Breakthrough COVID-19 Infections After mRNA Vaccination in Solid Organ Transplant Recipients in Miami, Florida

Anjan, Shweta; Natori, Yoichiro; Betances, Anmary A Fernandez; Agritelley, Matthew S; Mattiazzi, Adela; Arosemena, Leopoldo; Andrews, David; Simkins, Jacques; Guerra, Giselle; Abbo, Lilian M.

doi:10.1097/tp.0000000000003902

Cited by 35 publications

(40 citation statements)

References 5 publications

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“…Our findings are consistent with studies that implicate other immunocompromising conditions (e.g., solid-organ transplant, use of immune suppressing medications, active cancer diagnosis) have increased risk of breakthrough. 10 – 12 Regardless of CD4 count, the cumulative incidence of breakthroughs was higher among PWH versus PWoH, which is suggestive of residual immune function abnormalities despite CD4 count recovery.…”

Section: Discussionmentioning

confidence: 96%

“…Studies have indicated that solid-organ transplant recipients are at increased risk of breakthrough infections relative to individuals who are not immunocompromised. [10][11][12] People with HIV (PWH) are an immunocompromised population who may benefit from additional vaccination doses to minimize their risk of acquiring SARS-CoV-2 infection, though this has not been comprehensively investigated. Clinical trial data for vaccines available in the US were insufficiently powered to stratify outcomes by HIV status.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 infections post-vaccination by HIV status in the United States

Coburn

Humes

Lang

et al. 2021

Preprint

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Importance: Recommendations for additional doses of COVID vaccine are restricted to people with HIV who have advanced disease or unsuppressed HIV viral load. Understanding SARS-CoV-2 infection risk post-vaccination among PWH is essential for informing vaccination guidelines. Objective: Estimate the risk of breakthrough infections among fully vaccinated people with (PWH) and without (PWoH) HIV in the US. Design, setting, and participants: The Corona-Infectious-Virus Epidemiology Team (CIVET)-II cohort collaboration consists of 4 longitudinal cohorts from integrated health systems and academic health centers. Each cohort identified individuals ≥18 years old, in-care, and fully vaccinated for COVID-19 through 30 June 2021. PWH were matched to PWoH on date fully vaccinated, age group, race/ethnicity, and sex at birth. Incidence rates per 1,000 person-years and cumulative incidence of breakthrough infections with 95% confidence intervals ([,]) were estimated by HIV status. Cox proportional hazards models estimated adjusted hazard ratios (aHR) of breakthrough infections by HIV status adjusting for demographic factors, prior COVID-19 illness, vaccine type (BNT162b2, [Pfizer], mRNA-1273 [Moderna], Jansen Ad26.COV2.S [J&J]), calendar time, and cohort. Risk factors for breakthroughs among PWH, were also investigated. Exposure: HIV infection Outcome: COVID-19 breakthrough infections, defined as laboratory evidence of SARS-CoV-2 infection or COVID-19 diagnosis after an individual was fully vaccinated. Results: Among 109,599 individuals (31,840 PWH and 77,759 PWoH), the rate of breakthrough infections was higher in PWH versus PWoH: 44 [41, 48] vs. 31 [29, 33] per 1,000 person-years. Cumulative incidence at 210 days after date fully vaccinated was low, albeit higher in PWH versus PWoH overall (2.8% versus 2.1%, log-rank p<0.001, risk difference=0.7% [0.4%, 1.0%]) and within each vaccine type. Breakthrough infection risk was 41% higher in PWH versus PWoH (aHR=1.41 [1.28, 1.56]). Among PWH, younger age (18-24 versus 45-54), history of COVID-19 prior to fully vaccinated date, and J&J vaccination (versus Pfizer) were associated with increased risk of breakthroughs. There was no association of breakthrough with HIV viral load suppression or CD4 count. Conclusions and Relevance: COVID-19 vaccination is effective against infection with SARS-CoV-2 strains circulating through 30 Sept 2021. PWH have an increased risk of breakthrough infections compared to PWoH. Recommendations for additional vaccine doses should be expanded to all PWH.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

COVID-19 infections post-vaccination by HIV status in the United States

Coburn

Humes

Lang

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Early reports on effects of COVID-19 booster vaccination against symptomatic and severe COVID-19 suggested dramatic drops in the risk of infection after administration of a 3 rd vaccine dose (1). Out of concern of waning immunity and non-protective levels of antibodies, health authorities in many countries now recommend booster vaccination to specific risk groups based on comorbidities and/or age (2,3), or in some countries to the entire adult population (4,5). The emergence of the SARS-CoV-2 variant Omicron has widely stressed the national vaccine booster initiatives (6,7).…”

Section: Introductionmentioning

confidence: 99%

Characteristics associated with serological COVID-19 vaccine response and durability in an older population with significant comorbidity: the Danish Nationwide ENFORCE Study

Søgaard

Reekie

Johansen

et al. 2022

Clinical Microbiology and Infection

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“… Vaccination led to 80% reduction in the incidence of symptomatic COVID-19. Ravanan et al 85 UK transplant registry Unvaccinated n = 6748 Vaccinated n = 39727 28-day mortality rate was 12% in unvaccinated vs 7% in vaccinated individuals Malinis et al 86 Fully vaccinated SOT individuals, n = 459 Breakthrough infection occurred in 3/459 (0.65%) fully vaccinated individuals Anjan et al 87 Vaccinated SOT individuals (n = 2957) Breakthrough infections in 26 patients (0.87%) 5 (19.2%) had severe COVID-19 and 2 (7.6%) patients died. Qin et al 88 Fully Vaccinated SOT individuals (n =18215) Breakthrough infections in 151 patients (0.83%) Of those, 87 (0.48%) were hospitalized Of those, 14 (0.077%) died Mehta et al 89 Fully vaccinated kidney transplant individuals (n =1680) Breakthrough infections in 8 patients and 3 were hospitalized VE- Vaccine effectiveness …”

Section: Preventionmentioning

confidence: 99%