of the vaccine surveillance strategy are set on the page
COVID-19: vaccine surveillance strategy (1). As with all vaccines, the safety of COVID-19
vaccines is continuously being monitored by the MHRA. They conclude that overall, the benefits
of COVID-19 vaccines outweigh any potential risks (2).
Vaccine effectiveness
Several studies of vaccine effectiveness have been conducted in the UK against different
COVID-19 variants. Vaccine effectiveness against symptomatic disease with the Omicron
variant is substantially lower than against the Delta variant, with rapid waning. However,
protection against hospitalisation remains high, particularly after 3 doses.
Population impact
The impact of the vaccination programme on the population is assessed by taking into account
vaccine coverage, evidence on vaccine effectiveness and the latest COVID-19 disease
surveillance indicators.
Vaccine coverage tells us about the proportion of the population that have received 1, 2 and 3
doses of COVID-19 vaccines. By 30 January 2022, the overall vaccine uptake in England for
dose 1 was 69.2% and for dose 2 was 64.2%. Overall vaccine uptake in England in people with
at least 3 doses was 49.4%. In line with the programme rollout, coverage is highest in the oldest
age groups.
We present data on COVID-19 cases, hospitalisations and deaths by vaccination status. This
raw data should not be used to estimate vaccine effectiveness as the data does not take
into account inherent biases present such as differences in risk, behaviour and testing in the
vaccinated and unvaccinated populations. Vaccine effectiveness is measured in other ways as
detailed in the ‘Vaccine Effectiveness’ section.
3
Based on antibody testing of blood donors, 98.7% of the adult population now have antibodies
to COVID-19 from either infection or vaccination compared to 24.1% that have antibodies from
infection alone.
Vaccine effectiveness
Large clinical trials have been undertaken for each of the COVID-19 vaccines approved in the
UK which found that they are highly efficacious at preventing symptomatic disease in the
populations that were studied. The clinical trials have been designed to be able to assess the
efficacy of the vaccine against laboratory confirmed symptomatic disease with a relatively short
follow up period so that effective vaccines can be introduced as rapidly as possible.
Post implementation real world vaccine effectiveness studies are needed to understand vaccine
effectiveness against different outcomes (such as severe disease and onwards transmission),
effectiveness in different subgroups of the population and against different variants as well as to
understand the duration of protection.Vaccine effectiveness is estimated by comparing rates of
disease in vaccinated individuals to rates in unvaccinated individuals. Below we outline the
latest real-world evidence on vaccine effectiveness from studies in UK populations. Where
available we focus on data related to the Omicron variant which is currently dominant in the UK.
The findings are also summarised in Table 2.
Effectiveness against symptomatic disease

Vaccine effectiveness against symptomatic COVID-19 has been assessed in England based on
community testing data linked to vaccination data from the National Immunisation Management
System (NIMS), cohort studies such as the COVID Infection Survey and GP electronic health
record data. After 2 doses of the AstraZeneca vaccine, vaccine effectiveness against the
Omicron variant starts at 45 to 50% then drops to almost no effect from 20 weeks after the
second dose. With 2 doses of Pfizer or Moderna effectiveness dropped from around 65 to 70%
down to around 10% by 25 weeks after the second dose. Two to four weeks after a booster
dose of either the Pfizer or Moderna vaccine, effectiveness ranges from around 60 to 75%,
dropping to 25 to 40% from 15+ weeks after the booster. Vaccine effectiveness estimates for
the booster dose are very similar, irrespective of the primary course received (3). Vaccine
effectiveness is generally slightly higher in younger compared to older age groups.
4
Figure 1. Vaccine effectiveness against symptomatic disease by period after the second and booster doses for Delta (black
squares) and Omicron (grey circles) for a) recipients of 2 doses of Astrazeneca (ChAdOx1-S) vaccine as the primary course and
Pfizer (BNT162b2) or Moderna (mRNA-1273) as a booster; b) recipients of 2 doses of Pfizer vaccine as the primary course and
Pfizer or Moderna as a booster, and c) 2 doses of Moderna as a primary course and Pfizer or Moderna as a booster
a)
5
b)
6
c)
7
Data (based primarily on the Alpha and Delta variants) suggest that in most clinical risk
groups, immune response to vaccination is maintained and high levels of VE are seen with
both the Pfizer and AstraZeneca vaccines. Reduced antibody response and vaccine
effectiveness were seen after 1 dose of vaccine among the immunosuppressed group,
however, after a second dose the reduction in vaccine effectiveness is smaller (4).
Analyses by dosing interval suggest that immune response to vaccination and vaccine
effectiveness against symptomatic disease improves with a longer (greater than 6 week
interval) compared to a shorter interval of 3 to 4 weeks (5).
8
Effectiveness against hospitalisation

Several studies have estimated vaccine effectiveness against hospitalisation in older ages,
all of which indicate higher levels of protection against hospitalisation with all vaccines
against the Alpha and Delta variants (6, 7, 8, 9). Vaccine effectiveness against
hospitalisation with the Omicron variant has been estimated using a test-negative case
control study design (Figure 2). Two doses of either AstraZeneca (ChAdOx1-S) or Pfizer
(BNT162b2) vaccines was associated with a vaccine effectiveness of approximately 25 to
35% against hospitalisation following infection with the Omicron variant, after 25+ weeks.
After a Pfizer booster (after either primary vaccination course), vaccine effectiveness
against hospitalisation started at around 90% dropping to around 75% after 10 to 14
weeks. After a Moderna booster (mRNA-1273) (after either primary vaccination course),
vaccine effectiveness against hospitalisation was 90 to 95% up to 9 weeks after
vaccination.
9
Figure 2. Vaccine effectiveness against hospitalisation by period after the second and booster doses for Delta (black squares)
and Omicron (grey circles) for a) recipients of 2 doses of Astrazeneca (ChAdOx1-S) vaccine as the primary course and Pfizer
(BNT162b2) or Moderna (mRNA-1273) as a booster; b) recipients of 2 doses of Pfizer vaccine as the primary course and Pfizer or
Moderna as a booster
a)
10
b)
11
Effectiveness against mortality

High levels of protection (over 90%) are also seen against mortality with all 3 vaccines and
against both the Alpha and Delta variants with relatively limited waning (6, 10, 11). Vaccine
effectiveness against mortality with the Omicron variant has been estimated for those aged 50
years and older by combining the risk of becoming a symptomatic case with the risk of death
among symptomatic cases in vaccinated (all vaccines combined) compared to unvaccinated
individuals (Table 1). At 25+ weeks following the second dose, vaccine effectiveness was
around 60% while at 2 or more weeks following a booster vaccine effectiveness was 95%
against mortality.
Table 1. Hazard ratios and vaccine effectiveness against mortality (all vaccine brands
combined). OR = odds ratio, HR = hazards ratio, VE = vaccine effectiveness
OR v
Interval symptomatic
Dose after dose disease HR vs mortality VE vs mortality
2 25+ weeks 0.93 (0.9 - 0.96) 0.45 (0.19 - 1.03) 59% (4 - 82)
3 2+ weeks 0.41 (0.39 - 0.42) 0.12 (0.06 - 0.24) 95% (90 - 98)
12
Effectiveness against infection

Although individuals may not develop symptoms of COVID-19 after vaccination, it is possible
that they could still be infected with the virus and could transmit to others. Understanding how
effective vaccines are at preventing infection is therefore important to predict the likely impact of
the vaccination programme on the wider population. In order to estimate vaccine effectiveness
against infection, repeat asymptomatic testing of a defined cohort of individuals is required.
Studies have now reported on vaccine effectiveness against infection in healthcare workers,
care home residents and the general population with the Alpha and Delta variants (12, 13, 14,
15). Generally estimates are similar to or slightly lower than vaccine effectiveness estimates
against symptomatic disease and there is evidence of significant waning in protection against
infection over time. Estimates for vaccine effectiveness against infection with the Omicron
variant are not yet available.
Effectiveness against transmission

As described above, several studies have provided evidence that vaccines are effective at
preventing infection. Uninfected individuals cannot transmit; therefore, the vaccines are also
provide some protection against transmission. There may be additional benefit, beyond that due
to prevention of infection, if some of those individuals who become infected despite vaccination
are also at a reduced risk of transmitting (for example, because of reduced duration or level of
viral shedding). Several studies have provided evidence of reduced risk of household
transmission from vaccinated cases compared to unvaccinated cases (16, 17, 18, 19).
A summary of vaccine effectiveness evidence can be seen in Table 2.
13
Table 2. Summary of evidence on vaccine effectiveness against different outcomes (a)

Omicron (b) Delta (all vaccines combined)
a)
Dose 2 Dose 3
0-3 4-6 6+ 0-3 4-6 6+
months months months months months months
Insufficient Insufficient Insufficient Insufficient Insufficient Insufficient
Infection data data data data data data
Symptomatic Insufficient
25-70% 5-30% 0-10% 50-75% 40-50%
disease data
Insufficient
65-85% 55-65% 30-35% 80-95% 75-85%
Hospitalisation data
Insufficient Insufficient Insufficient Insufficient
40-70% 85-99%
Mortality data data data data
b)
Dose 2 Dose 3
0-3 4-6 6+ 0-3 4-6 6+
months months months months months months
Insufficient Insufficient Insufficient Insufficient
65-80% 50-65%
Infection data data data data
Symptomatic Insufficient
65-90% 45-65% 40-60% 90-99% 90-95%
disease data
Insufficient Insufficient
95-99% 80-90% 70-85% 95-99%
Hospitalisation data data
Insufficient Insufficient
95-99% 90-95% 80-99% 95-99%
Mortality data data
High Evidence from multiple studies which is consistent

