Rate and Risk Factors for Severe/Critical Disease Among Fully Vaccinated Persons With Breakthrough Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in a High-Risk National Population

Autor: Adeel A Butt, Peng Yan, Obaid S Shaikh, Florian B Mayr, Saad B Omer
Rok vydání: 2021
Předmět:
Zdroj: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
ISSN: 1537-6591
1058-4838
DOI: 10.1093/cid/ciab1023
Popis: 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 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.
Databáze: OpenAIRE
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