(LONDON) ONS Breakthrough Cases Report: Where infection occurs in people ‘fully vaccinated’ and deaths involving #COVID19 who also had first positive PCR Test at least 14-days after 2nd vaccine dose #AceHealthDesk report

#AceHealthReport – Sept.18: “ Breakthrough cases” are where infection has occurred in someone who is fully vaccinated. We define a “breakthrough death” as a death involving coronavirus (COVID-19) that occurred in someone who had received both vaccine doses, and had a first positive PCR test at least 14 days after the second vaccination dose. In total, there were 256 breakthrough deaths between 2 January and 2 July 2021 (Table 2)….

#CoronavirusNewsDesk says this is an ONS report from Jan.02 – July.02: 2021: On Cases of people who have received two doses of vaccine and showed 256 breakthrough deaths between those dates above ….

5. Characteristics of breakthrough deaths

We used the Public Health Data Asset (PHDA) to investigate the characteristics of breakthrough cases, leveraging information from the General Practice Extraction Service (GPES) data for coronavirus (COVID-19) pandemic planning and research and Hospital Episode Statistics (HES). The linked data includes 252 breakthrough deaths and 43,956 total deaths involving COVID-19, 98.4% and 85.7% respectively of all breakthrough and total deaths involving COVID-19 that occurred between 2 January and 2 July 2021.

Table 3 shows some characteristics of these deaths.

Notes:
  1. Office for National Statistics (ONS) figures based on death registrations up to 28 July 2021 for deaths that occurred between 2 January and 2 July 2021 (Week 1 – Week 26).
  2. Statistics are calculated using the Public Health Data Asset, a linked dataset of people resident in England who could be linked to the 2011 Census and GP Patient Register.
  3. Deaths were defined using the International Classification of Diseases, tenth revision (ICD-10). Deaths involving the coronavirus (COVID-19) are defined as those with an underlying cause, or any mention of, ICD-10 codes U07.1 (COVID-19 virus identified) or U07.2 (COVID-19, virus not identified). Please note, this differs from the definition used in the majority of mortality outputs (see Glossary).
  4. Age is defined on the date of death.
  5. See Glossary for definitions of health-related variables.

The median age for breakthrough deaths was 84 and 61.1% of the deaths occurred in males, despite there being more elderly women than men, and therefore initially more fully vaccinated women who could experience a breakthrough death. For all other deaths involving COVID-19 occurring between 2 January and 2 July 2021 in the PHDA dataset, the median age was 82 and 52.2% were male.

13.1% of the breakthrough deaths occurred in people who were immunocompromised, compared to 5.4% for other deaths involving COVID-19. Individuals were identified as immunocompromised if they had experienced a hospital episode since 1 January 2019 where the diagnosis or procedure code corresponded to an immunocompromised condition, or who had died and a condition corresponding to being immunocompromised was listed on the death certificate (see Measuring the data).

A greater proportion of breakthrough deaths occurred in those who were clinically extremely vulnerable (76.6%, 193 deaths), than other COVID-19 deaths (74.5%, 32,567 deaths) or non-COVID-19 deaths (69.7%, 128,454 deaths). A similar trend is observed for disability and long-term health problem status, with proportions of deaths among people self-reporting that they are “limited a lot” on the 2011 Census as 31.7%, 27.8% and 24.2% for breakthrough deaths, other deaths involving COVID-19 and non-COVID-19 deaths respectively. However, the characteristics of breakthrough deaths can reflect the characteristics of the population that is more likely to be double vaccinated as well as having an increased risk of a breakthrough death, and numbers are relatively low and should therefore be interpreted with caution.Back to table of contents

6. Glossary

Age standardised mortality rates

Age-standardised mortality rates (ASMRs) are used to allow comparisons between populations that may contain different proportions of people of different ages and sex. The 2013 European Standard Population is used to standardise rates. In this bulletin, the ASMRs are calculated for each week. For more information see Section 7: Measuring the data.

Coronaviruses

The World Health Organization (WHO) defines coronaviruses as “a large family of viruses that are known to cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS)”. Between 2001 and 2018, there were 12 deaths in England and Wales due to a coronavirus infection, with a further 13 deaths mentioning the virus as a contributory factor on the death certificate.

