the bmj | 21-28 August 2021 227 Cabezas C, Coma E, Mora-Fernandez N, et al Cite this as: BMJ 2021;374:n1868 Find this at: http://dx.doi.org/doi: 10.1136/ bmj.n1868 Study question What is the association of vaccination with Pfizer-BioNTech BNT162b2 with SARS-CoV-2 infection and hospital admission and death with covid-19 among nursing home residents and staff, and healthcare workers? Methods This prospective cohort study used linked electronic medical records, test data, and mortality data from28 456 nursing home residents, 26 170 staff, and 61 791 healthcare workers in Catalonia on 27 December 2020. Vaccination status was introduced as a time varying exposure, with a 14 day run-in after the first dose. Participants were followed until the earliest of an research Weight changes after behavioural weight loss programmes p 230 Cognitive stimulation at work and risk of dementia p 228 Impact of vaccination in nursing homes in Catalonia p 227 ORIGINAL RESEARCH Prospective cohort study Kaplan-Meier estimates of hospital admission and mortality with covid-19 according to vaccination status in nursing home residents Associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission Associations of BNT162b2 vaccination with SARS-CoV-2 infection and hospital admission and death with covid-19 in nursing homes and healthcare workers in Catalonia and death with covid-19 in nursing homes and healthcare workers in Catalonia for staff, and 0.13 (0.11 to 0.16) for healthcare workers. Adjusted hazard ratios for hospital admission and mortality after two dose vaccination were 0.05 (0.04 to 0.07) and 0.03 (0.02 to 0.04) for nursing home residents. Limitations include the observational nature of the analysis and the use of routinely collected health data and related confounding and misclassification. What this study adds Reductions in SARS-CoV-2 infections and covid- 19 related hospital admissions and deaths among nursing home residents associated with two dose vaccination were equivalent to those in randomised controlled trials. Funding, competing interests, and data sharing Partial support from the National Institute for Health Research UK. No competing interests. No patient level data can be shared. outcome (confirmed SARS-CoV-2 infection, hospital admission or death with covid-19) or 26 May 2021. Mixed effects Cox models were fitted to estimate hazard ratios using index month as a fixed effect. Models were adjusted for confounders, including sociodemographics, comorbidity, and previous medicine use. Study answer and limitations Among the nursing home residents, SARS-CoV-2 infection was found in 2482, 411 were admitted to hospital with covid-19, and 450 died with covid-19 during the study period; 1828 nursing home staff and 2968 healthcare workers were found to have SARS-CoV-2 infection. The adjusted hazard ratio for SARS- CoV-2 infection after two doses of vaccine was 0.09 (95% confidence interval 0.08 to 0.11) for nursing home residents, 0.20 (0.17 to 0.24) Time (days) Deaths Survival probability 0 14 28 42 56 70 84 96 112 126 140 154 Unvaccinated Strata 1 dose 2 doses Hospital admissions Survival probability 0.900 0.950 0.975 1.000 0.925 0.900 0.950 0.975 1.000 0.925 P<0.001 P<0.001 Time (days) 0 14 28 42 56 70 84 96 112 126 140 154