Severe SARS-CoV-2 Breakthrough Reinfection With Delta Variant After Recovery From Breakthrough Infection by Alpha Variant in a Fully Vaccinated Health Worker

Abstract

Background: Post infection immunity and post vaccination immunity both confer protection against COVID-19. However, there have been many whole genome sequencing proven reinfections and breakthrough infections. Both are most often mild and caused by Variants of Concern (VOC).Methods: The patient in our study underwent serial COVID-19 RT-PCR, blood tests for serology, acute phase reactants, and chest imaging as part of clinical care. We interviewed the patient for clinical history and retrieved reports and case papers. We retrieved stored RT-PCR positive samples for whole genome sequencing (WGS) of SARS-CoV-2 from the patient's breakthrough infections and the presumed index case.Findings: The patient had three RT-PCR confirmed SARS-CoV-2 infections. Two breakthrough infections occurred in quick succession with the first over 3 weeks after complete vaccination with COVISHIELD and despite post-vaccination seroconversion. The first breakthrough infection was due to the Alpha variant and the second due to the Delta variant. The Delta variant infection resulted in hypoxia, hospitalization, and illness lasting seven weeks. Serial serology, acute phase reactants, and chest imaging supported WGS in establishing distinct episodes of infection. WGS established a fully vaccinated family member as the index case.Interpretation: The patient had an Alpha variant breakthrough infection despite past infection, complete vaccination, and seroconversion. Despite boosting after this infection, the patient subsequently had a severe Delta variant breakthrough infection. This was also a WGS proven reinfection and, therefore, a case of breakthrough reinfection. The patient acquired the infection from a fully vaccinated family member.

Autopsy Findings and Causality Relationship between Death and COVID-19 Vaccination: A Systematic Review

“…Two cases are of interest for the scientific community: two deceased subjects tested positive for the COVID-19 infection. Although in both cases no signs of COVID-19 complications were found, these cases could be related to the SARS-CoV-2 variants that may allow the virus to escape host immunity, in particular, the immunity conferred by vaccination [44,45]. A direct relationship between vaccination and fatal adverse effects was reported by Choi et al [31] who identified myocarditis as a cause of death: these findings were confirmed in a recent report describing an increased risk of myocarditis in subjects vaccinated with BNT162b2 [46].…”

Mitigating Covid-19 in the face of emerging virus variants, breakthrough infections and vaccine hesitancy

“…Additionally, infected people can transmit the virus even before the symptoms become apparent. Furthermore, many individuals who have been vaccinated but later become infected may not show symptoms and unknowingly can continue to transmit the virus to other people [ 14 , 15 ], a challenging situation to blunt transmission ( Fig. 1 ).…”

SARS-CoV-2: Emergence of New Variants and Effectiveness of Vaccines

“…The 501.V2 are more transmissible and cause severe in comparison to the parental strain ( Wang et al., 2021 ). E484K mutation also plays an important role in immune mechanism, host receptor affinity, and infectivity ( Shastri et al., 2021 ). Initial findings have indicated that the Oxford–AstraZeneca vaccine has shown considerable reduction in effectiveness against these variants and was reviewed by the WHO ( Lopez Bernal et al., 2021 ).…”