Risk Factors Associated With Hospitalization and Death in COVID-19 Breakthrough Infections

• Published in: Open forum infectious diseases Vol. 9; no. 5; p. ofac116
• Main Authors: Suleyman, Geehan, Fadel, Raef, Brar, Indira, Kassab, Rita, Khansa, Rafa, Sturla, Nicholas, Alsaadi, Ayman, Latack, Katie, Miller, Joseph, Tibbetts, Robert, Samuel, Linoj, Alangaden, George, Ramesh, Mayur
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.05.2022
• Subjects: COVID-19; Disease transmission; Hospitalization; Infections; Major; Risk factors; Severe acute respiratory syndrome coronavirus 2; COVID-19; breakthrough infections; outcomes; hospitalizations
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofac116

Abstract Background Characterizations of coronavirus disease 2019 (COVID-19) vaccine breakthrough infections are limited. We aim to characterize breakthrough infections and identify risk factors associated with outcomes. Methods This was a retrospective case series of consecutive fully vaccinated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a multicenter academic center in Southeast Michigan, between December 30, 2020, and September 15, 2021. Results A total of 982 patients were identified; the mean age was 57.9 years, 565 (59%) were female, 774 (79%) were White, and 255 (26%) were health care workers (HCWs). The median number of comorbidities was 2; 225 (23%) were immunocompromised. BNT162b2 was administered to 737 (75%) individuals. The mean time to SARS-CoV-2 detection was 135 days. The majority were asymptomatic or exhibited mild to moderate disease, 154 (16%) required hospitalization, 127 (13%) had severeâ€"critical illness, and 19 (2%) died. Age (odds ratio [OR], 1.14; 95% CI, 1.04â€"1.07; Pâ€...<â€...001), cardiovascular disease (OR, 3.02; 95% CI, 1.55â€"5.89; Pâ€...=â€...001), and immunocompromised status (OR, 2.57; 95% CI, 1.70â€"3.90; Pâ€...<â€...001) were independent risk factors for hospitalization. Additionally, age (OR, 1.06; 95% CI, 1.02â€"1.11; Pâ€...=â€...006) was significantly associated with mortality. HCWs (OR, 0.15; 95% CI, 0.05â€"0.50; Pâ€...=â€...002) were less likely to be hospitalized, and prior receipt of BNT162b2 was associated with lower odds of hospitalization (OR, 0.436; 95% CI, 0.303â€"0.626; Pâ€...<â€...001) and/or death (OR, 0.360; 95% CI, 0.145â€"0.898; Pâ€...=â€...029). Conclusions COVID-19 vaccines remain effective at attenuating disease severity. However, patients with breakthrough infections necessitating hospitalization may benefit from early treatment modalities and COVID-19-mitigating strategies, especially in areas with substantial or high transmission rates.