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  • First and second doses of Covishield vaccine provided high level of protection against SARS-CoV-2 infection in highly transmissible settings: results from a prospective cohort of participants residing in congregate facilities in India

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First and second doses of Covishield vaccine provided high level of protection against SARS-CoV-2 infection in highly transmissible settings: results from a prospective cohort of participants residing in congregate facilities in India
  1. Tenzin Tsundue1,
  2. Tenzin Namdon1,
  3. Tenzin Tsewang1,
  4. Sonam Topgyal1,
  5. Tashi Dolma2,
  6. Dekyi Lhadon1,
  7. Tsering Choetso1,
  8. Tenzin Woesal1,
  9. Tenzin Yangkyi1,
  10. Amita Gupta3,4,
  11. David Peters3,4,
  12. Zorba Paster5,
  13. Dawa Phunkyi1,
  14. Tsetan Dorji Sadutshang1,
  15. Richard E Chaisson6,7,
  16. Kunchok Dorjee4,8
  1. 1Public Health and Tuberculosis Division, Tibetan Delek Hospital, Dharamsala, Himachal Pradesh, India
  2. 2Department of Pathology, Dr. Rajendra Prasad Govt. Medical College, Tanda, Himachal Pradesh, India
  3. 3Johns Hopkins Gupta-Klinsky India Institute, Johns Hopkins University, Baltimore, Maryland, USA
  4. 4Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  5. 5Department of Family Medicine, University of Wisconsin, Oregon, Wisconsin, USA
  6. 6Department of Medicine Infectious Diseases, Johns Hopkins University Center for Tuberculosis Research, Baltimore, Maryland, USA
  7. 7Department of International Health and Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  8. 8Department of Medicine Infectious Diseases, Johns Hopkins University, Center for TB Research and Johns Hopkins India Institute, Baltimore, Maryland, USA
  1. Correspondence to Dr Kunchok Dorjee; kdorjee1{at}jhmi.edu

Abstract

Objectives This study aimed to determine the effectiveness of Covishield vaccine among residents of congregate residential facilities.

Design A prospective cohort study in congregate residential facilities.

Setting Dharamshala, Himachal Pradesh, India, from December 2020 to July 2021.

Participants Residents of all ages in seven facilities—three monasteries, two old age homes and two learning centres—were enrolled.

Exposures First and second doses of Covishield vaccine against SARS-CoV-2 infection.

Main outcomes measures Primary outcome was development of COVID-19. Secondary outcome was unfavourable outcomes, defined as a composite of shortness of breath, hospitalisation or death. Vaccine effectiveness (%) was calculated as (1−HR)×100.

Results There were 1114 residents (median age 31 years) participating in the study, 82% males. Twenty-eight per cent (n=308/1114) were unvaccinated, 50% (n=554/1114) had received one dose and 23% (n=252/1114) had received two doses of Covishield. The point prevalence of COVID-19 for the facilities ranged from 11% to 57%. Incidence rates (95% CI) of COVID-19 were 76 (63 to 90)/1000 person-months in the unvaccinated, 25 (18 to 35)/1000 person-months in recipients of one dose and 9 (4 to 19)/1000 person-months in recipients of two doses. The effectiveness of first and second doses of Covishield were 71% (adjusted HR (aHR) 0.29; 95% CI 0.18 to 0.46; p<0.001) and 80% (aHR 0.20; 95% CI 0.09 to 0.44; p<0.001), respectively, against SARS-CoV-2 infection and 86% (aHR 0.24; 95% CI 0.07 to 0.82; p=0.023) and 99% (aHR 0.01; 95% CI 0.002 to 0.10; p<0.001), respectively, against unfavourable outcome. The effectiveness was higher after 14 days of receiving the first and second doses, 93% and 98%, respectively. Risk of infection was higher in persons with chronic hepatitis B (aHR 1.78; p=0.034) and previous history of tuberculosis (aHR 1.62; p=0.047).

Conclusion Covishield was effective in preventing SARS-CoV-2 infection and reducing disease severity in highly transmissible settings during the second wave of the pandemic driven by the Delta variant.

  • Epidemiology
  • Public Health
  • COVID-19

Data availability statement

Data are available upon reasonable request. As the data are generated from communities of Tibetan refugees in India, they are sensitive. We will make the data available on reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2021-008271

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    Data availability statement

    Data are available upon reasonable request. As the data are generated from communities of Tibetan refugees in India, they are sensitive. We will make the data available on reasonable request.

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors KD: Conceptualisation, study design, funding acquisition, investigation, data curation, formal analysis, methodology, project administration, resources, supervision, writing—original draft, writing—review and editing, and guarantor of overall content. T Tsundue: Investigation, study design, methodology, supervision, project administration, data analysis, writing—original draft, writing—review and editing. TN: Investigation, methodology, writing—review and editing. Tenzin Tsewang: Investigation, writing—review and editing. ST: Investigation, supervision, writing—review and editing. TD: Investigation, writing—review and editing. DL: Investigation, resources, supervision, writing—review and editing. TC: Investigation, resources, supervision, writing—review and editing. TW: Investigation, writing—review and editing. TY: Data curation, investigation, supervision, writing—review and editing. TK: Investigation, writing—review and editing. AG: Investigation, resources, validation, writing—review and editing. DP: Investigation, resources, validation, writing—review and editing. ZP: Funding acquisition, investigation, resources, supervision, writing—review and editing. DP: Funding acquisition, investigation, project administration, resources, supervision. TDS: Investigation, methodology, resources, supervision, writing—review and editing. REC: Funding acquisition, investigation, project administration, resources, supervision, validation, writing—review and editing.

    • Funding This work is being supported by individual philanthropist including The Chao Family, Ms Ann Down, the Johns Hopkins University Alliance for a Healthier World (80045453); US NIH/NIAID (K01AI148583); UN-STOP TB PARTNERSHIP TB REACH Wave 7 (STBP/TBREACH/GSA/W7-7692); The Pittsfield Anti-Tuberculosis Association and Friends of the Delek Hospital.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Author note The reflexivity statement for this paper is linked as an online supplemental file 1.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.