Incidence and Risk Factors of COVID-19 Vaccine Breakthrough Infections: A Prospective Cohort Study in Belgium

Overview

Journal Viruses

Publisher MDPI

Specialty Microbiology

Date 2022 Apr 23

PMID 35458532

Authors

Veerle Stouten

Pierre Hubin

Freek Haarhuis

Joris A F van Loenhout

Matthieu Billuart

Ruben Brondeel

Toon Braeye

Herman Van Oyen

Chloe Wyndham-Thomas

Lucy Catteau

Affiliations

Soon will be listed here.

Abstract

The objective of this study was to investigate the incidence and risk factors associated with COVID-19 vaccine breakthrough infections. We included all persons ≥18 years that had been fully vaccinated against COVID-19 for ≥14 days, between 1 February 2021 and 5 December 2021, in Belgium. The incidence of breakthrough infections (laboratory confirmed SARS-CoV-2-infections) was determined. Factors associated with breakthrough infections were analyzed using COX proportional hazard models. Among 8,062,600 fully vaccinated adults, we identified 373,070 breakthrough infections with an incidence of 11.2 (95%CI 11.2-11.3)/100 person years. Vaccination with Ad26.COV2.S (HR1.54, 95%CI 1.52-1.56) or ChAdOx1 (HR1.68, 95%CI 1.66-1.69) was associated with a higher risk of a breakthrough infection compared to BNT162b2, while mRNA-1273 was associated with a lower risk (HR0.68, 95%CI 0.67-0.69). A prior COVID-19-infection was protective against a breakthrough infection (HR0.23, 95%CI 0.23-0.24), as was an mRNA booster (HR0.44, 95%CI 0.43-0.45). During a breakthrough infection, those who had a prior COVID-19 infection were less likely to have COVID-19 symptoms of almost all types than naïve persons. We identified risk factors associated with breakthrough infections, such as vaccination with adenoviral-vector vaccines, which could help inform future decisions on booster vaccination strategies. A prior COVID-19 infection lowered the risk of breakthrough infections and of having symptoms, highlighting the protective effect of hybrid immunity.

Citing Articles

Navigating the Landscape of B Cell Mediated Immunity and Antibody Monitoring in SARS-CoV-2 Vaccine Efficacy: Tools, Strategies and Clinical Trial Insights.

OReilly S, Byrne J, Feeney E, Mallon P, Gautier V Vaccines (Basel). 2024; 12(10).

PMID: 39460256 PMC: 11511438. DOI: 10.3390/vaccines12101089.

COVID-19 breakthrough infections in vaccinated individuals at BPKIHS, Nepal.

Karmacharya A, Rai K, Siwakoti S, Khanal B, Bhattarai N BMC Infect Dis. 2024; 24(1):1003.

PMID: 39300352 PMC: 11411789. DOI: 10.1186/s12879-024-09902-z.

Exploring the Potential Long-term Impact of SARS-CoV-2 on Protein Misfolding and Amyloid-related Conditions.

Rashid M, Singha S, Arshad F, Sen P Protein Pept Lett. 2024; 31(8):602-610.

PMID: 39253910 DOI: 10.2174/0109298665333817240821111641.

COVID-19 Breakthrough Infections Among People With HIV: A Statewide Cohort Analysis.

Yang X, Zhang J, Chen S, Liu Z, Poland G, Olatosi B J Acquir Immune Defic Syndr. 2024; 97(2):107-116.

PMID: 39250644 PMC: 11386905. DOI: 10.1097/QAI.0000000000003475.

Incidence and risk factors of SARS-CoV-2 breakthrough infection in the early Omicron variant era among vaccinated and boosted individuals in Chicago.

Echevarria F, Caputo M, Camp D, Reddy S, Achenbach C PLoS One. 2024; 19(8):e0302338.

PMID: 39102410 PMC: 11299831. DOI: 10.1371/journal.pone.0302338.

References

Peter J, Wegner F, Gsponer S, Helfenstein F, Roloff T, Tarnutzer R . SARS-CoV-2 Vaccine Alpha and Delta Variant Breakthrough Infections Are Rare and Mild but Can Happen Relatively Early after Vaccination. Microorganisms. 2022; 10(5). PMC: 9146960. DOI: 10.3390/microorganisms10050857. View

Van Goethem N, Serrien B, Vandromme M, Wyndham-Thomas C, Catteau L, Brondeel R . Conceptual causal framework to assess the effect of SARS-CoV-2 variants on COVID-19 disease severity among hospitalized patients. Arch Public Health. 2021; 79(1):185. PMC: 8543112. DOI: 10.1186/s13690-021-00709-x. View

Shenai M, Rahme R, Noorchashm H . Equivalency of Protection From Natural Immunity in COVID-19 Recovered Versus Fully Vaccinated Persons: A Systematic Review and Pooled Analysis. Cureus. 2021; 13(10):e19102. PMC: 8627252. DOI: 10.7759/cureus.19102. View

Proesmans K, Hancart S, Braeye T, Klamer S, Robesyn E, Djiena A . COVID-19 contact tracing in Belgium: main indicators and performance, January - September 2021. Arch Public Health. 2022; 80(1):118. PMC: 9005619. DOI: 10.1186/s13690-022-00875-6. View

