TY - JOUR
T1 - BNT162b2 vaccine breakthrough
T2 - clinical characteristics of 152 fully vaccinated hospitalized COVID-19 patients in Israel
AU - Brosh-Nissimov, Tal
AU - Orenbuch-Harroch, Efrat
AU - Chowers, Michal
AU - Elbaz, Meital
AU - Nesher, Lior
AU - Stein, Michal
AU - Maor, Yasmin
AU - Cohen, Regev
AU - Hussein, Khetam
AU - Weinberger, Miriam
AU - Zimhony, Oren
AU - Chazan, Bibiana
AU - Najjar, Ronza
AU - Zayyad, Hiba
AU - Rahav, Galia
AU - Wiener-Well, Yonit
N1 - Publisher Copyright:
© 2021 European Society of Clinical Microbiology and Infectious Diseases
PY - 2021/11
Y1 - 2021/11
N2 - Objectives: The mRNA coronavirus disease 2019 (COVID-19) vaccines have shown high effectiveness in the prevention of symptomatic COVID-19, hospitalization, severe disease and death. Nevertheless, a minority of vaccinated individuals might become infected and experience significant morbidity. Characteristics of vaccine breakthrough infections have not been studied. We sought to portray the population of Israeli patients, who were hospitalized with COVID-19 despite full vaccination. Methods: A retrospective multicentre cohort study of 17 hospitals included patients fully vaccinated with Pfizer/BioNTech's BNT162b2 vaccine who developed COVID-19 more than 7 days after the second vaccine dose and required hospitalization. The risk for poor outcome, defined as a composite of mechanical ventilation or death, was assessed. Results: A total of 152 patients were included, accounting for half of hospitalized fully vaccinated patients in Israel. Poor outcome was noted in 38 patients and mortality rate reached 22% (34/152). Notably, the cohort was characterized by a high rate of co-morbidities predisposing to severe COVID-19, including hypertension (108; 71%), diabetes (73; 48%), congestive heart failure (41; 27%), chronic kidney and lung diseases (37; 24% each), dementia (29; 19%) and cancer (36; 24%), and only six (4%) had no co-morbidities. Sixty (40%) of the patients were immunocompromised. Higher viral load was associated with a significant risk for poor outcome. Risk also appeared higher in patients receiving anti-CD20 treatment and in patients with low titres of anti-Spike IgG, but these differences did not reach statistical significance. Conclusions: We found that severe COVID-19 infection, associated with a high mortality rate, might develop in a minority of fully vaccinated individuals with multiple co-morbidities. Our patients had a higher rate of co-morbidities and immunosuppression compared with previously reported non-vaccinated hospitalized individuals with COVID-19. Further characterization of this vulnerable population may help to develop guidance to augment their protection, either by continued social distancing, or by additional active or passive vaccinations.
AB - Objectives: The mRNA coronavirus disease 2019 (COVID-19) vaccines have shown high effectiveness in the prevention of symptomatic COVID-19, hospitalization, severe disease and death. Nevertheless, a minority of vaccinated individuals might become infected and experience significant morbidity. Characteristics of vaccine breakthrough infections have not been studied. We sought to portray the population of Israeli patients, who were hospitalized with COVID-19 despite full vaccination. Methods: A retrospective multicentre cohort study of 17 hospitals included patients fully vaccinated with Pfizer/BioNTech's BNT162b2 vaccine who developed COVID-19 more than 7 days after the second vaccine dose and required hospitalization. The risk for poor outcome, defined as a composite of mechanical ventilation or death, was assessed. Results: A total of 152 patients were included, accounting for half of hospitalized fully vaccinated patients in Israel. Poor outcome was noted in 38 patients and mortality rate reached 22% (34/152). Notably, the cohort was characterized by a high rate of co-morbidities predisposing to severe COVID-19, including hypertension (108; 71%), diabetes (73; 48%), congestive heart failure (41; 27%), chronic kidney and lung diseases (37; 24% each), dementia (29; 19%) and cancer (36; 24%), and only six (4%) had no co-morbidities. Sixty (40%) of the patients were immunocompromised. Higher viral load was associated with a significant risk for poor outcome. Risk also appeared higher in patients receiving anti-CD20 treatment and in patients with low titres of anti-Spike IgG, but these differences did not reach statistical significance. Conclusions: We found that severe COVID-19 infection, associated with a high mortality rate, might develop in a minority of fully vaccinated individuals with multiple co-morbidities. Our patients had a higher rate of co-morbidities and immunosuppression compared with previously reported non-vaccinated hospitalized individuals with COVID-19. Further characterization of this vulnerable population may help to develop guidance to augment their protection, either by continued social distancing, or by additional active or passive vaccinations.
KW - BNT162b2
KW - Breakthrough infection
KW - Coronavirus disease 2019
KW - Immune compromised
KW - Serology
KW - Severe acute respiratory syndrome coronavirus 2
KW - Vaccine effectiveness
KW - mRNA vaccine
UR - http://www.scopus.com/inward/record.url?scp=85110690486&partnerID=8YFLogxK
U2 - 10.1016/j.cmi.2021.06.036
DO - 10.1016/j.cmi.2021.06.036
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 34245907
AN - SCOPUS:85110690486
SN - 1198-743X
VL - 27
SP - 1652
EP - 1657
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 11
ER -