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Hospitalised patients with breakthrough COVID-19 following vaccination during two distinct waves in Israel, January to August 2021: a multicentre comparative cohort study.

ABSTRACT: BackgroundChanging patterns of vaccine breakthrough can clarify vaccine effectiveness.AimTo compare breakthrough infections during a SARS-CoV-2 Delta wave vs unvaccinated inpatients, and an earlier Alpha wave.MethodsIn an observational multicentre cohort study in Israel, hospitalised COVID-19 patients were divided into three cohorts: breakthrough infections in Comirnaty-vaccinated patients (VD; Jun-Aug 2021) and unvaccinated cases during the Delta wave (ND) and breakthrough infections during an earlier Alpha wave (VA; Jan-Apr 2021). Primary outcome was death or ventilation.ResultsWe included 343 VD, 162 ND and 172 VA patients. VD were more likely older (OR: 1.06; 95% CI: 1.05-1.08), men (OR: 1.6; 95% CI: 1.0-2.5) and immunosuppressed (OR: 2.5; 95% CI: 1.1-5.5) vs ND. Median time between second vaccine dose and admission was 179 days (IQR: 166-187) in VD vs 41 days (IQR: 28-57.5) in VA. VD patients were less likely to be men (OR: 0.6; 95% CI: 0.4-0.9), immunosuppressed (OR: 0.3; 95% CI: 0.2-0.5) or have congestive heart failure (OR: 0.6; 95% CI: 0.3-0.9) vs VA. The outcome was similar between all cohorts and affected by age and immunosuppression and not by vaccination, variant or time from vaccination.ConclusionsVaccination was protective during the Delta variant wave, as suggested by older age and greater immunosuppression in vaccinated breakthrough vs unvaccinated inpatients. Nevertheless, compared with an earlier post-vaccination period, breakthrough infections 6 months post-vaccination occurred in healthier patients. Thus, waning immunity increased vulnerability during the Delta wave, which suggests boosters as a countermeasure.

SUBMITTER: Brosh-Nissimov T

PROVIDER: S-EPMC9121662 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Hospitalised patients with breakthrough COVID-19 following vaccination during two distinct waves in Israel, January to August 2021: a multicentre comparative cohort study.

Brosh-Nissimov Tal T Maor Yasmin Y Elbaz Meital M Lipman-Arens Shelly S Wiener-Well Yonit Y Hussein Khetam K Orenbuch-Harroch Efrat E Cohen Regev R Zimhony Oren O Chazan Bibiana B Nesher Lior L Rahav Galia G Zayyad Hiba H Hershman-Sarafov Mirit M Weinberger Miriam M Najjar-Debbiny Ronza R Chowers Michal M

Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 20220501 20

BackgroundChanging patterns of vaccine breakthrough can clarify vaccine effectiveness.AimTo compare breakthrough infections during a SARS-CoV-2 Delta wave vs unvaccinated inpatients, and an earlier Alpha wave.MethodsIn an observational multicentre cohort study in Israel, hospitalised COVID-19 patients were divided into three cohorts: breakthrough infections in Comirnaty-vaccinated patients (VD; Jun-Aug 2021) and unvaccinated cases during the Delta wave (ND) and breakthrough infections during an ...[more]

PMID: 35593161

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Project description:BackgroundThe COVID-19 pandemic caused four waves of infection in Israel until October 2021. Israel was the first country to offer vaccinations to all the adult population followed by boosters. This study addresses how mortality rates reflect the effects of the pandemic.MethodsTotal mortality rates and rates of mortality without COVID-19 deaths (non-COVID-19 mortality) between March 2020 and October 2021 were compared with the average pre-COVID-19 rates in 2017-2019 by month, population group and by age group. In addition, a cohort vaccinated at least once by 31 March 2021 was followed up for mortality in the following seven months compared to the corresponding months in 2017-2019.ResultsA small number of excess deaths was found in the first wave and a greater excess in the following waves. The monthly mortality rate ratio was highest in October 2020, 23% higher than the average in 2017-2019, followed by August 2021 (22%), September 2021 (20%) and September 2020 (19%). Excess mortality in the Arab population was greater than for Jews and Others, and they had 65% and 43% higher mortality in September and October, 2020, 20-44% higher mortality between December 2020 and April 2021 and 33%, 45% and 22% higher mortality in August, September and October 2021, respectively. In most months of the pandemic, the non-COVID-19 mortality rates were not significantly different from those in 2017-2019. However, between November 2020 and March 2021, they were significantly lower for the total population and Jews and Others. They were significantly higher for the total population only in August 2021, and particularly for the Arab population. Non-COVID-19 mortality was also lower for most sex/age groups over the total study period. In a cohort of 5.07 million Israeli citizens vaccinated at least once by 31 March, 2021, age adjusted and age specific mortality rates for the following 7 months were lower than the average rates in 2017-2019 for these months, CONCLUSION: Israel has seen significant excess mortality during the COVID-19 pandemic, particularly in the Arab sector. Following lockdowns and administration of vaccinations excess mortality was reduced, and no excess mortality was seen amongst the vaccinated in the months after the vaccination campaign. These findings highlight the importance of public health measures such as mandating mask wearing and population vaccinations to control infection and reduce mortality.

Dataset Information

Hospitalised patients with breakthrough COVID-19 following vaccination during two distinct waves in Israel, January to August 2021: a multicentre comparative cohort study.

Publications

Hospitalised patients with breakthrough COVID-19 following vaccination during two distinct waves in Israel, January to August 2021: a multicentre comparative cohort study.

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