Covid-19 Breakthrough Infections in Vaccinated Health Care Workers
| Autor: | Gili Regev-Yochay, Victoria Indenbaum, Carmit Rubin, Adina Bar-Chaim, Yaniv Lustig, Michal Mandelboim, Einav G Levin, Moriah Bergwerk, Neta S. Zuckerman, Tal Gonen, Sharon Amit, Yitshak Kreiss, Marc Lipsitch, Malka Zavitan, Carmit Cohen, Ilana Tal |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty COVID-19 Vaccines Coronavirus disease 2019 (COVID-19) Health Personnel viruses Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) MEDLINE Treatment failure Internal medicine Health care Humans Medicine RNA Messenger Treatment Failure Israel BNT162 Vaccine Asymptomatic Diseases SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction business.industry Extramural Case-control study COVID-19 virus diseases General Medicine Middle Aged Myocarditis COVID-19 Nucleic Acid Testing Case-Control Studies Original Article Female business |
| Zdroj: | The New England Journal of Medicine |
| ISSN: | 1533-4406 0028-4793 |
| DOI: | 10.1056/nejmoa2109072 |
| Popis: | Background Despite the high efficacy of the BNT162b2 messenger RNA vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rare breakthrough infections have been reported, including infections among health care workers. Data are needed to characterize these infections and define correlates of breakthrough and infectivity. Methods At the largest medical center in Israel, we identified breakthrough infections by performing extensive evaluations of health care workers who were symptomatic (including mild symptoms) or had known infection exposure. These evaluations included epidemiologic investigations, repeat reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays, antigen-detecting rapid diagnostic testing (Ag-RDT), serologic assays, and genomic sequencing. Correlates of breakthrough infection were assessed in a case–control analysis. We matched patients with breakthrough infection who had antibody titers obtained within a week before SARS-CoV-2 detection (peri-infection period) with four to five uninfected controls and used generalized estimating equations to predict the geometric mean titers among cases and controls and the ratio between the titers in the two groups. We also assessed the correlation between neutralizing antibody titers and N gene cycle threshold (Ct) values with respect to infectivity. Results Among 1497 fully vaccinated health care workers for whom RT-PCR data were available, 39 SARS-CoV-2 breakthrough infections were documented. Neutralizing antibody titers in case patients during the peri-infection period were lower than those in matched uninfected controls (case-to-control ratio, 0.361; 95% confidence interval, 0.165 to 0.787). Higher peri-infection neutralizing antibody titers were associated with lower infectivity (higher Ct values). Most breakthrough cases were mild or asymptomatic, although 19% had persistent symptoms (>6 weeks). The B.1.1.7 (alpha) variant was found in 85% of samples tested. A total of 74% of case patients had a high viral load (Ct value |
| Databáze: | OpenAIRE |
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