Risk Factors Associated With SARS-CoV-2 Breakthrough Infections in Fully mRNA-Vaccinated Individuals: Retrospective Analysis.

Abstract

BACKGROUND:

COVID-19 messenger RNA (mRNA) vaccines have demonstrated efficacy and effectiveness in preventing symptomatic COVID-19, while being relatively safe in trial studies. However, vaccine breakthrough infections have been reported.

OBJECTIVE:

This study aims to identify risk factors associated with COVID-19 breakthrough infections among fully mRNA-vaccinated individuals.

METHODS:

We conducted a series of observational retrospective analyses using the electronic health records (EHRs) of the Columbia University Irving Medical Center/New York Presbyterian (CUIMC/NYP) up to September 21, 2021. New York City (NYC) adult residences with at least 1 polymerase chain reaction (PCR) record were included in this analysis. Poisson regression was performed to assess the association between the breakthrough infection rate in vaccinated individuals and multiple risk factors-including vaccine brand, demographics, and underlying conditions-while adjusting for calendar month, prior number of visits, and observational days in the EHR.

RESULTS:

The overall estimated breakthrough infection rate was 0.16 (95% CI 0.14-0.18). Individuals who were vaccinated with Pfizer/BNT162b2 (incidence rate ratio [IRR] against Moderna/mRNA-1273=1.66, 95% CI 1.17-2.35) were male (IRR against female=1.47, 95% CI 1.11-1.94) and had compromised immune systems (IRR=1.48, 95% CI 1.09-2.00) were at the highest risk for breakthrough infections. Among all underlying conditions, those with primary immunodeficiency, a history of organ transplant, an active tumor, use of immunosuppressant medications, or Alzheimer disease were at the highest risk.

CONCLUSIONS:

Although we found both mRNA vaccines were effective, Moderna/mRNA-1273 had a lower incidence rate of breakthrough infections. Immunocompromised and male individuals were among the highest risk groups experiencing breakthrough infections. Given the rapidly changing nature of the SARS-CoV-2 pandemic, continued monitoring and a generalizable analysis pipeline are warranted to inform quick updates on vaccine effectiveness in real time.

• Authors: Cong Liu, Junghwan Lee, Casey Ta, Ali Soroush, James R Rogers, Jae Hyun Kim, Karthik Natarajan, Jason Zucker, Yehoshua Perl, Chunhua Weng
• Journal: JMIR public health and surveillance (JMIR Public Health Surveill) Vol. 8 Issue 5 Pg. e35311 (05 24 2022) ISSN: 2369-2960 [Electronic] Canada
• PMID: 35486806 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: ©Cong Liu, Junghwan Lee, Casey Ta, Ali Soroush, James R Rogers, Jae Hyun Kim, Karthik Natarajan, Jason Zucker, Yehoshua Perl, Chunhua Weng. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 24.05.2022.

Chemical References

• 2019-nCoV Vaccine mRNA-1273
• BNT162 Vaccine

Topics

• 2019-nCoV Vaccine mRNA-1273 (administration & dosage)
• Adult
• BNT162 Vaccine (administration & dosage)
• COVID-19 (epidemiology, prevention & control)
• Female
• Humans
• Male
• New York City (epidemiology)
• Retrospective Studies
• Risk Factors