Incidence and Risk Factors of COVID-19 Vaccine Breakthrough Infections: A Prospective Cohort Study in Belgium

Stouten, Veerle; Hubin, Pierre; Haarhuis, Freek; Loenhout, Joris Adriaan Frank van; Billuart, Matthieu; Brondeel, Ruben; Braeye, Toon; Oyen, Herman Van; Wyndham-Thomas, Chloé; Catteau, Lucy

doi:10.3390/v14040802

Cited by 36 publications

(41 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, although individuals receiving AZD1222 vaccine (versus BNT162b2 [Pfizer BioNTech]) were more likely to have lower antibody levels after first and second vaccination, these differences were no longer evident after third vaccination. Our finding is also consistent with lower vaccine effectiveness estimates and increased post-vaccination infection incidence after first or second vaccination following AZD1222 versus BNT162b2 [15,42,43], but only minor differences after third vaccination [15,44].…”

Section: Discussionsupporting

confidence: 87%

Antibody levels following vaccination against SARS-CoV-2: associations with post-vaccination infection and risk factors

Cheetham

Kibble

Wong

et al. 2022

Preprint

View full text Add to dashboard Cite

SARS-CoV-2 antibody levels can be used to assess humoral immune responses following SARS-CoV-2 infection or vaccination, and may predict risk of future infection. From cross-sectional antibody testing of 9,361 individuals from TwinsUK and ALSPAC UK population-based longitudinal studies (jointly in April-May 2021, and TwinsUK only in November 2021-January 2022), we tested associations between antibody levels following vaccination and: (1) SARS-CoV-2 infection following vaccination(s); (2) health, socio-demographic, SARS-CoV-2 infection and SARS-CoV-2 vaccination variables.Within TwinsUK, single-vaccinated individuals with the lowest 20% of anti-Spike antibody levels at initial testing had 3-fold greater odds of SARS-CoV-2 infection over the next six to nine months, compared to the top 20%. In TwinsUK and ALSPAC, individuals identified as at increased risk of COVID-19 complication through the UK “Shielded Patient List” had consistently greater odds (2 to 4-fold) of having antibody levels in the lowest 10%. Third vaccination increased absolute antibody levels for almost all individuals, and reduced relative disparities compared with earlier vaccinations.These findings quantify the association between antibody level and risk of subsequent infection, and support a policy of triple vaccination for the generation of protective antibodies.Lay summaryIn this study, we analysed blood samples from 9,361 participants from two studies in the UK: an adult twin registry, TwinsUK (4,739 individuals); and the Avon Longitudinal Study of Parents and Children, ALSPAC (4,622 individuals). We did this work as part of the UK Government National Core Studies initiative researching COVID-19. We measured blood antibodies which are specific to SARS-CoV-2 (which causes COVID-19). Having a third COVID-19 vaccination boosted antibody levels. More than 90% of people from TwinsUK had levels after third vaccination that were greater than the average level after second vaccination. Importantly, this was the case even in individuals on the UK “Shielded Patient List”. We found that people with lower antibody levels after first vaccination were more likely to report having COVID-19 later on, compared to people with higher antibody levels. People on the UK “Shielded Patient List”, and individuals who reported that they had poorer general health, were more likely to have lower antibody levels after vaccination. In contrast, people who had had a previous COVID-19 infection were more likely to have higher antibody levels following vaccination compared to people without infection. People receiving the Oxford/AstraZeneca rather than the Pfizer BioNTech vaccine had lower antibody levels after one or two vaccinations. However, after a third vaccination, there was no difference in antibody levels between those who had Oxford/AstraZeneca and Pfizer BioNTech vaccines for their first two doses. These findings support having a third COVID-19 vaccination to boost antibodies.

show abstract

Section: Discussionsupporting

confidence: 87%

Antibody levels following vaccination against SARS-CoV-2: associations with post-vaccination infection and risk factors

Cheetham

Kibble

Wong

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Interestingly, Stouten et al noted a BTI incidence of 4.6% (n = 373,070/8,0620,600) in fully vaccinated individuals in Belgium. The researchers calculated a 11 per 100 person years risk to develop a BTI after BNT162b2-based vaccination, which was lower than subjects vaccinated with adeno-vector-based vaccines but higher than those who received the mRNA-1273 vaccine [76]. Moreover, a report evaluating BTI occurrence in the capital region of Denmark (n = 1,088,879) mentioned an overall low incidence (hazard ratio of 0.2%) with a tendency towards higher risk to develop BTI with longer time post-vaccination [77].…”

Section: Discussionmentioning

confidence: 99%

High Incidence of SARS-CoV-2 Variant of Concern Breakthrough Infections Despite Residual Humoral and Cellular Immunity Induced by BNT162b2 Vaccination in Healthcare Workers: A Long-Term Follow-Up Study in Belgium