Confidence and comprehensive
Medium Evidence is emerging from a limited number of
Confidence studies or with a moderately level of uncertainty
Low Little evidence is available at present and results are
Confidence inconclusive
14
Effectiveness against Omicron variant BA.2

The Omicron variant sub-lineage known as BA.2 was designated VUI-22JAN-01 on 19 January
2022. An increase in the number of sequences of the Omicron sub-lineage BA.2 was noted in
the UK in the week starting the 3 January 2022. Vaccine effectiveness against symptomatic
disease following BA.2 infection was analysed in a test-negative case control design, as
compared to the Omicron BA.1 sub-lineage. Pillar 2 testing data from symptomatic cases tested
between 27 December and 21 January were included. Analysis combined all vaccines (Table
3). Vaccine effectiveness against symptomatic disease was similar for BA.1 and BA.2 sub-
lineagues of Omicron. After 2 doses effectiveness was 9% (7-10%) and 13% (-26-40%)
respectively for BA.1 and BA.2, after 25+ weeks. This increased to 63% (63-64%) for BA.1 and
70% (58-79%) for BA.2 at 2 weeks following a booster vaccine.
Table 3. Vaccine effectiveness against symptomatic disease (all vaccine brands

combined) for BA.1 and BA.2. OR = odds ratio, VE = vaccine effectiveness.
BA.1 BA.2
Dose Interval after dose (VE (95% CI)) (VE (95% CI))
2 25+ weeks 9% (7 - 10) 13% (-26 - 40)
3 2+ weeks 63% (63 - 64) 70% (58 - 79)
15
Vaccine effectiveness publications

UKHSA and collaborators have published a significant amount of research into vaccine
effectiveness, which is summarised on pages 4 to 15. The publications listed in table 4 provide
further results and details on the methods used.
Table 4. UKHSA publications on the effectiveness of COVID-19 vaccination
Publication Subject
Effectiveness of BNT162b2 and ChAdOx1 This study reports on vaccine effectiveness
against SARS-CoV-2 household transmission: against transmission of COVID-19 with the
a prospective cohort study in England Alpha and Delta variants.
Effectiveness of 3 doses of COVID-19 vaccines Updated analysis on the effectiveness of 3

against symptomatic COVID-19 and doses of COVID-19 vaccines against
hospitalisation in adults aged 65 years and symptomatic COVID-19 and hospitalisation
older in adults aged 65 years and older.
Effectiveness of BNT162b2 COVID-19 booster This study provides real world evidence of
vaccine against COVID-19 related symptoms significant increased protection from the
and hospitalization in England booster vaccine dose against symptomatic
disease and hospitalisation irrespective of
the primary course.
Effectiveness of COVID-19 vaccines against This study reports on the vaccine
the Omicron (B.1.1.529) variant of concern effectiveness against symptomatic disease
with 2 dose courses of BNT1622 and
ChAdOx1-S as well as booster doses of
BNT162b2 following a primary course of
either BNT1622 or ChAdOx1-S.
Effectiveness of BNT162b2 (Comirnaty, Pfizer- Results from the first UK real-world study by
BioNTech) COVID-19 booster vaccine against UKHSA show significantly increased
COVID-19 related symptoms in England: test protection against symptomatic disease from
negative case-control study a booster dose of the Pfizer-BioNTech
vaccine in those aged 50 years and older.
Duration of Protection against Mild and Severe This study reports on the vaccine
Disease by COVID-19 Vaccines effectiveness and duration of protection of
Comirnaty, Vaxzevria and Spikevax against
mild and severe COVID-19 in the UK.
Serological responses and vaccine This study investigates the impact of
effectiveness for extended COVID-19 vaccine different dosing schedules on immune
schedules in England response and vaccine effectiveness.
16
Publication Subject
Pfizer-BioNTech and Oxford AstraZeneca This study reports on the immune response
COVID-19 vaccine effectiveness and immune and clinical effectiveness of COVID-19
response among individuals in clinical risk vaccine among individuals in clinical risk
groups groups. A supplementary appendix is also
available to download.
Effectiveness of COVID-19 vaccines against This study reports on the effectiveness of
hospital admission with the Delta (B.1.617.2) COVID-19 vaccines on hospitalisation
variant disease with the Delta variant. A
supplementary appendix is also available to
download.
Effectiveness of COVID-19 Vaccines against This study reports on the effectiveness of
the B.1.617.2 (Delta) Variant COVID-19 vaccines on symptomatic disease
with the Delta variant.
Effectiveness of BNT162b2 mRNA and A study using the SARI watch surveillance
ChAdOx1 adenovirus vector COVID-19 system of COVID-19 hospitalisations found
vaccines on risk of hospitalisation among older high levels of protection against
adults in England: an observational study using hospitalisation after both a single dose and 2
surveillance data doses of COVID-19 vaccines.
Effectiveness of BNT162b2 mRNA vaccine and A study on deaths with COVID-19 indicates
ChAdOx1 adenovirus vector vaccine on that COVID-19 vaccines offer high levels of
mortality following COVID-19 protection against mortality.
Effect of Vaccination on Household Impact of vaccination on household
Transmission of SARS-CoV-2 in England transmission of SARS-COV-2 in England is
an analysis to determine whether individuals
who have received vaccine, but still become
infected with SARS-COV-2 up to 60 days
after the first dose, are less likely than
unvaccinated cases to transmit to their
unvaccinated household contacts.
Vaccine effectiveness of the first dose of The VIVALDI study found evidence that
ChAdOx1 nCoV-19 and BNT162b2 against COVID-19 vaccines were associated with a
SARS-CoV-2 infection in residents of Long- substantially reduced risk of infection in care
Term Care Facilities (VIVALDI study) home residents.
Effectiveness of BNT162b2 and ChAdOx1 The Avon CAP study, conducted in 2
nCoV-19 COVID-19 vaccination at preventing hospitals in Bristol, found evidence of high
hospitalisations in people aged at least 80 levels of protection against hospitalisation in
years: a test-negative, case-control study 80+ year olds with a single dose of either
vaccine.
COVID-19 vaccine coverage in health-care Early data from PHE’s SIREN study shows a
workers in England and effectiveness of promising impact on infection in healthcare
17
Publication Subject
BNT162b2 mRNA vaccine against infection workers aged under 65. Healthcare workers
(SIREN): a prospective, multicentre, cohort in the study are tested for COVID-19 every 2
study weeks – whether or not they have
symptoms.
Effectiveness of the Pfizer-BioNTech and Early data from routine COVID-19 testing in
Oxford-AstraZeneca vaccines on COVID-19 older adults shows that vaccines are
related symptoms, hospital admissions, and effective at preventing COVID-19 disease
mortality in older adults in England: test and severe outcomes.
negative case-control study
Impact of COVID-19 vaccination programme on Report on the Impact of COVID-19
seroprevalence in blood donors in England, vaccination programme on seroprevalence
2021 in blood donors in England, 2021.
18
Population impact
Vaccines typically have both direct effects on those who are vaccinated and indirect effects on
the wider population due to a reduced probability that people will come into contact with an
infected individual. The overall impact of the vaccination programme may therefore extend
beyond that estimated through vaccine effectiveness analysis.
Estimating the impact of a vaccination programme is challenging as there is no completely

unaffected control group. Furthermore, the effects of the vaccination programme need to be
differentiated from that of other interventions (for example, lockdowns or outbreak control
measures), changes in behaviour and any seasonal variation in COVID-19 activity.
UKHSA and other government and academic partners monitor the impact of the of the
vaccination programme on levels of COVID-19 antibodies in the population and different
disease indicators, including hospitalisations and mortality. This is done through population-
based testing and through modelling which combines vaccine coverage rates in different
populations, estimates of vaccine effectiveness and disease surveillance indicators.
Vaccine coverage
The data in this week’s report covers the period from 8 December 2020 to 30 January 2022
(week 4) (Figure 3). It shows the provisional number and percentage of living people in England
who have had received 1, 2 or 3 doses of a COVID-19 vaccination by age group and week
since the start of the programme. Further data on vaccine uptake by age in England can be
found in the national flu and COVID-19 surveillance reports. Age is calculated as age on the 31
August 2021, that is, academic cohort for all ages.
19
Figure 3. Cumulative weekly vaccine uptake by age

a) Dose 1
Over 80 75 to under 80 70 to under 75 65 to under 70 60 to under 65 55 to under 60
50 to under 55 45 to under 50 40 to under 45 35 to under 40 30 to under 35 25 to under 30
20 to under 25 18 to under 20 16 to under 18 12 to under 16 Under 12
100.0
90.0
80.0
70.0
60.0
% vaccine uptake
50.0
40.0
30.0
20.0
10.0
0.0
Week number
20
b) Dose 2
Over 80 75 to under 80 70 to under 75 65 to under 70 60 to under 65 55 to under 60
100.0
90.0
80.0
70.0
60.0
% vaccine uptake
50.0
40.0
30.0
20.0
10.0
0.0
Week number
21
c) Dose 3 - please note the data for this graph is shown from week 35 (week ending 05/09/2021)
Over 80 D3 75 to under 80 D3 70 to under 75 D3 65 to under 70 D3 60 to under 65 D3 55 to under 60
100.0
90.0
80.0
70.0
60.0
% vaccine uptake
50.0
40.0
30.0
20.0
10.0
0.0
Week number
22
Vaccination in immunosuppressed individuals