Green A, Curtis H, Hulme W, Williamson E, McDonald H, Bhaskaran K . Describing the population experiencing COVID-19 vaccine breakthrough following second vaccination in England: a cohort study from OpenSAFELY. BMC Med. 2022; 20(1):243. PMC: 9255436. DOI: 10.1186/s12916-022-02422-0. View

Cavanaugh A, Spicer K, Thoroughman D, Glick C, Winter K . Reduced Risk of Reinfection with SARS-CoV-2 After COVID-19 Vaccination - Kentucky, May-June 2021. MMWR Morb Mortal Wkly Rep. 2021; 70(32):1081-1083. PMC: 8360277. DOI: 10.15585/mmwr.mm7032e1. View

Baden L, El Sahly H, Essink B, Kotloff K, Frey S, Novak R . Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2020; 384(5):403-416. PMC: 7787219. DOI: 10.1056/NEJMoa2035389. View

Reynolds M, Xie Y, Knuth K, Mack C, Brinkley E, Toovey S . COVID-19 Vaccination Breakthrough Infections in a Real-World Setting: Using Community Reporters to Evaluate Vaccine Effectiveness. Infect Drug Resist. 2022; 15:5167-5182. PMC: 9451035. DOI: 10.2147/IDR.S373183. View

Lopez Bernal J, Andrews N, Gower C, Gallagher E, Simmons R, Thelwall S . Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant. N Engl J Med. 2021; 385(7):585-594. PMC: 8314739. DOI: 10.1056/NEJMoa2108891. View

10.

Corchado-Garcia J, Zemmour D, Hughes T, Bandi H, Cristea-Platon T, Lenehan P . Analysis of the Effectiveness of the Ad26.COV2.S Adenoviral Vector Vaccine for Preventing COVID-19. JAMA Netw Open. 2021; 4(11):e2132540. PMC: 8564583. DOI: 10.1001/jamanetworkopen.2021.32540. View

11.

Wurtz A, Kinnerup M, Pugdahl K, Schlunssen V, Vestergaard J, Nielsen K . Healthcare workers' SARS-CoV-2 infection rates during the second wave of the pandemic: follow-up study. Scand J Work Environ Health. 2022; 48(7):530-539. PMC: 10539104. DOI: 10.5271/sjweh.4049. View

12.

Iheanacho C, Eze U, Adida E . A systematic review of effectiveness of BNT162b2 mRNA and ChAdOx1 adenoviral vector COVID-19 vaccines in the general population. Bull Natl Res Cent. 2021; 45(1):150. PMC: 8383253. DOI: 10.1186/s42269-021-00607-w. View

13.

Polack F, Thomas S, Kitchin N, Absalon J, Gurtman A, Lockhart S . Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020; 383(27):2603-2615. PMC: 7745181. DOI: 10.1056/NEJMoa2034577. View

14.

Voysey M, Clemens S, Madhi S, Weckx L, Folegatti P, Aley P . Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2020; 397(10269):99-111. PMC: 7723445. DOI: 10.1016/S0140-6736(20)32661-1. View

15.

Sadoff J, Gray G, Vandebosch A, Cardenas V, Shukarev G, Grinsztejn B . Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19. N Engl J Med. 2021; 384(23):2187-2201. PMC: 8220996. DOI: 10.1056/NEJMoa2101544. View

16.

Harder T, Kulper-Schiek W, Reda S, Treskova-Schwarzbach M, Koch J, Vygen-Bonnet S . Effectiveness of COVID-19 vaccines against SARS-CoV-2 infection with the Delta (B.1.617.2) variant: second interim results of a living systematic review and meta-analysis, 1 January to 25 August 2021. Euro Surveill. 2021; 26(41). PMC: 8518304. DOI: 10.2807/1560-7917.ES.2021.26.41.2100920. View

17.

Antonelli M, Penfold R, Merino J, Sudre C, Molteni E, Berry S . Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis. 2021; 22(1):43-55. PMC: 8409907. DOI: 10.1016/S1473-3099(21)00460-6. View

18.

Kshirsagar M, Nasir M, Mukherjee S, Becker N, Dodhia R, Weeks W . The Risk of Hospitalization and Mortality After Breakthrough SARS-CoV-2 Infection by Vaccine Type: Observational Study of Medical Claims Data. JMIR Public Health Surveill. 2022; 8(11):e38898. PMC: 9645422. DOI: 10.2196/38898. View

19.

Gazit S, Shlezinger R, Perez G, Lotan R, Peretz A, Ben-Tov A . The Incidence of SARS-CoV-2 Reinfection in Persons With Naturally Acquired Immunity With and Without Subsequent Receipt of a Single Dose of BNT162b2 Vaccine : A Retrospective Cohort Study. Ann Intern Med. 2022; 175(5):674-681. PMC: 8855786. DOI: 10.7326/M21-4130. View

20.

Israel A, Merzon E, Schaffer A, Shenhar Y, Green I, Golan-Cohen A . Elapsed time since BNT162b2 vaccine and risk of SARS-CoV-2 infection: test negative design study. BMJ. 2021; 375:e067873. PMC: 9083235. DOI: 10.1136/bmj-2021-067873. View