Coronavirus Disease 2019 Vaccine-Breakthrough Infections Requiring Hospitalization in Mayo Clinic Florida Through August 2021

Bosch, Wendelyn; Cowart, Jennifer B.; Bhakta, Shivang; Carter, Rickey E.; Wadei, Hani M.; Shah, Sadia; Sanghavi, Devang; Pollock, Benjamin D.; Neville, Matthew R.; Oman, Sven P.; Speicher, Leigh; Scindia, Ameya D; Matson, Mark W; Franco, Pablo Moreno

doi:10.1093/cid/ciab932

Cited by 26 publications

(38 citation statements)

References 9 publications

(11 reference statements)

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“…The clinical and baseline characteristics of our cohort are similar to those of the other two groups of patients hospitalized due to breakthrough COVID-19 (Bosch et al, 2021;Brosh-Nissimov et al, 2021). Compared to unvaccinated COVID-19 admissions, those patients appear to be older, are more likely to be immunosuppressed, and have more comorbidities (Alimohamadi et al, 2021;Andrés et al, 2021;Berenguer et al, 2020).…”

Section: Discussionmentioning

confidence: 62%

Hospitalized patients with breakthrough COVID-19: Clinical features and poor outcome predictors

Moreno-Pérez

Ribes

Boix

et al. 2022

International Journal of Infectious Diseases

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Objectives To describe breakthrough COVID-19 in patients who needed hospitalization and the factors associated with poor outcomes. Methods A retrospective study on complete (diagnosed two weeks after the second dose of the Pfizer/Moderna/AstraZeneca or first dose of the Janssen vaccine was administered) or partial vaccine scheme (CV or PV) patients hospitalized for COVID-19 between December 27, 2020, and October 17, 2021, was conducted. The main outcomes were all-cause mortality and the need for invasive mechanical ventilation (IMV). The baseline factors associated with the outcomes were analyzed by multiple logistic regression, estimating the odds ratios (OR; 95% CI). Results One hundred and forty-five patients (101 CV) were included. The CV subgroup was mainly composed of elderly males with high comorbidity (Charlson index ≥3, 72%; immunosuppression, 20%), with bilateral pneumonia in 63.4%; limited therapeutic effort (LTE) was agreed upon for 28% of the patients. In the CV subgroup, endotracheal intubation was required in 10.9%, reaching 15.3% when excluding LTE patients; the global mortality was 22.8% and 41.4% in the subgroup with LTE. Although the PV patients were younger and had fewer comorbidities, the main outcomes did not differ significantly between the CV and PV groups. The predictors of poor outcomes were age ≥ 65 years, confusion, ferritin > 500 mg/L, extensive lung infiltrates, and a Charlson index ≥ 3. Conclusions Fully vaccinated patients hospitalized due to breakthrough COVID-19 tend to be elderly, with comorbidities, and have high mortality.

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Section: Discussionmentioning

confidence: 62%

Hospitalized patients with breakthrough COVID-19: Clinical features and poor outcome predictors

Moreno-Pérez

Ribes

Boix

et al. 2022

International Journal of Infectious Diseases

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“…First, the study was a non-controlled observational study based on real-life data obtained from pandemic surveillance activities, aimed not to establish vaccine efficacy compared to a matched unvaccinated control group, but to report a virological characterisation of those patients reported with SARS-CoV-2 infection despite being vaccinated. Therefore, our observation should be replicated and extended on larger cohorts established ad hoc, also including other vaccine formulations as differences in incidence rates of breakthrough infections were observed in previous real-life studies (21,26,27). No follow-up samples were available for the post-vaccination infected individuals so that it was not possible to monitor viral loads dynamics and the shedding.…”

Section: Discussionmentioning

confidence: 77%

“…Severe disease was significantly less frequent in patients infected after a full vaccination course as compared to the patients who acquired the infection after a single dose, supporting the importance of the full vaccination schedule in naïve individuals. Those patients with severe symptoms presented pre-existing co-morbidities (i.e., cardiovascular chronic diseases, diabetes, obesity, renal affections, and neurological disorders) and those aged over 80, which represent still relevant risk factors for disease severity and are prognostic for a negative outcome (3,(23)(24)(25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