Provisional vaccine uptake data in living and resident people identified as immunosuppressed in England to the end of week 4 can be found
in Table 5. This shows that vaccine uptake in the 532,303 people identified as immunosuppressed was 95.6% for at least dose 1, 94.1% for
at least 2 doses and 86.9% for at least 3 doses. Additional data on vaccine uptake in people with at least 3 doses by age in England can be
found in the National flu and COVID-19 surveillance reports.
Table 5. Vaccine uptake in people identified as immunosuppressed in England
Immuno- People Numbers Percentage Numbers Percentage Numbers Percentage

suppression in NIMs vaccinated vaccine vaccinated vaccine vaccinated vaccine uptake
Cohort with at least uptake with at with at least uptake with at with at least with at least 3
1 dose least 1 dose 2 doses least 2 doses 3 doses doses
England 532,303 508,702 95.6 500,879 94.1 462,384 86.9
Detailed information on the characterisation of the immunosuppressed group by NHS Digital is available.
23
Vaccination in pregnancy
Vaccination of pregnant women alongside their peers is recommended in the UK and other
countries as an important way to protect pregnant women and their unborn children against
COVID-19 disease. Vaccination of pregnant women is strongly recommended by the Royal
College of Obstetricians and Gynaecologists and the Royal College of Midwives.
Increased severity of COVID-19 disease in pregnant and recently pregnant women has been
reported after the first SARS-CoV-2 wave in England (20,21) and in Scotland (22,23). Pregnant
women who develop severe disease have increased rates of admission to ICU, need for
invasive ventilation and pre-term delivery. Data from the US Centers for Disease Control and
Prevention (CDC) found that pregnant women were around 3 times more likely to be admitted to
ICU and nearly 3 times more likely to require invasive ventilation compared to non-pregnant
women with COVID-19 disease and 25% more likely to die (24).
From 16 April 2021, the Joint Committee on Vaccination and Immunisation (JCVI) advised that
pregnant women be offered COVID-19 vaccines at the same time as people of the same age or
risk group (25). Therefore, any pregnant women not in a high-risk group would likely have
received their first dose from mid-April 2021 as part of the general adult population programme
in those aged under 50 years. This was offered by decreasing age group (25). As part of the
ongoing review of the programme, the JCVI met on 2 December 2021 and considered further
data on severity of SARS-CoV-2 infection in pregnant women and their pregnancies together
with data on vaccine safety; as a result pregnant women were added to the UK's priority
COVID-19 vaccine list (26).
Prior to 16 April 2021, COVID-19 vaccine was delivered to priority groups, based on clinical risk
and risk of exposure, and delivered in order of priority. On 22 December 2020, JCVI advised
that vaccine could be offered to pregnant and breast-feeding women who were in these risk
categories The Pfizer vaccine was rolled out from early December 2020, AstraZeneca vaccine
was used from 4 January 2021 and the Moderna vaccine became available from April 2021.
There is evidence of high levels of protection against SARS-CoV-2 infection in pregnant women
after COVID-19 vaccination (27, 28, 29) and evidence that vaccination induces higher antibody
levels than after disease (29). Between February and September 2021, 0.4% of 1,714 pregnant
women with COVID-19 symptoms who required hospital treatment in the UK had received 2
doses of COVID-19 vaccine and, of 235 pregnant women who were admitted to intensive care
with COVID-19 disease in that period, none had received 2 doses of vaccine (30). Similar
findings have been reported from Scotland (23,31) with the most recent study reporting that
90.9% (748 out of 823; 95% CI 88.7−92.7) of SARS-CoV-2 associated with hospital admission,
98% (102 out of 104; 95% CI 92.5−99.7) of SARS-CoV-2 associated with critical care admission
and all baby deaths, occurred in pregnant women who were unvaccinated at the time of their
COVID-19 diagnosis (22). The researchers also found high extended perinatal mortality rate for
24
women who gave birth within 28 days of a COVID-19 diagnosis compared to rates across the
pandemic period and in women vaccinated and going on to give birth within 28 days.
COVID-19 vaccines used in the UK programme do not contain live SARS-CoV-2 virus and
therefore cannot infect a pregnant woman or her unborn child with the virus. Whilst, as is
commonly the case in trials of medicinal products, pregnant women were excluded from the
original COVID-19 vaccine trials, there is accumulating experience and evidence of the safe and
effective use of mRNA vaccines (such as the Pfizer-BioNTech or Moderna) in pregnant women.
In Scotland COVID-19 vaccine had been administered in more than 18,000 pregnancies to the
end of October 2021 (22) and nearly 4,000 women in Wales had received their first dose of
vaccine before they gave birth (between 1 January 2021 and 30 November 2021) (32). In the
USA more than 180,000 women have indicated they were pregnant at the time they received
COVID-19 vaccination to 22 November 2021 (33).
No safety concerns relating to COVID-19 vaccination of pregnant women have been found in
published studies to date (34, 35, 36, 37). The rate of vaccine side-effects appears to be similar
in pregnant and non-pregnant populations (34).
This report presents data on vaccine coverage and outcomes for women delivering up to the
end of October 2021 and updates the early data on COVID-19 vaccination in pregnant women
published in the COVID-19 vaccine surveillance report – week 47 COVID-19 vaccine weekly
surveillance reports (weeks 39 to 3, 2021 to 2022). Findings continue to be considered
preliminary.
Vaccine coverage
COVID-19 vaccine coverage in women before they give birth has increased as more women
have become eligible for vaccination. In August 2021, 22.5% of women giving birth had
received at least 1 dose of vaccine. This increased to 32.1% of women who gave birth in
September, and 41.3% in October 2021. 29.4% of women who gave birth in October 2021 had
received 2 doses of the vaccine (Table 6).
In the overall period between January and October 2021 a total of 442,481 women gave birth of
whom 58,165 had received at least one dose of COVID-19 vaccine prior to delivery (39,782 of
these women had received at least 2 doses). There were 1,228 women who had received their
first dose prior to pregnancy, 3,819 in the first trimester, 16,324 in the second and 19,530 in the
third trimester. A further 17,264 women were known to have received dose one before giving
birth but without enough information to establish which trimester. Of these women, 15,274 were
known to have received this dose in pregnancy, and 1,990 were around the start of pregnancy.
Of all vaccinated women giving birth, 37,627 had received one or more doses of only Pfizer
vaccine; 2,725 one or more doses of only Moderna; 1,350 one or more doses of only
AstraZeneca and the remaining 16,463 of vaccinated women received a mixture of doses:
25
12,494 received a combination of Pfizer and Moderna and 3,969 received AstraZeneca with
Pfizer or Moderna.
Table 6. Overall vaccine coverage in women giving birth, by month of delivery1
Unvaccinated
who went on
Women One or more Two or more
Unvaccinated to receive
Month giving doses by time doses by time
at delivery dose(s) after
birth of delivery of delivery
pregnancy to
19/01/2022
Jan-21 41,949 18 (0%) 1 (0%) 41,765 (99.6%) 31,621 (75.7%)
Feb-21 40,093 82 (0.2%) (0%) 39,872 (99.4%) 30,212 (75.8%)
Mar-21 44,589 293 (0.7%) 25 (0.1%) 44,164 (99%) 33,156 (75.1%)
Apr-21 42,874 489 (1.1%) 94 (0.2%) 42,214 (98.5%) 31,234 (74%)
May-21 44,177 1,249 (2.8%) 306 (0.7%) 42,744 (96.8%) 30,700 (71.8%)
Jun-21 43,813 4,344 (9.9%) 639 (1.5%) 39,312 (89.7%) 26,674 (67.9%)
Jul-21 47,226 7,632 (16.2%) 2,152 (4.6%) 39,403 (83.4%) 25,000 (63.4%)
Aug-21 45,789 10,319 (22.5%) 5,921 (12.9%) 35,275 (77%) 20,610 (58.4%)
Sep-21 46,219 14,828 (32.1%) 9,999 (21.6%) 31,205 (67.5%) 16,155 (51.8%)
Oct-21 45,752 18,911 (41.3%) 13,473 (29.4%) 26,637 (58.2%) 11,795 (44.3%)
11,725 women could not be matched with a NIMS record; their vaccine status is therefore unknown, they are excluded from
these figures.
Table 7. Vaccine coverage by ethnicity, for women giving birth August to October 2021
(latest 3 months)1
Women Unvaccinated
giving who went on
One or more Two or more
birth in Unvaccinated to receive
doses by time doses by time
August to at delivery dose(s) after
of delivery of delivery
October pregnancy to
2021 19/01/2022
Asian 16,563 4,459 (26.9%) 2,768 (16.7%) 12,104 (73.1%) 7,100 (58.7%)
Black 6,265 834 (13.3%) 429 (6.8%) 5,431 (86.7%) 1,765 (32.5%)
Other 5,320 1,476 (27.7%) 1,032 (19.4%) 3,844 (72.3%) 1,712 (44.5%)
Mixed 3,272 845 (25.8%) 559 (17.1%) 2,427 (74.2%) 955 (39.3%)
White 99,234 34,401 (34.7%) 23,252 (23.4%) 64,833 (65.3%) 34,799 (53.7%)
Unknown 7,106 2,043 (28.8%) 1,353 (19%) 4,478 (63%) 2,229 (49.8%)
1585 women could not be matched with a NIMS record; their vaccine status is therefore unknown, they are excluded from these
figures.
26
Table 8. Vaccine coverage by quintile of deprivation of the small area in which the
woman lived, for women giving birth August to October 2021 (latest 3 months)1
Two or Unvaccinated
Women giving One or more
more who went on
birth in August doses by Unvaccinated
doses by to receive
to October time of at delivery
time of dose(s) after
2021 delivery
delivery pregnancy
1 - most 6,035 3,381 26,977 10,636
33,012
deprived (18.3%) (10.2%) (81.7%) (39.4%)
7,973 5,077 21,620 10,417
2 29,593
(26.9%) (17.2%) (73.1%) (48.2%)
9,237 6,145 17,416
3 26,653 9,730 (55.9%)
(34.7%) (23.1%) (65.3%)
9,940 6,875 14,813
4 24,753 9,367 (63.2%)
(40.2%) (27.8%) (59.8%)
5 - least 10,677 7,784 11,717
22,394 8,186 (69.9%)
deprived (47.7%) (34.8%) (52.3%)
Unknown 1,355 196 (14.5%) 131 (9.7%) 574 (42.4%) 224 (39%)
figures.
Table 9. Vaccine coverage by age of mother, for women giving birth August to October
2021 (latest 3 months)1
Women
giving Unvaccinated
One or more Two or more
birth in Unvaccinated who went on to
Age doses by time doses by time
August to at delivery receive dose(s)
of delivery of delivery
October after pregnancy
2021
Under 20 2,562 226 (8.8%) 77 (3%) 2,336 (91.2%) 602 (25.8%)
20 to 24 15,407 2,156 (14%) 904 (5.9%) 13,251 (86%) 4,967 (37.5%)
25 to 29 35,024 7,781 (22.2%) 4,281 (12.2%) 27,243 (77.8%) 13,703 (50.3%)
30 to 34 48,607 18,075 (37.2%) 12,419 (25.5%) 30,532 (62.8%) 17,780 (58.2%)
35 to 39 28,571 12,731 (44.6%) 9,475 (33.2%) 15,840 (55.4%) 9,349 (59%)
40 and above 6,962 3,089 (44.4%) 2,237 (32.1%) 3,873 (55.6%) 2,159 (55.7%)
Unknown 627 (0%) (0%) 42 (6.7%) (0%)
figures.
27
Using the most recent 3-month period, there were 137,760 women who gave birth of whom
44,058 (32.0%) were vaccinated. These women accounted for 76% of all vaccinated women
giving birth since January. There were differences in vaccine coverage by both ethnicity (Table
7) and by quintile of deprivation (Table 8). Women of black ethnicity and women living in the
most deprived areas in England were least likely to have been vaccinated with 1 or 2 doses of
COVID-19 vaccine before they gave birth. Coverage increased as levels of deprivation
decreased (Table 8). Vaccine coverage increased with increasing age group to those aged 35
to 39 years in whom uptake was 43.9% for 1 dose and 33.2% for 2 doses (Table 9), with similar
coverage in women who were aged 40 years or over when they gave birth.
Methods
Data on COVID-19 vaccination status together with details of each vaccine administered are
recorded in a central data set called the National Immunisation Management Service (NIMS) 1.
In addition, NHS Digital manages the Hospital Episode Statistics (HES) data sets, containing
information about hospital activity in England.
Records of women giving birth (‘delivery records’) in the months since 1 January 2021 were
identified in HES. De-duplication of delivery records resulted in a data set of women who had
given birth with 1 record per woman, identified by her NHS Number, and the latest ‘delivery
episode’ associated with her. An ‘earliest’ and ‘latest’ likely pregnancy start date were assigned
to each woman’s record, using the known delivery date and further information from her record,
where available:
1. Where a valid gestational age was recorded (GESTAT_1 between 24 and
42), the woman’s earliest pregnancy start date was calculated by taking the
number of weeks away from the delivery date, and then calculating an
additional earlier week, to account for GESTAT_1 recording completed
weeks of pregnancy. In a similar way, latest pregnancy start date was
calculated by taking the number of weeks of GESTAT_1 away from the
delivery date.
2. Where no valid GESTAT_1 was available, the first 12 diagnoses codes were
examined to identify any with a code suggesting delivery at term (O60.2). In
this case the gestational age at delivery was assumed to be between 37 and
42 completed weeks of pregnancy, and a similar method was used to
establish earliest and latest pregnancy start dates.
3. Where no valid GESTAT_1 was available and there were no codes

