Severe acute respiratory syndrome coronavirus 2 vaccine breakthrough infections: A single metro-based testing network experience

• Type of Material: Article
• Authors: Samantha S. Strickler, Emory University; Annette Esper, Emory University; Leona Wells, Emory University; Anna Wood, Emory University; Jennifer Frediani, Emory University; Eric Nehl, Emory University; Jesse Waggoner, Emory University; Paulina Rebolledo, Emory University; Joshua Levy, Emory University; Janet Figueroa, Emory University; Thanuja Ramachandra, Emory University; Wilbur Lam, Emory University; Gregory Martin, Emory University
• Language: English
• Date: 2022-11-25
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Final Published Version
• Copyright Statement: © 2022 Strickler, Esper, Wells, Wood, Frediani, Nehl, Waggoner, Rebolledo, Levy, Figueroa, Ramachandra, Lam and Martin.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fmed.2022.1031083
• Title of Journal or Parent Work: FRONTIERS IN MEDICINE
• Volume: 9
• Start Page: 1031083
• End Page: 1031083
• Grant/Funding Information: This work was supported by the NIH RADx, Grant/Award Numbers: U54 EB027690 02S1 and UL1 TR002378.
• Keywords: COVID-19 vaccine; pandemic; General & Internal Medicine; breakthrough infections; partial vaccinations; Medicine, General & Internal; SARS-CoV-2; Life Sciences & Biomedicine; Science & Technology
• Research Categories: Health Sciences, Public Health; Health Sciences, Immunology; Biology, Virology

Abstract

Objectives: Understanding the incidence and characteristics that influence severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine breakthrough infections (VBIs) is imperative for developing public health policies to mitigate the coronavirus disease of 2019 (COVID-19) pandemic. We examined these factors and post-vaccination mitigation practices in individuals partially and fully vaccinated against SARS-CoV-2. Materials and methods: Adults >18 years old were voluntarily enrolled from a single metro-based SARS-CoV-2 testing network from January to July 2021. Participants were categorized as asymptomatic or symptomatic, and as unvaccinated, partially vaccinated, or fully vaccinated. All participants had confirmed SARS-CoV-2 infection based on standard of care (SOC) testing with nasopharyngeal swabs. Variant analysis by rRT-PCR was performed in a subset of time-matched vaccinated and unvaccinated individuals. A subgroup of partially and fully vaccinated individuals with a positive SARS-CoV-2 rRT-PCR was contacted to assess disease severity and post-vaccination mitigation practices. Results: Participants (n = 1,317) voluntarily underwent testing for SARS-CoV-2 during the enrollment period. A total of 29.5% of the population received at least one SARS-CoV-2 vaccine (n = 389), 12.8% partially vaccinated (n = 169); 16.1% fully vaccinated (n = 213). A total of 21.3% of partially vaccinated individuals tested positive (n = 36) and 9.4% of fully vaccinated individuals tested positive (n = 20) for SARS-CoV-2. Pfizer/BioNTech mRNA-1273 was the predominant vaccine received (1st dose = 66.8%, 2nd dose = 67.9%). Chronic liver disease and immunosuppression were more prevalent in the vaccinated (partially/fully) group compared to the unvaccinated group (p = 0.003, p = 0.021, respectively). There were more asymptomatic individuals in the vaccinated group compared to the unvaccinated group [n = 6 (10.7%), n = 16 (4.1%), p = 0.045]. CT values were lower for the unvaccinated group (median 24.3, IQR 19.1–30.5) compared to the vaccinated group (29.4, 22.0–33.7, p = 0.004). In the vaccinated group (n = 56), 18 participants were successfully contacted, 7 were lost to follow-up, and 2 were deceased. A total of 50% (n = 9) required hospitalization due to COVID-19 illness. Adherence to nationally endorsed mitigation strategies varied post-vaccination. Conclusion: The incidence of SARS-CoV-2 infection at this center was 21.3% in the partially vaccinated group and 9.4% in the fully vaccinated group. Chronic liver disease and immunosuppression were more prevalent in the vaccinated SARS-CoV-2 positive group, suggesting that these may be risk factors for VBIs. Partially and fully vaccinated individuals had a higher incidence of asymptomatic SARS-CoV-2 and higher CT values compared to unvaccinated SARS-CoV-2 positive individuals.