Coronavirus (COVID-19) advice for people on the Highest Risk List: evidence review

• COVID-related deaths for those on the highest risk list are recorded by Highest Risk List groups therefore specific data on children is not available.

• Children & young people were at very low risk of severe illness and death from COVID-19.

• The mortality rate of children & young people who died from SARS-CoV -2 in England equates to 2 per million between Mar 2020 and Feb 2021.

• Vaccination rates in 12 to 15 year olds at higher risk of COVID-19 in Jul 2021 showed:

Public Health Scotland COVID-19 Statistical Report

JCVI statement on COVID-19 vaccination of children and young people: 22 December 2021 - GOV.UK (www.gov.uk)

COVID-19: Pfizer vaccine provides 90% protection against infection in children aged 5-11, study finds | The BMJ

Efficacy of two doses of COVID-19 vaccine against severe COVID-19 in those with risk conditions and residual risk to the clinically extremely vulnerable: the REACT-SCOT case-control study.

• 110 COVID-related deaths following a positive test in the transplant group between August 2020 and January 2022.
• The number of COVID-related deaths following a positive test was the lowest in the transplant group between August 2020 and January 2022. There has also been a decrease in the number of COVID-related deaths following a positive test in this group from 15 in January 2021 to 7 in January 2022.

• Strong recommendation that, wherever possible, transplant recipients and patients on the transplant waiting list should have two doses of the vaccine for maximum protection against contracting or dying from COVID-19.
• REACT-SCOT study found: In comparison with double-vaccinated individuals of the same age and sex without risk conditions, double-vaccinated solid organ transplant recipients have a rate ratio of the order of 100-fold for severe disease, but even in this group the absolute risk of severe disease in the double-vaccinated is less than 1 in 1000 per month.

• Third dose of vaccine does bring significant amplification of immune response.
• In January 2022 the transplant group had a COVID-related mortality rate 9 times higher than that of the non-highest risk population. This fell from a high of 59 times higher in June 2021.

• Vaccination rates in people who were advised to shield as of Jan 2022 are;

Public Health Scotland COVID-19 Statistical Report

Randomized Trial of a Third Dose of mRNA-1273 Vaccine in Transplant Recipients | NEJM

'Immunological responses to SARS-CoV-2 vaccines in kidney transplant recipients'.

Immunogenicity of a Single Dose of SARS-CoV-2 Messenger RNA Vaccine in Solid Organ Transplant Recipients.

Efficacy of two doses of COVID-19 vaccine against severe COVID-19 in those with risk conditions and residual risk to the clinically extremely vulnerable: the REACT-SCOT case-control study.

COVID-19 statistical report - 2 March 2022 - COVID-19 statistical report - Publications - Public Health Scotland

• 364 COVID-related deaths following a positive test in the cancer group between August 2020 and January 2022.
• Decrease in COVID-related deaths following a positive test in this group, from 63 in January 2021 to 28 in January 2022.

• Two doses of vaccine protect against severe COVID-19 in CEV individuals but the residual risk in double-vaccinated individuals remains far higher in those who are CEV than in those who are not.

• The cancer group had a COVID-related mortality rate 12 times higher than that of the non-highest risk population in January 2022. This group had the highest relative COVID-related mortality rate in January 2022, the same as the rare diseases and clinician identified groups.

• Vaccination rates in people who were advised to shield as of Jan 2022 are;

97% Dose 1
96% Dose 2
91% Booster or Dose 3
*no further breakdown of rates in specific highest risk groups is available.

Efficacy of two doses of COVID-19 vaccine against severe COVID-19 in those with risk conditions and residual risk to the clinically extremely vulnerable: the REACT-SCOT case-control study.

COVID-19 statistical report - 2 March 2022 - COVID-19 statistical report - Publications - Public Health Scotland

• 919 COVID-related deaths following a positive test in the respiratory group between August 2020 and January 2022.
• The number of COVID-19 related deaths following a positive test was the highest for those in the respiratory group between August 2020 and January 2022. Although there has been a decrease in the number of COVID-related deaths following a positive test from 205 in January 2021 to 32 in January 2022.

• Two doses of vaccine protect against severe COVID-19 in CEV individuals but the residual risk in double-vaccinated individuals remains far higher in those who are CEV than in those who are not.

• The respiratory group had a COVID-related mortality rate 9 times higher than that of the non-highest risk population in January 2022. This was similar to those in the transplant group.

• Vaccination rates in people who were advised to shield as of Jan 2022 are;

97% Dose 1
96% Dose 2
91% Booster or Dose 3
*no further breakdown of rates in specific highest risk groups is available.