suggesting term delivery, the first 12 diagnoses codes were examined to
1 NIMS Data controllers are NHSEI and NHSD. The NIMS IT software is commissioned by NHSEI via South
Central West CSU and is provided by the System C & Graphnet Care Alliance
28
identify any suggesting pre-term delivery (O60.1 or O60.3). In this case the
gestational age at delivery was assumed to be between 24 and 36
completed weeks of pregnancy, and these values were used to establish
earliest and latest pregnancy start dates.
4. In the absence of any additional information in the woman’s record (or in

conflicting cases where diagnoses codes suggesting both term and pre-term
delivery appeared in the same record), the gestational age at delivery was
assumed to be between 24 and 42 completed weeks of pregnancy, and
these values were used to establish earliest and latest pregnancy start
dates.
Earliest and latest dates for the start of each trimester were established in a similar way, using
the windows of trimester 1: day 0 to day 97 (where day 0 is the earliest or latest pregnancy start
date, as established using the method above), trimester 2: day 98 to day 195 and trimester 3:
day 196 to delivery. Each woman’s delivery record was linked to her record(s) in the NIMS
using the NHS Number, establishing her vaccine status as either having had one or more doses
before delivery (including any prior to becoming pregnant) or not having had any doses of the
vaccine prior to delivery, using the NIMS vaccine records.
For each vaccine dose (this analysis considered doses 1 to 4) the woman was known to have
received, the following information was ascertained:
Dose administered pre- Dose administered before the earliest

pregnancy pregnancy start date
Dose administered in Dose administered after the latest pregnancy

pregnancy start date and before the delivery date
Dose administered post- Dose administered on or after the delivery

pregnancy date based on NIMS records extracted on 19
January 2022
Dose in pregnancy: Dose administered around the start or

unknown pregnancy: after the earliest pregnancy start
date and before the latest pregnancy start
date
Unvaccinated No vaccine records exist for the woman,

based on NHS number
29
And the following information about trimester
Dose administered pre- Dose administered before the earliest

pregnancy pregnancy start date

trimester 1 start date and before the earliest pregnancy
start date +97 days

trimester 2 start date +98 days and before the earliest
pregnancy start date +195 days

trimester 3 start date + 196 days and before the delivery
date
Dose administered post- Dose administered on or after the delivery

pregnancy date based on NIMS records extracted on 19
January 2022
Dose in trimester Dose administered in the ‘gap’ between

unknown trimesters, because of inaccuracy in
establishing pregnancy start date
Unvaccinated No vaccine records exist for the woman,