Coronavirus (COVID-19)

COVID-19 refers to the “coronavirus disease 2019” and is a disease that can affect the lungs and airways. It is caused by a type of coronavirus. Further information is available from the World Health Organization (WHO).

Statistical significance

The term “significant” refers to statistically significant changes or differences. Significance has been determined using the 95% confidence intervals, where instances of non-overlapping confidence intervals between estimates indicate the difference is unlikely to have arisen from random fluctuation.

95% confidence intervals

A confidence interval is a measure of the uncertainty around a specific estimate. If a confidence interval is 95%, it is expected that the interval will contain the true value on 95 occasions if repeated 100 times. As intervals around estimates widen, the level of uncertainty about where the true value lies increases. The size of the interval around the estimate is strongly related to the number of deaths, prevalence of health states and the size of the underlying population. At a national level, the overall level of error will be small compared with the error associated with a local area or a specific age and sex breakdown. More information is available on our uncertainty pages.

Deaths involving COVID-19

For this analysis we define a death as involving COVID-19 if either of the ICD-10 codes U07.1 (COVID-19, virus identified) or U07.2 (COVID-19, virus not identified) is mentioned on the death certificate. In contrast to the definition used in the weekly deaths release, deaths where the ICD-10 code U09.9 (post-COVID condition, where the acute COVID-19 had ended before the condition immediately causing death occurred) is mentioned on the death certificate and neither of the other two COVID-19 codes are mentioned are not included, as they are likely to be the result of an infection caught a long time previously, and therefore not linked to the vaccination status of the person at date of death. Deaths involving U10.9 (multisystem inflammatory syndrome associated with COVID-19) where U07.1 or U07.2 are mentioned are also excluded. This is a rare complication affecting children, and there are no such deaths in our dataset for the data released in Deaths involving COVID-19 by vaccination status, England: deaths occurring between 2 January and 2 July 2021. 

Limitation by a long-term health problem of disability

Limitation by a long-term health problem or disability is self-reported on the 2011 Census for the question, “Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months?”. Answers are one of, “Yes, limited a lot”, “Yes, limited a little”, or “No”.

Clinical vulnerability

Clinical vulnerability is determined according to the QCOVID risk model for health conditions that result in a higher risk of COVID-19. Health conditions are determined using the General Practice Extraction Service (GPES) and Hospital Episode Statistics (HES) data.

Immunocompromised

A person was identified as immunocompromised if they had a hospital episode recorded in the Hospital Episode Statistics dataset (HES) Admitted Patient Care dataset that started on or after 1 January 2019, with a diagnosis code (ICD-10) or procedure code (OPCD) corresponding to a condition that is associated with either primary or secondary immunosuppression. A person was also flagged as immunocompromised if they died and at least one of these ICD-10 diagnosis codes was mentioned on the death certificate or if they had SNOMED codes recorded in the General Practice Extraction Service dataset corresponding to a prescription of immunosuppressants.

The ICD-10 diagnosis codes included are based on the Immunocompromised State Diagnosis codes from the US Agency for Healthcare Research and Quality. These are ICD-10-CM codes, therefore we used only those codes that were up to 4 digits long to correspond to ICD-10 codes. 

The OPCS-4 procedure codes are based on the OPCS-4 codes listed in the NHS shielding list published by NHS Digital for the following disease groups: transplant, or cancer undergoing active chemo or radiotherapy.

Full lists of the ICD-10 codes and OPCS-4 codes used are given in the reference tables.

Date infected with COVID-19

The first positive test date of the most recent COVID-19 infection recorded in Test and Trace data is used to determine when a person who died from COVID-19 was infected relative to their vaccination data. The absence of a positive test can be either due to a linkage failure (the person was tested but we could not find them in the Test and Trace dataset) or to infection having occurred either not in England or before mass testing was available.

A COVID-19 infection can have multiple positive test results, and a person may be reinfected at a later period. The first positive test result was taken as the start of the first infection, and subsequent infections were determined as starting on the first positive test date that occurred >90 days after the start of the previous infection. The most recent infection is then defined as the start of the last recorded infection.

NOTE: This data is subject to change or fluctuation

#AceHealthDesk report ……..Published: Sept.18: 2021:

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