Clinical and immunological benefits of full primary COVID-19 vaccination in individuals with SARS-CoV-2 breakthrough infections: A prospective cohort study in non-hospitalized adults

Prelog, Martina ; Jeske, Samuel D. ; Asam, Claudia ; Fuchs, Andre ; Wieser, Andreas ; Gall, Christine ; Wytopil, Monika ; Mueller-Schmucker, Sandra M. ; Beileke, Stephanie ; Goekkaya, Mehmet ; Kling, Elisabeth ; Geldmacher, Christof ; Rubio-Acero, Raquel ; Plank, Michael ; Christa, Catharina ; Willmann, Annika ; Vu, Martin ; Einhauser, Sebastian ; Weps, Manuela ; Lampl, Benedikt M. J. ; Almanzar, Giovanni ; Kousha, Kimia ; Schwägerl, Valeria ; Liebl, Bernhard ; Weber, Beatrix ; Drescher, Johannes ; Scheidt, Jörg ; Gefeller, Olaf ; Messmann, Helmut ; Protzer, Ulrike ; Liese, Johannes ; Hoelscher, Michael ; Wagner, Ralf ; Überla, Klaus ; Steininger, Philipp

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Details

Item type:	Article
Journal or Publication Title:	Journal of Clinical Virology
Publisher:	Elsevier
Volume:	170
Page Range:	p. 105622
Date:	28 November 2023
Institutions:	Medicine > Lehrstuhl für Medizinische Mikrobiologie und Hygiene Medicine > Institut für Epidemiologie und Präventivmedizin Medicine > Institut für Epidemiologie und Präventivmedizin > Lehrstuhl für Epidemiologie
Identification Number:	Value Type 10.1016/j.jcv.2023.105622 DOI
Keywords:	SARS-CoV-2, Breakthrough infection, Vaccine effectiveness, COVID-19 symptoms, Antibodies, Viral load
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Partially
Item ID:	77481

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Abstract

Background SARS-CoV-2 variants of concern (VOC) may result in breakthrough infections (BTIs) in vaccinated individuals. The aim of this study was to investigate the effects of full primary (two-dose) COVID-19 vaccination with wild-type-based SARS-CoV-2 vaccines on symptoms and immunogenicity of SARS-CoV-2 VOC BTIs. Methods In a longitudinal multicenter controlled cohort study in Bavaria, ...

Abstract

Background
SARS-CoV-2 variants of concern (VOC) may result in breakthrough infections (BTIs) in vaccinated individuals. The aim of this study was to investigate the effects of full primary (two-dose) COVID-19 vaccination with wild-type-based SARS-CoV-2 vaccines on symptoms and immunogenicity of SARS-CoV-2 VOC BTIs.
Methods
In a longitudinal multicenter controlled cohort study in Bavaria, Germany, COVID-19 vaccinated and unvaccinated non-hospitalized individuals were prospectively enrolled within 14 days of a PCR-confirmed SARS-CoV-2 infection. Individuals were visited weekly up to 4 times, performing a structured record of medical data and viral load assessment. SARS-CoV-2-specific antibody response was characterized by anti-spike-(S)- and anti-nucleocapsid-(N)-antibody concentrations, anti-S-IgG avidity and neutralization capacity.
Results
A total of 300 individuals (212 BTIs, 88 non-BTIs) were included with VOC Alpha or Delta SARS-CoV-2 infections. Full primary COVID-19 vaccination provided a significant effectiveness against five symptoms (relative risk reduction): fever (33 %), cough (21 %), dysgeusia (22 %), dizziness (52 %) and nausea/vomiting (48 %). Full primary vaccinated individuals showed significantly higher 50 % inhibitory concentration (IC50) values against the infecting VOC compared to unvaccinated individuals at week 1 (269 vs. 56, respectively), and weeks 5–7 (1,917 vs. 932, respectively) with significantly higher relative anti-S-IgG avidity (78% vs. 27 % at week 4, respectively).
Conclusions
Full primary COVID-19 vaccination reduced symptom frequencies in non-hospitalized individuals with BTIs and elicited a more rapid and longer lasting neutralization capacity against the infecting VOC compared to unvaccinated individuals. These results support the recommendation to offer at least full primary vaccination to all adults to reduce disease severity caused by immune escape-variants.

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