based on NHS number
The ethnicity, residence and age information used to generate Tables 7 to 9 was taken from the
NIMS record. The analysis within this section was carried out on 19 January 2022. The latest
HES data available were for October 2021, and HES data since April 2021 is considered
provisional.
30
Pregnancy outcomes
The following figures present rates of women in England who:
1. Gave birth to one or more live-born babies at term without low birthweight; that is, they
experienced none of the following adverse outcomes considered (outcomes 2 to 4),
according to their delivery record.
2. Gave birth to a stillborn baby (based on recorded diagnoses)
3. Gave birth to a baby with low birthweight (<2,500g) or a very low birthweight (<1,500g).
The babies with a very low birthweight are therefore a subset of the low birthweight
babies.
4. Gave birth prematurely (<37 weeks gestation), very prematurely (<32 weeks gestation)
and extremely prematurely (<28 weeks gestation). The very premature and extremely
premature are therefore a subset of women who gave birth prematurely.
These analyses assess whether rates were different in women giving birth between January
and October 2021, who received one or more COVID-19 vaccination doses during their
pregnancy compared with those who did not (either because they were unvaccinated or had
only received vaccine doses prior to pregnancy). The analyses do not take other factors that
might affect these outcomes into account, such as age (except for outcome 1 above) and
whether the woman was categorised as clinically at risk. However, women who gave birth after
17 April 2021 without the reported complications (outcome 1 above), were also reviewed with
vaccinations given from 16 April onwards. This is a more homogenous group of pregnant
women who were eligible for vaccination based solely on age and not because they were
considered at high risk of exposure or severe disease. Therefore, data is also presented for
women giving birth between April and October 2021 for comparison.
31
Figure 4: Women giving birth January to October 2021 to live-born babies at term without
low birthweight
100
80
60
%
40
20
0
Women having live babies at term without low birthweight
One or more doses in pregnancy No doses in pregnancy Average
Figure 5: Women giving birth January to October 2021 to live-born babies at term without
low birthweight, by age
100
80
60
%
40
20
0 Age under 25 Age 25 to 29 Age 30 to 34 Age 35 to 39 Age 40 and above
32
Figure 6: Women giving birth April to October 2021 to live-born babies at term without
low birthweight
Figure 7: Women giving birth April to October 2021 to live-born babies at term without
low birthweight, by age
33
Figure 8: Stillbirths experienced by women giving birth January to October 2021
10
Rate per 1,000 women giving birth
0
Stillbirth rate
Figure 9: Low birthweight babies to women giving birth January to October 2021
10
9
8
7
6
% 5
4
3
2
1
0
Low birthweight Very low birthweight
34
Figure 10: Women giving birth prematurely January to October 2021
10
9
8
7
6
% 5
4
3
2
1
0
Premature Very premature Extremely premature
The proportion of women giving birth between January and October without adverse outcomes
having received one or more doses in pregnancy (91.9% 95%CI 91.6 to 92.1) is similar to the
proportion in women who did not receive any doses in pregnancy (91.6% 95%CI 91.5 to 91.6)
(Figure 4). These positive outcomes were similar across all age groups in vaccinated and
unvaccinated women (Figure 5). For the more recent period (women vaccinated from 16 April
and delivering from 17 April 2021), when all pregnant women were routinely offered vaccination
on the basis of age, women who had received at least 1 dose of COVID-19 vaccine during their
pregnancy were more likely to give birth without any of the reported adverse outcomes than
women who had not been vaccinated in pregnancy (92.9% 95%CI 92.7 to 93.1 compared with
91.6% 95%CI 91.5 to 91.7) (Figure 6).This difference was more apparent in those aged 30
years and older (Figure 7).
The stillbirth rate for women who gave birth having received one or more doses in pregnancy
(3.60 per 1,000, 95%CI 3.14 to 4.13) was similar to the rate for those who had not received any
doses in pregnancy (3.90 per 1,000, 95%CI 3.71 to 4.10) giving birth between January and
October 2021 (Figure 8). In the same period, the proportion of women who had received one or
more doses in pregnancy giving birth to babies with low birthweight (5.01%, 95%CI 4.84 to
5.19) was comparable to those who had not received any doses in pregnancy (5.33%, 95%CI
5.26 to 5.40) (Figure 6). Similarly, 0.87% (95%CI 0.79 to 0.95) of women who had received one
or more doses in pregnancy and 0.77% (95%CI 0.74 to 0.80) of those who had not, gave birth
to a very low birthweight baby (Figure 9).
The proportion of women who received one or more doses in pregnancy having premature
births was 5.97% (95%CI 5.78 to 6.17), compared with 5.88% (95%CI 5.81 to 5.96) in those
35
who had not (Figure 10). The proportion of women with very premature births was 1.47%
(95%CI 1.37 to 1.57) in those who received one or more dose in pregnancy and 1.72% (95%CI
1.68 to 1.77) in those who had not. The proportion of women with extremely premature births
was 0.89% (95%CI 0.82 to 0.97) in those who received one or more dose in pregnancy and
1.21% (95%CI 1.18 to 1.25) in those who had not.
Interpretation and limitations
The first women to be offered COVID-19 vaccine were those who were categorised as at risk of
severe disease and women of older age who are at increased risk of the 3 adverse outcomes
presented here (given the medical conditions that placed them in this category), together with
healthcare professionals at higher risk of COVID-19 exposure. Women with underlying
conditions that put them at very high risk of serious complications of COVID-19 will thus account
for a relatively high proportion of early deliveries in women who had received one or more
doses of the vaccine before 16 April 2021. It is therefore very reassuring that women who had
received at least 1 dose of the vaccine in pregnancy were as likely to deliver live born babies at
term without low birthweight and had no overall increased risk of any adverse outcome through
January to October.
These findings support the conclusions on vaccine safety from COVID-19 vaccine surveillance
report – week 47 (COVID-19 vaccine weekly surveillance reports (weeks 39 to 3, 2021 to 2022).
More detailed statistical analyses are planned (see COVID-19 vaccination in pregnancy
surveillance protocol. The adverse pregnancy outcomes considered are routinely reported as
official statistics annually by ONS, however HES data was used to monitor outcomes more
quickly than ONS data allows. There are recognised limitations of the data sets including the
level of completeness of the relevant fields.
Methods
The same methods as used to establish coverage figures were used to group records of
deliveries into those who had received at least 1 dose of the vaccine during their pregnancy and
those who had not. The definition of this second group includes any women who received
dose(s) only prior to pregnancy and those who received their first dose after delivery, as well as
those unvaccinated as of 19 January 2022. Outcomes are also presented by age at delivery,
using the woman’s date of birth as recorded in NIMS.
To identify deliveries where adverse outcomes were experienced; the following criteria were
applied. The outcomes are related: for example babies born prematurely are more likely to be
born with low birthweight, and therefore a delivery may have more than one adverse outcome.
Stillbirths were identified as records where any 1 or more of the first 12 diagnoses was the
following: Z37.1: Single stillbirth; Z37.3 Twins, 1 liveborn and 1 stillborn; Z37.4 Twins, both
stillborn; Z37.6: Other multiple births, some liveborn; Z37.7: Other multiple births, all stillborn.
36
Low birthweight and very low birthweight deliveries were identified as records where any of the
first 4 babies born had a known birthweight between 500g and 2,499g (1,499g or lower for very
low birthweight).
Premature deliveries were identified as records where the gestational length was less than 37
weeks (less than 32 weeks for very premature, and less than 28 weeks for extremely
premature).
Low birthweight is by convention presented as a percentage of all deliveries with known

birthweights, and prematurity usually presented as a percentage of all deliveries with known
gestational length. However here they are presented as percentages of all deliveries, to reduce
the chance of significant findings arising from a change in the overall success of recording these
fields during the pandemic. Figures will therefore differ from official statistics and should be
considered for surveillance purposes only.
Confidence intervals were calculated using the Wilson Score method (38). A confidence interval
is a range of values that is used to quantify the imprecision in the estimate of a particular
indicator. Specifically it quantifies the imprecision that results from random variation in the
measurement of the indicator. A wider confidence interval shows that the indicator value
presented is likely to be a less precise estimate of the true underlying value.
Main findings
COVID-19 vaccination is the safest and most effective way for women to protect themselves
and their babies against severe COVID-19 disease.
COVID-19 vaccine coverage in pregnant women at delivery has increased as more women
have become eligible for vaccination reaching 41.3% for women who gave birth in October 2021
having had one or more dose before their baby was born. This is in line with coverage reported
across the UK with 42.8% of women in Scotland and 41.0% in Wales delivering in October 2021
who had received any dose and their first dose of COVID-19 vaccine respectively prior to
delivery.
As in the previous report, coverage increased with decreasing levels of deprivation and women
of black ethnicity had the lowest vaccine coverage. Coverage increased with increasing age
group to 35 to 39 years.
Whilst coverage has improved since the August coverage presented in the 25 November report
(week 47 COVID-19 vaccine weekly surveillance reports (weeks 39 to 3, 2021 to 2022)) across
all groups it continues to highlight inequalities consistent with those seen across the entire
37
COVID-19 vaccination programme. The percentage point differences between the groups with
highest and lowest coverage were greater than those in the November report.
It is very reassuring that women who had received at least 1 dose of the vaccine in pregnancy
were as likely to deliver live born babies at term without low birthweight as women who were not
vaccinated in pregnancy.
The group of women who were most likely to be immunised on the basis of their age group
alone (vaccinated from 16 April 2021 and giving birth from 17 April 2021) were significantly
more likely to deliver live born babies at term without low birthweight than women giving birth in
the same period who were not vaccinated in pregnancy.
The specific outcomes that were considered (stillbirth, low birthweight and premature delivery)
were similar in women who were and were not vaccinated whilst pregnant.
38
Vaccination status in cases, deaths and

hospitalisations
Please note that from 31 January 2022, UKHSA moved all COVID-19 case reporting in England
to use a new episode-based definition which includes possible reinfections. Each infection
episode is counted separately if there are at least 91 days between positive test results. Each
infection episode begins with the earliest positive specimen date. Further information can be
found on the UK COVID-19 dashboard.
Vaccination status of COVID-19 cases, deaths and hospitalisations by week of specimen date
over the past 4 weeks up to week 4 (up to 30 January 2022) are shown in tables 10 to 12.
Please note that data on COVID-19 cases presenting to emergency care (within 28 days of a
positive specimen) resulting in an overnight inpatient admission by vaccination status was
unavailable for the week 5 report due to the update to the new episode-based case definition
this week.
This data is published to help understand the implications of the pandemic to the NHS, for
example understanding workloads in hospitals, and to help understand where to prioritise
vaccination delivery. This raw data should not be used to estimate vaccine effectiveness.
We have published a blog post to accompany this section of the vaccine surveillance report.
Methods
COVID-19 cases and deaths identified through routine collection from the Second Generation
Surveillance System (SGSS) and from UKHSA EpiCell's deaths data, as described in the
technical summary, were linked to the National Immunisation Management System (NIMS) to
derive vaccination status, using an individual’s NHS number as the unique identifier.
Attendance to emergency care at NHS trusts was derived from the Emergency Care DataSet
(ECDS) managed by NHS Digital. The same data source was used to identify COVID-19 cases
where the attendance to emergency care resulted in admission to an NHS trust.
ECDS is updated weekly, and cases are linked to this data twice weekly. Data from ECDS is
subject to reporting delays as, although NHS trusts may update data daily, the mandatory
deadline for submission is by the 21st of every month. This means that for weeks immediately
following the 21st of a month, numbers may be artificially low and are likely to be higher in later
versions of the report.
Data from ECDS also only reports on cases who have been presented to emergency care and
had a related overnight patient admission and do not show those who are currently in hospital
with COVID-19. As such, it is not appropriate for use for surveillance of those currently
hospitalised with COVID-19. In addition, this data will not show cases who were directly
admitted as inpatients without presenting to emergency care.
39
The outcome of overnight inpatient admission following presentation to emergency care, was
limited to those occurring within 28 days of the specimen date for a COVID-19 case.
Deaths include those who died (a) within 28 days of the most recent episode of infection or (b)
within 60 days of the episode specimen date or more than 60 days after the episode specimen
date with COVID-19 mentioned on the death certificate.
The rate of COVID-19 cases, hospitalisation, and deaths in fully vaccinated and unvaccinated
groups was calculated using vaccine coverage data for each age group extracted at the mid-
point of the reporting period from the National Immunisation Management Service.
Results
The rate of a positive COVID-19 test varies by age and vaccination status. This is likely to be
due to a variety of reasons, including differences in the population of vaccinated and
unvaccinated people as well as differences in testing patterns.
The rate of hospitalisation within 28 days of a positive COVID-19 test increases with age, and is
substantially greater in unvaccinated individuals compared to vaccinated individuals.
The rate of death within 28 days or within 60 days of a positive COVID-19 test increases with
age, and again is substantially greater in unvaccinated individuals compared to fully vaccinated
individuals.
Interpretation of data
This data should be considered in the context of the vaccination status of the population groups
shown in the rest of this report. In the context of very high vaccine coverage in the population,
even with a highly effective vaccine, it is expected that a large proportion of cases,
hospitalisations and deaths would occur in vaccinated individuals, simply because a larger
proportion of the population are vaccinated than unvaccinated and no vaccine is 100% effective.
This is especially true because vaccination has been prioritised in individuals who are more
susceptible or more at risk of severe disease. Individuals in risk groups may also be more at risk
of hospitalisation or death due to non-COVID-19 causes, and thus may be hospitalised or die
with COVID-19 rather than from COVID-19.
The vaccination status of cases, inpatients and deaths should not be used to assess vaccine
effectiveness because of differences in risk, behaviour and testing in the vaccinated and
unvaccinated populations. The case rates in the vaccinated and unvaccinated populations are
crude rates that do not take into account underlying statistical biases in the data. There are
likely to be systematic differences between vaccinated and unvaccinated populations, for
example:
40
• testing behaviour is likely to be different between people with different vaccination

