Outbreak of SARS-CoV-2 B.1.1.7 Lineage after Vaccination in Long-Term Care Facility, Germany, February–March 2021

Abstract

O utbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in long-term care facilities (LTCF) are of great concern and have been reported to have high case-fatality rates (1). Consequently, national vaccination strategies prioritize residents of LTCFs (2).The coronavirus disease (COVID-19) mRNA vaccine BNT162b2 (Pfi zer-BioNTech, https://www.pfi zer.com) has demonstrated high effi cacy against COV-ID-19 (3). Protection has been observed >12 days after the fi rst vaccination, and reported vaccine effi cacy is 52% between the fi rst and second dose and 91% in the fi rst week after the second dose (3). Although breakthrough infections have been reported, vaccinated persons were at substantially lower risk for infection and symptomatic disease (4,5).The variant of concern (VOC) B.1.1.7 rapidly became the predominant lineage in Europe in 2021. Analyses estimated that B.1.1.7 has increased transmissibility and a <0.7 higher reproduction number (6). Neutralization activity of serum samples from BNT162b2-vaccinated persons has been shown to be slightly reduced against B.1.1.7 in cell culture ( 7), but observational data from Israel suggest BNT162b2 vaccination is effective against B.1.1.7 (8).We investigated a SARS-CoV-2 B.1.1.7 outbreak in a LTCF, which involved 20 BNT162b2-vaccinated residents and 4 unvaccinated residents. We report on clinical outcomes, viral kinetics, and control measures applied for outbreak containment. The study was approved by the ethics committee of Charité-Universitätsmedizin Berlin (EA2/066/20) and conducted in accordance with the Declaration of Helsinki and guidelines of Good Clinical Practice (https://www.ema. europa.eu/en/documents/scientifi c-guideline/ich-e-6-r2-guideline-good-clinical-practice-step-5_en.pdf). The StudyOn February 4, 2021, daily SARS-CoV-2 screening of employees yielded a positive antigen point-ofcare test (AgPOCT) result in 1 caregiver in a LTCF in Berlin, Germany. Among 24 residents of the unit under their responsibility, 20 (83%) residents had received the second dose of BNT162b2 on January

Poor Antibody Response to BioNTech/Pfizer Coronavirus Disease 2019 Vaccination in Severe Acute Respiratory Syndrome Coronavirus 2–Naive Residents of Nursing Homes

“…Reports on lower Ab responses to COVID-19 mRNA vaccination in older people and people with chronic comorbidities raise concern about the susceptibility of NH residents to severe breakthrough infections, especially with SARS-CoV-2 variants of concern [10][11][12][13][14]39,40]. In this study, SARS-CoV-2 infection-naïve NH residents had lower Ab responses to BNT162b2 mRNA vaccination as compared to naïve staff, in line with data reported by Canaday et al [41].…”

Long-Lasting Immunity Against SARS-CoV-2: Dream or Reality?

“…One initial question to be answered is the probability of reinfections, which have already been reported in recent studies ( 14 , 15 ). Apparently, the rate of reinfection or infection in vaccinated subjects is increasing ( 14 ).…”

SARS-CoV-2 Infection in Fully Vaccinated Individuals of Old Age Strongly Boosts the Humoral Immune Response

“…Meanwhile, there are initial reports of outbreaks of SARS-CoV-2 following vaccination in care homes for the elderly ( 20 ). The hopeful picture that seems to emerge from this is that the vast majority of infections are mild after complete vaccination.…”