Virological and Serological Characterisation of SARS-CoV-2 Infections Diagnosed After mRNA BNT162b2 Vaccination Between December 2020 and March 2021

et al. 2022

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BackgroundVaccines for coronavirus disease 2019 (COVID-19) are proving to be very effective in preventing severe illness; however, although rare, post-vaccine infections have been reported. The present study focuses on virological and serological features of 94 infections that occurred in Lazio Region (Central Italy) between 27 December 2020, and 30 March 2021, after one or two doses of mRNA BNT162b2 vaccine.MethodsWe evaluated clinical features, virological (viral load; viral infectiousness; genomic characterisation), and serological (anti-nucleoprotein Ig; anti-Spike RBD IgG; neutralising antibodies, nAb) characteristics of 94 post-vaccine infections at the time of diagnosis. Nasopharyngeal swabs (NPSs) and serum samples were collected in the framework of the surveillance activities on SARS-CoV-2 variants established in Lazio Region (Central Italy) and analysed at the National Institute for Infectious Diseases “L. Spallanzani” in Rome.ResultsThe majority (92.6%) of the post-vaccine infections showed pauci/asymptomatic or mild clinical course, with symptoms and hospitalisation rate significantly less frequent in patients infected after full vaccination course as compared to patients who received a single dose vaccine. Although differences were not statistically significant, viral loads and isolation rates were lower in NPSs from patients infected after receiving two vaccine doses as compared to patients with one dose. Most cases (84%) had nAb in serum at the time of infection diagnosis, which is a sub-group of vaccinees, were found similarly able to neutralise Alpha and Gamma variants. Asymptomatic individuals showed higher nAb titres as compared to symptomatic cases (median titre: 1:120 vs. 1:40, respectively). Finally, the proportion of post-vaccine infections attributed either to Alpha and Gamma variants was similar to the proportion observed in the contemporary unvaccinated population in the Lazio region, and mutational analysis did not reveal enrichment of a defined set of Spike protein substitutions depending on the vaccination status.ConclusionOur study conducted using real-life data, emphasised the importance of monitoring vaccine breakthrough infections, through the characterisation of virological, immunological, and clinical features associated with these events, in order to tune prevention measures in the next phase of the COVID-19 pandemic.

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“…Different studies and a meta-analysis assessing the impact of primary vaccination observed a ≃ 10% reduction in vaccine efficacy against asymptomatic and symptomatic infections with delta VOC, but no reduction of vaccine efficacy against severe forms 2,17 . Some authors have noted that the higher incidence of infections with this VOC may also be due to the fact that when delta became predominant, those infected had received their primary vaccination 4 to 10 months before, meaning that the infection may have been related to the waning of the level of vaccine-induced antibodies 18 .…”

Section: Discussionmentioning

confidence: 99%

Symptoms and severity in vaccinated and unvaccinated patients hospitalised with SARS-CoV-2 delta (B.1.617.2) variant infection

Épaulard

Abgrall

Lefèbvre

et al. 2022

Preprint

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Background: The diffusion of the SARS-CoV-2 delta (B.1.617.2) variant and the waning of immune response after primary Covid-19 vaccination favoured the breakthrough SARS-CoV-2 infections in vaccinated subjects. To assess the impact of vaccination, we determined the severity of infection in hospitalised patients according to vaccine status. Methods: We retrospectively analysed data from patients hospitalised in 10 centres with a SARS-CoV-2 infection (delta variant) from July to November 2021: i) all patients who had completed their primary vaccination at least 14 days before hospital admission; and ii) the same number of completely unvaccinated patients. We assessed the impact of vaccination and other risk factors through logistic regression. Findings: We included 955 patients (474 vaccinated and 481 unvaccinated). Vaccinated patients were significantly older, more frequently males, and with more comorbidities. They were less often admitted for Covid-19 (59.3% vs. 75.1%, p<0.001), showed fewer lung lesions, and required oxygen less frequently (57.5% vs. 73.0%, p<0.001), at a lower flow (3.0 vs. 6.0 L/min, p<0.001), and for a shorter duration (3 vs. 6 days, p<0.001). They less frequently required intensive care unit admission (16.2 % vs. 36.0 %, p<0.001). Mortality at day 28 was not different between the two groups (16.7% vs. 12.2%, p=0.075), but multivariate logistic regression showed that vaccination significantly decreased the risk of negative outcomes, including mortality, even when considering older patients, and those with comorbidities. Conclusions: Among patients hospitalised with a delta variant SARS-CoV-2 infection, vaccination was associated with less severe forms, even in the presence of comorbidities.

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Coronavirus Disease 2019 Vaccine-Breakthrough Infections Requiring Hospitalization in Mayo Clinic Florida Through August 2021

Cited by 26 publications

References 9 publications

Hospitalized patients with breakthrough COVID-19: Clinical features and poor outcome predictors

Hospitalized patients with breakthrough COVID-19: Clinical features and poor outcome predictors

Virological and Serological Characterisation of SARS-CoV-2 Infections Diagnosed After mRNA BNT162b2 Vaccination Between December 2020 and March 2021

Symptoms and severity in vaccinated and unvaccinated patients hospitalised with SARS-CoV-2 delta (B.1.617.2) variant infection

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