status, resulting in differences in the chances of being identified as a case
• many of those who were at the head of the queue for vaccination are those at higher
risk from COVID-19 due to their age, their occupation, their family circumstances or
because of underlying health issues
• people who are fully vaccinated and people who are unvaccinated may behave
differently, particularly with regard to social interactions and therefore may have
differing levels of exposure to COVID-19
• people who have never been vaccinated are more likely to have caught COVID-19 in
the weeks or months before the period of the cases covered in the report. This gives
them some natural immunity to the virus which may have contributed to a lower case
rate in the past few weeks
These biases become more evident as more people are vaccinated and the differences
between the vaccinated and unvaccinated population become systematically different in ways
that are not accounted for without undertaken formal analysis of vaccine effectiveness. Vaccine
effectiveness has been formally estimated from a number of different sources and is described
on pages 4 to 15 in this report.
Denominator
The potential sources of denominator data are either the National Immunisation Management
Service (NIMS) or the Office for National Statistics (ONS) mid-year population estimates. Each
source has its strengths and limitations which have been described in detail on the NHS website
and GOV.Wales.
NIMS may over-estimate denominators in some age groups, for example because people are
registered with the NHS but may have moved abroad. However, as it is a dynamic register,
such patients, once identified by the NHS, are able to be removed from the denominator. On the
other hand, ONS data uses population estimates based on the 2011 census and other sources
of data. When using ONS, vaccine coverage exceeds 100% of the population in some age
groups, which would in turn lead to a negative denominator when calculating the size of the
unvaccinated population.
UKHSA uses NIMS throughout its COVID-19 surveillance reports including in the calculation
rates of COVID-19 infection, hospitalisation and deaths by vaccination status because it is a
dynamic database of named individuals, where the numerator and the denominator come from
the same source and there is a record of each individual’s vaccination status. Additionally,
NIMS contains key sociodemographic variables for those who are targeted and then receive the
vaccine, providing a rich and consistently coded data source for evaluation of the vaccine
programme. Large scale efforts to contact people in the register will result in the identification of
people who may be overcounted, thus affording opportunities to improve accuracy in a dynamic
fashion that feeds immediately into vaccine uptake statistics and informs local vaccination
efforts.
41
Sources of further information

UKHSA has published a blog post to accompany this section of the report.
The Office of the Statistics Regulator has published a blog post.
UKHSA has published a significant amount of research into vaccine effectiveness which is
summarised on pages 4 to 15 of this report.
The Office for National Statistics has published research into the risk of testing positive for
COVID-19 by vaccination status, impact of Delta on viral burden and vaccine effectiveness (4),
and the risk of death by vaccination status.
42
Table 10. COVID-19 cases by vaccination status between week 1 2022 and week 4 2022
Please note that corresponding rates by vaccination status can be found in Table 13.
Cases
reported by Received one Received one Second dose Third dose ≥14
specimen date dose (1 to 20 dose, ≥21 days ≥14 days days before
between week Total Unlinked* Not vaccinated specimen
days before before before
1 2022 (w/e date1
specimen date) specimen date specimen date1
09/01/2022)
and week 4
2022 (w/e [This data should be interpreted with caution. See information below in footnote about the correct interpretation of these
30/01/2022) figures]
Under 18 814,347 46,904 612,529 8,151 121,434 24,018 1,311
18 to 29 512,080 46,298 91,944 4,387 30,908 217,861 120,682
30 to 39 523,577 37,348 76,644 2,583 20,293 182,366 204,343
40 to 49 421,265 25,690 37,245 979 9,522 108,733 239,096
50 to 59 302,201 17,986 16,507 392 3,922 50,303 213,091
60 to 69 160,768 10,026 5,915 160 1,395 14,724 128,548
70 to 79 82,218 5,409 2,032 68 589 4,415 69,705
80 or over 55,621 5,809 1,463 28 576 4,911 42,834
* Individuals whose NHS numbers were unavailable to link to the NIMS.

1 In the context of very high vaccine coverage in the population, even with a highly effective vaccine, it is expected that a large proportion of cases, hospitalisations and
deaths would occur in vaccinated individuals, simply because a larger proportion of the population are vaccinated than unvaccinated and no vaccine is 100% effective.
This is especially true because vaccination has been prioritised in individuals who are more susceptible or more at risk of severe disease. Individuals in risk groups may
also be more at risk of hospitalisation or death due to non-COVID-19 causes, and thus may be hospitalised or die with COVID-19 rather than because of COVID-19.
43
Table 11. COVID-19 cases presenting to emergency care (within 28 days of a positive specimen) resulting in an overnight
inpatient admission by vaccination status between week 52 2021 and week 3 2022
Please note that corresponding rates by vaccination status can be found in Table 13. Please be aware that this data was not
updated for the week 5 report.
Cases presenting to Received one Received one Second dose
emergency care (within 28 Third dose
dose (1 to 20 dose, ≥21 ≥14 days
days of a positive test) Not ≥14 days
Total Unlinked* days before days before before before
resulting in overnight vaccinated
specimen specimen specimen specimen
inpatient admission, by date) date date1 date1
specimen date between
week 52 2021 (w/e
02/01/2022) and week 3 [This data should be interpreted with caution. See information below in footnote about the correct
2022 (w/e 23/01/2022) interpretation of these figures]
Under 18 1,835 85 1,597 10 118 21 4

18 to 29 1,445 32 522 10 140 580 161
30 to 39 1,395 11 546 9 105 513 211
40 to 49 1,349 27 389 7 92 482 352
50 to 59 1,696 17 461 10 76 530 602
60 to 69 1,866 21 446 13 66 480 840
70 to 79 2,683 11 411 6 68 576 1,611
80 or over 4,025 6 435 3 96 817 2,668
44
Table 12. COVID-19 deaths (a) within 28 days and (b) within 60 days of positive specimen or with COVID-19 reported on
death certificate, by vaccination status between week 1 2022 and week 4 2022
Please note that corresponding rates by vaccination status can be found in Table 13.
(a)
Death within 28 Received one Received one Second dose Third dose ≥14
days of positive Not dose (1 to 20 dose, ≥21 days ≥14 days days before
COVID-19 test by Total** Unlinked* specimen
vaccinated days before before specimen before
date of death specimen date) date specimen date1 date1
between week 1
2022 (w/e
09/01/2022) and [This data should be interpreted with caution. See information below in footnote about the correct interpretation of
week 4 2022 (w/e these figures]
30/01/2022)
Under 18 12 0 8 0 2 2 0
18 to 29 31 1 16 0 1 9 4
30 to 39 76 0 30 0 6 30 10
40 to 49 125 1 49 0 13 38 24
50 to 59 311 4 106 0 21 115 65
60 to 69 642 12 192 1 21 227 189
70 to 79 1220 4 241 3 51 372 549
80 or over 3,137 16 373 5 89 910 1,744
** number of deaths of people who had had a positive test result for COVID-19 and either died within 60 days of the first positive test or have COVID-19 mentioned on
their death certificate.
45
(b)
Death within 60 Received one Received one Second dose Third dose
days of positive dose (1 to 20 dose, ≥21 ≥14 days ≥14 days
Not before
COVID-19 test by Total** Unlinked* days before days before before
vaccinated specimen
date of death specimen specimen specimen
between week 1 date) date date1 date1
2022 (w/e
09/01/2022) and [This data should be interpreted with caution. See information below in footnote about the correct interpretation of
week 4 2022 (w/e these figures]
30/01/2022)
Under 18 13 0 9 0 2 2 0
18 to 29 45 1 25 0 1 13 5
30 to 39 102 1 43 0 9 36 13
40 to 49 159 2 64 0 14 49 30
50 to 59 407 9 139 0 29 146 84
60 to 69 775 13 234 1 23 276 228
70 to 79 1427 5 268 4 60 453 637
80 or over 3,555 18 395 5 97 1,081 1,959
** number of deaths of people who had had a positive test result for COVID-19 and either died within 60 days of the first positive test or have COVID-19 mentioned on
their death certificate.
46
Table 13. Unadjusted rates of COVID-19 infection, hospitalisation and death in vaccinated and unvaccinated populations.
Please note that the following table should be read in conjunction with pages 39 to 42 of this report, and the footnotes provided on page 47.
Cases presenting to emergency care

(within 28 days of a positive test) resulting Death within 28 days of positive COVID-19 Death within 60 days of positive COVID-19
Cases reported by specimen date between
in overnight inpatient admission, by test by date of death between week 1 2022 test by date of death between week 1 2022
week 1 2022 (w/e 09/01/2022) and week 4 2022
specimen date between week 52 2021 (w/e (w/e 09/01/2022) and week 4 2022 (w/e (w/e 09/01/2022) and week 4 2022 (w/e
(w/e 30/01/2022)
09/01/2022) and week 3 2022 (w/e 30/01/2022) 30/01/2022)
30/01/2022)*
[see information on population bases and unadjusted rates in footnotes 1 and 2 below this table]
Unadjusted rates Unadjusted rates Unadjusted rates

