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Breakthrough Infections and Hospitalization

 Hospitalization in COVID-19 Breakthrough Cases

    Countless studies have proven that one of the most important forms of protection from COVID-19 infection is vaccination. As of Sep 21, 2021 54.8% of Americans and 64.5% of people who are age 12 and above are fully vaccinated. While the chances of COVID-19 infection after vaccination are significantly reduced, there have been reports of rare cases of SARS-CoV-2 breakthrough infection in fully vaccinated individuals. (See COVID-19 Breakthrough Infections) Previous studies have found that the viral load of an individual with a COVID-19 breakthrough infection is not significantly different than that of an individual who is unvaccinated. (See Can Vaccination Reduce COVID-19 Transmission?) However, more questions related to breakthrough infections have arisen including whether or not a vaccinated individual with COVID-19 has a reduced risk of severe illness and hospitalization. A study published in The Lancet in September 2021 collected real world data to analyze hospitalization records among COVID-19 breakthrough infections in vaccinated individuals.

About the Study

    Data of patients with confirmed SARS-CoV-2 infection was collected via the Yale New Haven Health System. The investigators did a systematic review of patients admitted to hospital with SARS-CoV-2 (confirmed by a positive PCR test at the time of admission) between March 23 and July 1, 2021. The COVID-19 vaccination data of each patient was recorded, including the specific vaccine type and vaccination dates. Patients were considered fully vaccinated if the final dose (either second dose of Prizer or Moderna vaccine, or first dose of Janssen) was administered at least 2 weeks before symptom onset or a positive PCR test for SARS-CoV-2. A total of 969 patients were identified with a positive PCR test for SARS-CoV-2.

Study Results

    Among these 969 patients, 103 received a partial vaccine course (one dose of either Pfizer or Moderna) while 15 received a complete vaccine course within 14 days before symptom onset or a positive PCR test. 54 were fully vaccinated and deemed to have a COVID-19 breakthrough infection. Among the 54 breakthrough patients, 25 (46%) patients were asymptomatic, 4 (7%) had mild disease, 11 (20%) had moderate disease, and 14 (26%) had severe or critical illness. 
   Of the 14 patients with severe/critical illness, 3 died. However, many patients with severe/critical illness, were older in age (median age of 80 years) and had pre-existing comorbidities including overweight (n = 9), cardiovascular disease (n = 12), lung disease (n = 7), malignancy (n = 4), type 2 diabetes (n = 7), and immunosuppressants (n = 4). Additionally, 13 of the 14 patients received the Pfizer vaccine. 

What does this mean?

     The findings indicate that older people or individuals with underlying conditions are more likely to have severe illness during breakthrough infections. Although the incidence of severe or critical COVID-19 illness remains low in those who are fully vaccinated, there was a higher incidence of severe or critical breakthrough illness among those who had received the Pfizer vaccine in comparison those who received Moderna or Janssen. The data also indicates that those who are fully vaccinated are less likely to be hospitalized than those with a partial vaccine course or those who are unvaccinated. However, with limited patient numbers and data from only one location, the results from this finding need to be further investigated. Overall, the study found that COVID-19 vaccination is highly effective against COVID-19 infection and hospitalization with COVID-19. 

Sources

1. Juthani, Prerak V, et al. “Hospitalisation among Vaccine Breakthrough COVID-19 Infections.” The Lancet Infectious Diseases, 7 Sept. 2021, doi:10.1016/s1473-3099(21)00558-2.

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