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Evaluation of COVID-19 vaccine breakthrough infections among immunocompromised patients fully vaccinated with BNT162b2 (preprint)
medrxiv; 2021.
Preprint
in English
| medRxiv | ID: ppzbmed-10.1101.2021.10.12.21264707
ABSTRACT
Objective:
To evaluate COVID-19 vaccine breakthrough infections among immunocompromised (IC) individuals.Methods:
Individuals vaccinated with BNT162b2 were selected from the US HealthVerity database (12/10/2020-7/8/2021). COVID-19 vaccine breakthrough infections were examined in fully vaccinated ([≥]14 days after 2nd dose) IC individuals (IC cohort), 12 mutually exclusive IC condition groups, and a non-IC cohort. IC conditions were identified using an algorithm based on diagnosis codes and immunosuppressive (IS) medication usage.Results:
Of 1,277,747 individuals [≥]16 years of age who received 2 BNT162b2 doses, 225,796 (17.7%) were identified as IC (median age 58 years; 56.3% female). The most prevalent IC conditions were solid malignancy (32.0%), kidney disease (19.5%), and rheumatologic/inflammatory conditions (16.7%). Among the fully vaccinated IC and non-IC cohorts, a total of 978 breakthrough infections were observed during the study period; 124 (12.7%) resulted in hospitalization and 2 (0.2%) were inpatient deaths. IC individuals accounted for 38.2% (N=374) of all breakthrough infections, 59.7% (N=74) of all hospitalizations, and 100% (N=2) of inpatient deaths. The proportion with breakthrough infections was 3 times higher in the IC cohort compared to the non-IC cohort (N=374 [0.18%] vs. N=604 [0.06%]; unadjusted incidence rates were 0.89 and 0.34 per 100 person-years, respectively. Organ transplant recipients had the highest incidence rate; those with >1 IC condition, antimetabolite usage, primary immunodeficiencies, and hematologic malignancies also had higher incidence rates compared to the overall IC cohort. Incidence rates in older ([≥]65 years old) IC individuals were generally higher versus younger IC individuals (<65).Limitations:
This retrospective analysis relied on coding accuracy and had limited capture of COVID-19 vaccine receipt.Conclusions:
COVID-19 vaccine breakthrough infections are rare but are more common and severe in IC individuals. The findings from this large study support FDA authorization and CDC recommendations to offer a 3rd vaccine dose to increase protection among IC individuals.
Full text:
Available
Collection:
Preprints
Database:
medRxiv
Main subject:
Breakthrough Pain
/
COVID-19
/
Kidney Diseases
Language:
English
Year:
2021
Document Type:
Preprint
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