Unadjusted rates Unadjusted rates Unadjusted rates Unadjusted rates Unadjusted rates
among persons among persons among persons
among persons among persons not among persons not among persons not among persons not
vaccinated with at vaccinated with at vaccinated with at
vaccinated with at least vaccinated (per vaccinated (per vaccinated (per vaccinated (per
least 3 doses (per least 3 doses (per least 3 doses (per
3 doses (per 100,000) 100,000)1,2 100,000)2 100,000)2 100,000)2
100,000) 100,000) 100,000)
Under 18 2,299.0 5,985.1 8.4 15.6 0.0 0.1 0.0 0.1

18-29 3,898.4 3,003.3 5.5 16.9 0.1 0.5 0.2 0.8
30-39 5,236.0 2,810.8 5.7 19.9 0.3 1.1 0.3 1.6
40-49 5,019.8 2,278.8 7.6 23.7 0.5 3.0 0.6 3.9
50-59 3,430.4 1,661.7 9.8 46.3 1.0 10.7 1.4 14.0
60-69 2,398.2 1,116.5 15.8 84.0 3.5 36.2 4.3 44.2
70-79 1,536.1 847.9 35.6 171.1 12.1 100.6 14.0 111.8
≥80 1,705.0 1,205.7 106.3 356.9 69.4 307.4 78.0 325.5
* Please note that this data was not updated for the week 5 report
1 Comparing case rates among vaccinated and unvaccinated populations should not be used to estimate vaccine effectiveness against COVID-19 infection. Vaccine effectiveness has been formally
estimated from a number of different sources and is summarised on pages 4 to 15 in this report.
The rates are calculated per 100,000 in people who have received either 3 doses of a COVID-19 vaccine or in people who have not received a COVID-19 vaccine. These figures are updated each week as
the number of unvaccinated individuals and individuals vaccinated with 3 doses in the population changes.
The case rates in the vaccinated and unvaccinated populations are unadjusted crude rates that do not take into account underlying statistical biases in the data and there are likely to be systematic
differences between these 2 population groups. For example:
• testing behaviour is likely to be different between people with different vaccination status, resulting in differences in the chances of being identified as a case
• many of those who were at the head of the queue for vaccination are those at higher risk from COVID-19 due to their age, their occupation, their family circumstances or because of underlying health
issues
• people who are fully vaccinated and people who are unvaccinated may behave differently, particularly with regard to social interactions and therefore may have differing levels of exposure to COVID-19
• people who have never been vaccinated are more likely to have caught COVID-19 in the weeks or months before the period of the cases covered in the report. This gives them some natural immunity to
the virus which may have contributed to a lower case rate in the past few weeks
2
Case rates are calculated using NIMS – a database of named individuals from which the numerator and the denominator come from the same source and there is a record of each individuals vaccination
status. Further information on the use of NIMS as the source of denominator data is presented on page 41 of this report.
Unadjusted case rates among persons vaccinated have been formatted in grey to further emphasise the caution to be employed when interpreting this data.
47
Vaccine impact on proportion of population with

antibodies to COVID-19
Seroprevalence
The results from testing samples provided by healthy adult blood donors aged 17 years and
older, supplied by the NHS Blood and Transplant (NHS BT collection) between weeks 35 2020
and week 52 2021 are summarised. As of week 44 2020, approximately 250 samples from each
geographic NHS region are tested each week.
The COVID-19 vaccination campaign began on the 8 December 2020 (week 50) with a phased
roll out by age and risk group. From the beginning of September 2021, a third dose was offered
to individuals with severe immunosuppression. A booster dose was introduced from 16
September 2021 for individuals aged 50 years and over, frontline health and social care staff,
individuals aged 16 to 49 with certain underlying health conditions and household contacts of
immunosuppressed individuals. Eligibility for booster doses was extended to individuals aged
40 years and over from 22 November and from December to those aged 18 to 39 in a phased
rollout by age group. Booster doses are generally given at least 6 months after the second
dose, although the minimum interval was reduced to at least 3 months from the second or third
dose in an effort to accelerate the roll out with the emergence of the Omicron variant.
Please note that this section will be updated monthly. Last update was published on 13 January
2022.
Seroprevalence in blood donors aged 17 years and older

The results presented here are based on testing samples with Roche nucleoprotein (N) and
Roche spike (S) antibody assays.
Nucleoprotein (Roche N) assays only detect post-infection antibodies, whereas spike (Roche S)
assays will detect both post-infection antibodies and vaccine-induced antibodies. Thus, changes
in seropositivity for the Roche N assay reflect the effect of natural infection. Increases in
seropositivity as measured by S antibody reflect both infection and vaccination. Antibody
responses to both targets reflect infection or vaccination occurring at least 2 to 3 weeks
previously given the time taken to generate a COVID-19 antibody response. Currently donors
are asked to defer donations for at least 7 full days post vaccination, and for at least 28 days
post recovery if side-effects following vaccination or COVID-19 infection.
This report presents Roche N and Roche S seropositivity estimates on the same set of
samples, using a 12-week rolling prevalence for national, age group and regional estimates.
Seropositivity estimates are plotted using the mid-point of a 12-weekly rolling period that
reduces to 8 weeks in the most recent weeks to allow for a more representative current
estimate of seropositivity. However, this also means the data will reflect seroprevalence several
48
weeks previously, and are unlikely to reflect the recent increase in infection due to the Omicron
variant. Seroprevalence estimates reported are based on seropositivity which are unadjusted for
the sensitivity and specificity of the assays used.
National prevalence
Overall population weighted (by age group, sex and NHS region) antibody prevalence among
blood donors aged 17 years and older in England was 24.1% (95% CI 23.3% - 24.9%) using the
Roche N assay and 98.7% (95% CI 98.4% - 98.9%) using the Roche S assay for the period 8
November to 31 December (weeks 45 to 52 2021). 2,855 out of 12,163 were Roche N positive
and 11,848 out of 12,010 samples were Roche S positive. This compares with 20.5% (95% CI
19.9% - 21.1%) Roche N seropositivity and 98.1% (95% CI 97.9% - 98.3%) Roche S
seropositivity for the period of 16 August to 7 November 2021 (weeks 33 to 44 2021).
Seropositivity (weighted by region, age group and sex) varies over time. Figure 11 shows the
overall 12-weekly rolling proportion seropositive over time for the Roche N and Roche S assays.
Seropositivity estimates are plotted weekly using the mid-point of a rolling 12-weekly period.
Figure 11. Overall 12-weekly rolling SARS-CoV-2 antibody seroprevalence (%

seropositive) in blood donors
100
90
80
70
% seropositive
60
50
40
30
20
10
0
35 39 43 47 51 2 6 10 14 18 22 26 30 34 38 42 46 50
week number (12-week period mid point)
Roche S (infection / vaccination) Roche N (infection) vaccination introduced
49
Regional prevalence of infection over time

Seropositivity (weighted by age group and sex) using the Roche N assay which detects
infection only, varies by region (Figure 12).
Figure 12. 12-weekly rolling SARS-CoV-2 antibody seroprevalence (% seropositive) in

blood donors by region, using Roche N test; error bars show 95% confidence intervals.
35
30
25
% seropositive
20
15
10
0
48 50 52 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
London Midlands North West
North East & Yorks South West South East
East of Eng
Table 14. Roche N seropositivity (95%CI) estimates by NHS region
NHS region Weeks 33 to 44 Weeks 45 to 52

East of England 15.9% (14.6% - 17.3%) 17.5% (15.8% - 19.5%)
London 28.6% (27.0% - 30.2%) 29.2% (26.9% - 31.5%)
Midlands 19.2% (17.6% - 20.8%) 26.5% (24.3% - 28.8%)
North East and Yorkshire 21.0% (19.5% - 22.7%) 27.7% (25.6% - 29.9%)
North West 26.6% (24.9% - 28.4%) 28.5% (26.4% -30.8%)
South East 16.1% (14.8% - 17.6%) 17.8% (16.0% - 19.7%)
South West 14.0% (12.7% - 15.4%) 17.6% (15.9% - 19.4%)
Increases in Roche N seropositivity have recently been observed across all regions (Table 14)
compared to the previous 12-week period with the most notable increases in the Midlands and
North East and Yorkshire regions.
50
London has consistently seen the highest Roche N seropositivity although levels have remained
relatively stable in recent weeks. Seropositivity in the North West has continued to increase
and is approaching similar levels to London. Whilst seropositivity has consistently been lowest
in the South West, recent increases have resulted in the region reaching similar levels to those
observed in the East of England and the South East. With the emergence of the Omicron
variant considerable increases in COVID-19 case rates in England have been observed across
all regions with the highest case rates are in the North West and North East (Weekly national
Influenza and COVID-19 surveillance report week 1). However the impact of the Omicron wave
is not currently evident in the most recent seroprevalence data, given that it takes approximately
2 to 3 weeks to developing an antibody response following infection and the 28 day deferral for
individuals to donate following infection.
Prevalence by age group

Seropositivity estimates by age group using the Roche N assay are presented below.
Figure 13. Population weighted 12-weekly rolling SARS-CoV-2 antibody seroprevalence

(% seropositive) in blood donors from the Roche N assay by age group
40
35
30
25
% seropositive
20
15
10
0
48 50 52 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
17-29 30-39 40-49 50-59 60-69 70-84
Based on testing samples using the Roche N assay (Figure 13) as a marker of infection, the
highest seropositivity continues to be observed in those aged 17 to 29 and the lowest in those
aged 70 to 84.
51
Table 15. Roche N seropositivity (95%CI) estimates by age group
Age group Weeks 33 to 44 Weeks 45 to 52
17-29 30.0% (28.2% - 31.9%) 33.6% (31.3% - 36.1%)