Calcoen

Callewaert

Vandenbulcke

et al. 2022

Viruses

View full text Add to dashboard Cite

To mitigate the massive COVID-19 burden caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), several vaccination campaigns were initiated. We performed a single-center observational trial to monitor the mid- (3 months) and long-term (10 months) adaptive immune response and to document breakthrough infections (BTI) in healthcare workers (n = 84) upon BNT162b2 vaccination in a real-world setting. Firstly, serology was determined through immunoassays. Secondly, antibody functionality was analyzed via in vitro binding inhibition and pseudovirus neutralization and circulating receptor-binding domain (RBD)-specific B cells were assessed. Moreover, the induction of SARS-CoV-2-specific T cells was investigated by an interferon-γ release assay combined with flowcytometric profiling of activated CD4+ and CD8+ T cells. Within individuals that did not experience BTI (n = 62), vaccine-induced humoral and cellular immune responses were not correlated. Interestingly, waning over time was more pronounced within humoral compared to cellular immunity. In particular, 45 of these 62 subjects no longer displayed functional neutralization against the delta variant of concern (VoC) at long-term follow-up. Noteworthily, we reported a high incidence of symptomatic BTI cases (17.11%) caused by alpha and delta VoCs, although vaccine-induced immunity was only slightly reduced compared to subjects without BTI at mid-term follow-up.

show abstract

“…Contrary to other research the menace of BT infection was lower amongst previously infected people. 4 , 33 Stamatatos et al reported that previously infected COVID‐19 patients will benefit from immunization as it will significantly increase neutralizing antibody responses against vaccine‐matched and emerging variants. However, little research showed that prior infection in vaccinated people did not significantly reduce the risk of BT infection.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 2 As the COVID‐19 vaccine manufacturer companies started to be administered globally, the despondency consequences of COVID‐19 were mitigated. 3 , 4 …”

Section: Introductionmentioning

confidence: 99%

“… 11 , 12 , 13 Other risk factors such as age, gender, occupation, prior COVID‐19 infections, COVID‐19 variants, vaccine types, and coexisting diseases may decrease vaccine effectiveness. 4 , 10 , 14 , 15 , 16 These risk factors, separately or together, could result in vaccine breakthrough (BT) infections. Vaccine BT infection happens when a fully vaccinated individual gets COVID‐19 infection.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

COVID‐19 vaccine breakthrough infection among fully vaccinated healthcare workers in Duhok governorate, Iraqi Kurdistan: A retrospective cohort study

Almufty

Mamani

Ali

et al. 2022

Journal of Medical Virology

View full text Add to dashboard Cite

The aims of this study were: to determine the incidence of Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) infection among vaccinated healthcare workers (HCWs), assess risk factors associated with the vaccine breakthrough (BT), and compare the effectiveness of vaccine manufacturers against SARS‐CoV‐2 variant of concern among HCWs in Duhok governorate. It is a multicenter retrospective cohort study, which enrolled 944 HCWs through March 2022. COVID‐19 vaccinated HCWs aging 18 and above were included. A random sampling process was performed by asking the participants to fill out a standardized questionnaire by means of interviews or participant‐completed surveys. Fully vaccinated HCWs with positive polymerase chain reaction tests were considered to have vaccine BT infection. Two hundred and eighty‐four (30.1%) out of 944 vaccinated HCWs had SARS‐CoV‐2 infection postvaccination, of whom 241 (84.9%) were fully vaccinated, concluding that the incidence of BT infection is 25.5%. There were 422 (44.7%) males and 522 (55.3%) females. Most vaccine BT infections had developed in SARS‐CoV‐2 Omicron variant (53.5%). The majority of BT infections were mild to moderate (95.5%). Occupation, namely dentist was a significant risk factor, with a p value of 0.001. HCWs with a history of SARS‐CoV‐2 infection prevaccination were more prone to a vaccine BT infection ( p value =0.002). Pfizer vaccine manufacturers revealed the highest effectiveness against BT infection ( p value =0.0001). Paramedics showed a significant association with the disease severity ( p value =0.02). The three available vaccine manufacturers in the Duhok governorate are effective against COVID‐19 BT infections. Dentists and paramedics were significantly associated with poor COVID‐19 outcomes.

show abstract

Incidence and Risk Factors of COVID-19 Vaccine Breakthrough Infections: A Prospective Cohort Study in Belgium

Cited by 36 publications

References 31 publications

Antibody levels following vaccination against SARS-CoV-2: associations with post-vaccination infection and risk factors

Antibody levels following vaccination against SARS-CoV-2: associations with post-vaccination infection and risk factors

High Incidence of SARS-CoV-2 Variant of Concern Breakthrough Infections Despite Residual Humoral and Cellular Immunity Induced by BNT162b2 Vaccination in Healthcare Workers: A Long-Term Follow-Up Study in Belgium

COVID‐19 vaccine breakthrough infection among fully vaccinated healthcare workers in Duhok governorate, Iraqi Kurdistan: A retrospective cohort study

Contact Info

Product

Resources

About