Public Health Scotland COVID-19 Statistical Report

Efficacy of two doses of COVID-19 vaccine against severe COVID-19 in those with risk conditions and residual risk to the clinically extremely vulnerable: the REACT-SCOT case-control study.

COVID-19 statistical report - 2 March 2022 - COVID-19 statistical report - Publications - Public Health Scotland

• 170 COVID-related deaths following a positive test in the rare diseases group between August 2020 and January 2022.
• There has been a decrease in the number of COVID-related deaths following a positive test in this group from 34 in January 2021 to 8 in January 2022. Among the lower groups within the HRL.

• The number of COVID-related deaths following a positive test was the second lowest in the rare diseases group between August 2020 and January 2022.

• The rare diseases group had generally low relative mortality rates ranging from 0 to 9 times higher than that of the non-highest risk population between April and August 2021, however there was an increase in September 2021 to a relative mortality rate of 20 times higher. This reduced to a mortality rate of 12 times higher than that of the non-highest risk population in January 2022.

• Vaccination rates in people who were advised to shield as of Jan 2022 are;

97% Dose 1
96% Dose 2
91% Booster or Dose 3
*no further breakdown of rates in specific highest risk groups is available.

Public Health Scotland COVID-19 Statistical Report

Efficacy of two doses of COVID-19 vaccine against severe COVID-19 in those with risk conditions and residual risk to the clinically extremely vulnerable: the REACT-SCOT case-control study.

COVID-19 statistical report - 2 March 2022 - COVID-19 statistical report - Publications - Public Health Scotland

• 306 COVID-related deaths following a positive test in the immunosuppression group between August 2020 and January 2022.
• There has been a decrease in the number of COVID-related deaths following a positive test in this group from 44 in January 2021 to 15 in January 2022.

• The OCTAVE trial has published preliminary data today showing that 89% of people who are immunocompromised or immunosuppressed generate antibodies following vaccination, and 60% generated a strong antibody response following 2 doses of a vaccine.
• However, 40% of people in these groups mounted a low, or undetectable, immune response after 2 doses, and the level of antibody response varies between the groups studied.
• The level of antibodies required for protection from COVID-19 is still not known. These findings therefore do not provide a conclusive assessment of the protection vaccines offer people with weakened immune systems.

• For the majority the immune response to the COVID-19 vaccine was equitable to that of someone with a full immune system.
• 40% of people in the patient groups mounted a low response following two doses of the vaccine.
• 11% of immunocompromised patients failed to generate any antibodies four weeks after two doses of the vaccine.

• Vaccination rates in people who are severely Immunosuppressed as of 05 April 2022 were;

Public Health Scotland COVID-19 Statistical Report

Joint Committee on Vaccination and Immunisation (JCVI) advice on third primary dose vaccination - GOV.UK (www.gov.uk) . Examining the immunological effects of COVID-19 vaccination in patients with conditions potentially leading to diminished immune response capacity – the OCTAVE Trial.

COVID-19 statistical report - 2 March 2022 - COVID-19 statistical report - Publications - Public Health Scotland

• Zero COVID-related deaths in the pregnant with heart disease group..

• There were no COVID-related deaths in this group.

• No research available specifically regarding pregnant women with heart disease.
• Recent publication of Coronavirus (COVID-19) Infection in Pregnancy review by Royal College of Midwives and Royal college of Obstetricians & gynaecologists found;

• Vaccination rates in people who were advised to shield as of Jan 2022 are;

Public Health Scotland COVID-19 Statistical Report

Coronavirus (COVID-19), infection in pregnancy | RCOG

s COVID-19 statistical report - 2 March 2022 - COVID-19 statistical report - Publications - Public Health Scotland

• 690 COVID-related deaths following a positive test in the clinician identified group between August 2020 and January 2022.
• There has been a decrease in number of COVID-related deaths following a positive test in this group from 146 in January 2021 to 43 in January 2022. The number of COVID-related deaths following a positive test was the second highest in the clinician identified group between August 2020 and January 2022.

• Two doses of vaccine protect against severe COVID-19 in CEV individuals but the residual risk in double-vaccinated individuals remains far higher in those who are CEV than in those who are not.

• The clinician identified group had a COVID-related mortality rate 12 times higher than that of the non-highest risk population in January 2022. This group had the highest relative COVID-related mortality rate in January 2022, same as the cancer and rare diseases groups.

• Vaccination rates in people who were advised to shield as of Jan 2022 are;

Public Health Scotland COVID-19 Statistical Report

Efficacy of two doses of COVID-19 vaccine against severe COVID-19 in those with risk conditions and residual risk to the clinically extremely vulnerable: the REACT-SCOT case-control study | medRxiv COVID-19 statistical report - 2 March 2022 - COVID-19 statistical report - Publications - Public Health Scotland