30-39 23.3% (22.0% - 24.7%) 25.7% (23.9% - 27.6%)
40-49 21.3% (20.1% - 22.6%) 29.8% (27.9% - 31.7%)
50-59 19.6% (18.6% - 20.7%) 22.9% (21.4% - 24.4%)
60-69 14.5% (13.4% - 15.7%) 17.2% (15.7% - 19.0%)
70-84 8.8% (7.4% - 10.4%) 9.2% (7.3% - 11.4%)
Increases in Roche N seropositivity have recently been observed across all age groups (Table
15) compared to the previous 12-week period. In the most recent period, the largest increase in
seropositivity was observed in those aged 40 to 49, this age group has the second highest
seropositivity after the 17 to 29 year olds. In England, COVID-19 case rates for weeks 48 to 52
increased across all age groups with the highest rates in individuals aged 20 to 29 followed by
30 to 39 years olds (Weekly national Influenza and COVID-19 surveillance report week 1).
Roche S seropositivity in blood donors has plateaued and is now over 96% across all age
groups.
Seropositivity estimates for S antibody in blood donors are likely to be higher than would be
expected in the general population and this probably reflects the fact that donors are more likely
to be vaccinated. Seropositivity estimates for N antibody will underestimate the proportion of
the population previously infected due to (i) blood donors are potentially less likely to be
exposed to natural infection than age matched individuals in the general population (ii) waning
of the N antibody response over time and (iii) recent observations from UKHSA surveillance
data that N antibody levels are lower in individuals who acquire infection following 2 doses of
vaccination. These lower N antibody responses in individuals with breakthrough infections
(post-vaccination) compared to primary infection likely reflect the shorter and milder infections in
these patients. Patients with breakthrough infections do have significant increases in S antibody
levels consistent with boosting of their antibody levels.
Vaccination has made an important contribution to the overall Roche S increases observed
since the roll out of the vaccination programme, initially amongst individuals aged 50 years and
above who were prioritised for vaccination as part of the phase 1 programme and subsequently
in younger adults as part of phase 2 of the vaccination programme. The impact of the booster
vaccination programme can be assessed by monitoring Roche S antibody levels across the
population over time.
52
Roche S levels by age group and month

The Roche S assay that the UKHSA uses for serological surveillance is fully quantitative,
meaning that it measures the level of antibodies in a blood sample; an antibody level above 0.8
AU/ml (approximately 1 IU/ml using the WHO standard) is deemed positive. The UKHSA
surveillance over the past few months has found that over 97% of the population of blood
donors test positive for S-antibodies, which may have resulted from either COVID-19 infection
or vaccination. With such high seropositivity, it is important to look at population antibody levels
in order to assess the impact of the vaccination booster programme. In the previous report,
groupings of antibody level ranges were updated to better illustrate changes over time.
Figure 14 shows monthly categorised Roche S levels in N-antibody negative individuals by age
group. Almost all tested S-antibody negative during December. In the 3 oldest age groups, the
impact of first vaccine dose, then second vaccine dose, can be seen from January through
June, as the profile of population antibody levels increases. Then from June through September
the profile of antibody levels in these cohorts gradually decreases, consistent with waning.
During October there was a small increase in percentage of donors with very high antibody
levels of 10,000+ AU/ml for the 50 to 84 age group, following the initiation of the booster
programme. In November the proportion of donors with very high antibody levels of 10,000+
AU/ml increased further particularly in those aged 70 to 84 years. In December large increases
were observed in the proportion of donors aged 50 to 69 with very high antibody levels of
10,000+ AU/ml. Increases were also observed in younger age groups as the booster
programme was accelerated due to the emergence of the Omicron variant. The higher profile of
antibody levels in the youngest age group, is likely a result of a combination of factors including
stronger immune responses in younger individuals and the higher antibody levels produced
after mRNA vaccination.
Figure 15 shows categorised Roche S levels in N-antibody positive individuals, those likely to
have experienced past infection. Pre-vaccination antibody levels will be influenced by time since
infection, variant and severity of infection, as well as individual factors such as underlying health
conditions and age. At the start of the vaccination rollout in December 2020 antibody levels
typically sat within the range of 0.8 to 2,500 AU/ml, after vaccination antibody levels typically
exceed 2,500 AU/ml. In November more than half of donors aged 70 to 84 years had very high
antibody levels of 25,000+ AU/ml. In December increases in the proportion of donors with very
high antibody levels of 25,000+ AU/ml were observed across all age groups with the largest
increases in the 50 to 69 age groups. Comparing Figure 14 with Figure 15, the overall higher
profile of antibody levels in those who have experienced past infection is evident; both
vaccination post infection and breakthrough infection following vaccination are expected to
boost existing antibody levels.
Researchers across the globe are working to better understand what antibody levels mean in
terms of protection against COVID-19. Current thinking is that there is no threshold antibody
level that offers complete protection against infection, but instead that higher antibody levels are
likely to be associated with lower probability of infection.
53
Figure 14. Categorised Roche S antibody levels by age group and month in N negative
samples, December 2020 to December 2021
Figure 15. Categorised Roche S antibody levels by age group and month in N positive
samples, December 2020 to December 2021
54
Summary of impact on hospitalisations, infections

and mortality
UKHSA previously reported on the number of hospitalisations directly averted by vaccination. In
total, around 261,500 hospitalisations have been prevented in those aged 45 years and over up
to 19 September 2021.
UKHSA and University of Cambridge MRC Biostatistics Unit previously reported on the direct
and indirect impact of the vaccination programme on infections and mortality. Estimates suggest
that 127,500 deaths and 24,144,000 infections have been prevented as a result of the COVID-
19 vaccination programme, up to 24 September.
Neither of these models will be updated going forward. This is due to these models being
unable to account for the interventions that would have been implemented in the absence of
vaccination. Consequently, over time the state of the actual pandemic and the no-vaccination
pandemic scenario have become increasingly less comparable. For further context surrounding
this figure and for previous estimates, please see previous vaccine surveillance reports.
55
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About the UK Health Security Agency
UKHSA is responsible for protecting every member of every community from the impact of
infectious diseases, chemical, biological, radiological and nuclear incidents and other health
threats. We provide intellectual, scientific and operational leadership at national and local level,
as well as on the global stage, to make the nation heath secure.
UKHSA is an executive agency, sponsored by the Department of Health and Social Care.
© Crown copyright 2022
Published: 3 February 2022

Publishing reference: GOV-11284
You may re-use this information (excluding logos) free of charge in any format or medium,
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COVID-19 vaccine surveillance report

Effectiveness against symptomatic disease

Effectiveness against hospitalisation

Effectiveness against mortality

Effectiveness against infection

Effectiveness against transmission

A summary of vaccine effectiveness evidence can be seen in Table 2.

Table 2. Summary of evidence on vaccine effectiveness against different outcomes (a)

High Evidence from multiple studies which is consistent

Effectiveness against Omicron variant BA.2

Table 3. Vaccine effectiveness against symptomatic disease (all vaccine brands

Vaccine effectiveness publications

Table 4. UKHSA publications on the effectiveness of COVID-19 vaccination

Effectiveness of 3 doses of COVID-19 vaccines Updated analysis on the effectiveness of 3

Estimating the impact of a vaccination programme is challenging as there is no completely

Figure 3. Cumulative weekly vaccine uptake by age

Vaccination in immunosuppressed individuals

Table 5. Vaccine uptake in people identified as immunosuppressed in England

Immuno- People Numbers Percentage Numbers Percentage Numbers Percentage

Table 6. Overall vaccine coverage in women giving birth, by month of delivery1

3. Where no valid GESTAT_1 was available and there were no codes

4. In the absence of any additional information in the woman’s record (or in

Dose administered pre- Dose administered before the earliest

Dose administered in Dose administered after the latest pregnancy

Dose administered post- Dose administered on or after the delivery

Dose in pregnancy: Dose administered around the start or

Unvaccinated No vaccine records exist for the woman,

And the following information about trimester

Dose administered pre- Dose administered before the earliest

Dose administered in Dose administered after the latest pregnancy

Dose administered in Dose administered after the latest pregnancy

Dose administered in Dose administered after the latest pregnancy

Dose administered post- Dose administered on or after the delivery

Dose in trimester Dose administered in the ‘gap’ between

Unvaccinated No vaccine records exist for the woman,

One or more doses in pregnancy No doses in pregnancy Average

0 Age under 25 Age 25 to 29 Age 30 to 34 Age 35 to 39 Age 40 and above

One or more doses in pregnancy No doses in pregnancy Average

Figure 8: Stillbirths experienced by women giving birth January to October 2021

One or more doses in pregnancy No doses in pregnancy Average

One or more doses in pregnancy No doses in pregnancy Average

Figure 10: Women giving birth prematurely January to October 2021

One or more doses in pregnancy No doses in pregnancy Average

Interpretation and limitations

Low birthweight is by convention presented as a percentage of all deliveries with known

Vaccination status in cases, deaths and

• testing behaviour is likely to be different between people with different vaccination

Sources of further information

The Office of the Statistics Regulator has published a blog post.

* Individuals whose NHS numbers were unavailable to link to the NIMS.

Under 18 1,835 85 1,597 10 118 21 4

Cases presenting to emergency care

Unadjusted rates Unadjusted rates Unadjusted rates

Under 18 2,299.0 5,985.1 8.4 15.6 0.0 0.1 0.0 0.1

Vaccine impact on proportion of population with

Seroprevalence in blood donors aged 17 years and older

Figure 11. Overall 12-weekly rolling SARS-CoV-2 antibody seroprevalence (%

Regional prevalence of infection over time

Figure 12. 12-weekly rolling SARS-CoV-2 antibody seroprevalence (% seropositive) in

Table 14. Roche N seropositivity (95%CI) estimates by NHS region

NHS region Weeks 33 to 44 Weeks 45 to 52

Prevalence by age group

Figure 13. Population weighted 12-weekly rolling SARS-CoV-2 antibody seroprevalence