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Post-Vaccination Coronavirus Disease 2019: A Case-Control Study and Genomic Analysis of 119 Breakthrough Infections in Partially Vaccinated Individuals.
Baltas, Ioannis; Boshier, Florencia A T; Williams, Charlotte A; Bayzid, Nadua; Cotic, Marius; Afonso Guerra-Assunção, José; Irish-Tavares, Dianne; Haque, Tanzina; Hart, Jennifer; Roy, Sunando; Williams, Rachel; Breuer, Judith; Mahungu, Tabitha W.
  • Baltas I; Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom.
  • Boshier FAT; Institute of Education, University College London, London, United Kingdom.
  • Williams CA; Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
  • Bayzid N; Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
  • Cotic M; Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
  • Afonso Guerra-Assunção J; Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
  • Irish-Tavares D; Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
  • Haque T; Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom.
  • Hart J; Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom.
  • Roy S; Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom.
  • Williams R; Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
  • Breuer J; Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
  • Mahungu TW; Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
Clin Infect Dis ; 75(2): 305-313, 2022 08 25.
Article in English | MEDLINE | ID: covidwho-1708892
ABSTRACT

BACKGROUND:

Post-vaccination infections challenge the control of the coronavirus disease 2019 (COVID-19) pandemic.

METHODS:

We matched 119 cases of post-vaccination severe acute respiratory syndrome coronavirus 2 infection with BNT162b2 mRNA or ChAdOx1 nCOV-19 to 476 unvaccinated patients with COVID-19 (September 2020-March 2021) according to age and sex. Differences in 60-day all-cause mortality, hospital admission, and hospital length of stay were evaluated. Phylogenetic, single-nucleotide polymorphism (SNP), and minority variant allele (MVA) full-genome sequencing analysis was performed.

RESULTS:

Overall, 116 of 119 cases developed COVID-19 post-first vaccination dose (median, 14 days). Thirteen of 119 (10.9%) cases and 158 of 476 (33.2%) controls died (P < .001), corresponding to the 4.5 number needed to treat (NNT). Multivariably, vaccination was associated with a 69.3% (95% confidence interval [CI] 45.8 to 82.6) relative risk (RR) reduction in mortality. Similar results were seen in subgroup analysis for patients with infection onset ≥14 days after first vaccination and across vaccine subgroups. Hospital admissions (odds ratio, 0.80; 95% CI .51 to 1.28) and length of stay (-1.89 days; 95% CI -4.57 to 0.78) were lower for cases, while cycle threshold values were higher (30.8 vs 28.8, P = .053). B.1.1.7 was the predominant lineage in cases (100 of 108, 92.6%) and controls (341 of 446, 76.5%). Genomic analysis identified 1 post-vaccination case that harbored the E484K vaccine-escape mutation (B.1.525 lineage).

CONCLUSIONS:

Previous vaccination reduces mortality when B.1.1.7 is the predominant lineage. No significant lineage-specific genomic changes during phylogenetic, SNP, and MVA analysis were detected.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid / Vaccines / Variants Limits: Humans Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid / Vaccines / Variants Limits: Humans Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid