Adeel A Butt1,2,3, Peng Yan1, Obaid S Shaikh1,4, Florian B Mayr1,5, Saad B Omer6. 1. VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA. 2. Departments of Medicine and Population Health Sciences, Weill Cornell Medical College, and Doha, Qatar. 3. Hamad Medical Corporation, Doha, Qatar. 4. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 5. Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 6. Yale Institute for Global Health, Yale School of Medicine New Haven, Connecticut, USA.
Abstract
BACKGROUND: Breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections after vaccination have been reported. Outcomes among persons with breakthrough infection are poorly understood. METHODS: We identified all veterans with a confirmed SARS-CoV-2 infection >14 days after the second dose of an mRNA vaccine between 15 December 2020 and 30 June 2021 and propensity score-matched unvaccinated controls with SARS-CoV-2 infection. The primary outcome was severe/critical disease, defined as admission to an intensive care unit, need for mechanical ventilation, or death within 28 days of diagnosis or during index hospitalization. RESULTS: Among 502 780 vaccinated and 599 974 unvaccinated persons, there were 2332 (0.5%) breakthrough infections in the vaccinated group and 40 540 (6.8%) infections in the unvaccinated group over a follow-up period of 69 083 person-days in each group. Among these groups, we identified 1728 vaccinated persons with breakthrough infection (cases) and 1728 propensity score-matched unvaccinated controls with infection. Among the former, 95 (5.5%) persons met the criteria for severe/critical disease, while 200 (11.6%) persons met the criteria among the latter group. The incidence rate for severe/critical disease per 1000 person-days (95% confidence interval [CI]) was .55 (.45-.68) among vaccinated persons with breakthrough infection and 1.22 (1.07-1.41) among the unvaccinated matched controls who developed infection (P < .0001). Risk was higher; the hazard ratio (95% CI) with increasing age per 10-year increase was 1.25 (1.11-1.41); for those with >4 comorbidities, it was 2.85 (1.49-5.43), while being vaccinated was associated with strong protection against severe/critical disease (HR, 0.41; 95% CI: .32-.52). CONCLUSIONS: The rate of severe/critical disease is higher among older persons and those with >4 comorbidities but lower among fully vaccinated persons with breakthrough infection compared with unvaccinated controls who develop infection.
BACKGROUND: Breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections after vaccination have been reported. Outcomes among persons with breakthrough infection are poorly understood. METHODS: We identified all veterans with a confirmed SARS-CoV-2 infection >14 days after the second dose of an mRNA vaccine between 15 December 2020 and 30 June 2021 and propensity score-matched unvaccinated controls with SARS-CoV-2 infection. The primary outcome was severe/critical disease, defined as admission to an intensive care unit, need for mechanical ventilation, or death within 28 days of diagnosis or during index hospitalization. RESULTS: Among 502 780 vaccinated and 599 974 unvaccinated persons, there were 2332 (0.5%) breakthrough infections in the vaccinated group and 40 540 (6.8%) infections in the unvaccinated group over a follow-up period of 69 083 person-days in each group. Among these groups, we identified 1728 vaccinated persons with breakthrough infection (cases) and 1728 propensity score-matched unvaccinated controls with infection. Among the former, 95 (5.5%) persons met the criteria for severe/critical disease, while 200 (11.6%) persons met the criteria among the latter group. The incidence rate for severe/critical disease per 1000 person-days (95% confidence interval [CI]) was .55 (.45-.68) among vaccinated persons with breakthrough infection and 1.22 (1.07-1.41) among the unvaccinated matched controls who developed infection (P < .0001). Risk was higher; the hazard ratio (95% CI) with increasing age per 10-year increase was 1.25 (1.11-1.41); for those with >4 comorbidities, it was 2.85 (1.49-5.43), while being vaccinated was associated with strong protection against severe/critical disease (HR, 0.41; 95% CI: .32-.52). CONCLUSIONS: The rate of severe/critical disease is higher among older persons and those with >4 comorbidities but lower among fully vaccinated persons with breakthrough infection compared with unvaccinated controls who develop infection.
Authors: Florian B Mayr; Victor B Talisa; Obaid S Shaikh; Saad B Omer; Adeel A Butt; Sachin Yende Journal: Open Forum Infect Dis Date: 2022-06-24 Impact factor: 4.423
Authors: Florian B Mayr; Victor B Talisa; Alexander D Castro; Obaid S Shaikh; Saad B Omer; Adeel A Butt Journal: Nat Commun Date: 2022-06-25 Impact factor: 17.694
Authors: Adeel A Butt; Victor B Talisa; Peng Yan; Obaid S Shaikh; Saad B Omer; Florian B Mayr Journal: Clin Infect Dis Date: 2022-08-24 Impact factor: 20.999
Authors: Christine J Lee; Wongi Woo; Ah Young Kim; Dong Keon Yon; Seung Won Lee; Ai Koyanagi; Min Seo Kim; Kalthoum Tizaoui; Elena Dragioti; Joaquim Radua; Sungsoo Lee; Lee Smith; Jae Il Shin Journal: J Med Virol Date: 2022-06-01 Impact factor: 20.693
Authors: Ivan Castellví; Diego Castillo; Hèctor Corominas; Anaís Mariscal; Sandra Orozco; Natividad Benito; Virginia Pomar; Andrés Baucells; Isabel Mur; David de la Rosa-Carrillo; David Lobo; Ana Milena Millan; Nerea Hernández de Sosa; David Filella; Laia Matas; Laura Martínez-Martínez; Cándido Juarez; Jordi Casademont; Pere Domingo Journal: Front Med (Lausanne) Date: 2022-08-08