Skip to main content

Master of Public Health

Incidence and predictors of breakthrough and severe breakthrough infections of SARS-CoV-2 after primary series vaccination in adults: A population-based survey of 22,575 participants

AUTHORS

DeSantis SM , Yaseen A , Hao T , León-Novelo L , Talebi Y , Valerio-Shewmaker MA , Pinzon Gomez CL , Messiah SE , Kohl HW , Kelder SH , Ross JA , Padilla LN , Silberman M , Tuzo S , Lakey D , Shuford JA , Pont SJ , Boerwinkle E , Swartz MD , . The Journal of infectious diseases. 2023 2 2; ().

ABSTRACT

BACKGROUND: Breakthrough infections of SARS-CoV-2 are well-documented. The current study estimates breakthrough incidence across pandemic waves, and evaluates predictors of breakthrough and severe breakthrough infections (defined as those requiring hospitalization).

METHODS: 89,762 participants underwent longitudinal antibody surveillance. Incidence rates were calculated using total person-days contributed. Bias-corrected and age-adjusted logistic regression determined multivariable predictors of breakthrough and severe breakthrough infection, respectively.

RESULTS: The incidence was 0.45 (0.38, 0.50) during pre-Delta, 2.80 (2.25, 3.14) during Delta, and 11.2 (8.80, 12.95) during Omicron, per 10,000 person-days. Factors associated with elevated odds of breakthrough included Hispanic ethnicity (vs non-Hispanic White, OR=1.243[1.073, 1.441]), larger household size (OR=1.251 [1.048, 1.494] for 3-5 vs. 1 and OR=1.726 [1.317, 2.262] for more than 5 vs. 1 person), rural vs urban living (OR=1.383 [1.122, 1.704]), receiving Pfizer or Johnson&Johnson vs. Moderna, and multiple comorbidities. Of the 1,700 breakthrough infections, 1,665 reported on severity; 112 (6.73%) were severe. Higher BMI, Hispanic ethnicity, vaccine type, asthma, and hypertension predicted severe breakthroughs.

CONCLUSION: Breakthrough infection was 4-25 times more common during the Omicron-dominant wave versus earlier waves. Higher burden of severe breakthrough infections was identified in subgroups.

Tags: