In-depth Characterization of Vaccine Breakthrough Infections With SARS-CoV-2 Among Health Care Workers in a Dutch Academic Medical Center

Lidewij W Rümke; Femke C Groenveld; Yvonne M G van Os; Patrique Praest; Anniek A N Tanja; Dorien T C M de Jong; Jori Symons; Rob Schuurman; Tessa Reinders; L Marije Hofstra; Stefan Nierkens; Steven F T Thijsen; Michiel Heron; Robert-Jan Lebbink; Jeffrey M Beekman; Monique Nijhuis; Annemarie M J Wensing

doi:10.1093/ofid/ofab553

In-depth Characterization of Vaccine Breakthrough Infections With SARS-CoV-2 Among Health Care Workers in a Dutch Academic Medical Center

Open Forum Infect Dis. 2021 Nov 6;9(1):ofab553. doi: 10.1093/ofid/ofab553. eCollection 2022 Jan.

Authors

Lidewij W Rümke¹, Femke C Groenveld¹, Yvonne M G van Os², Patrique Praest¹, Anniek A N Tanja¹, Dorien T C M de Jong¹, Jori Symons¹, Rob Schuurman¹, Tessa Reinders¹, L Marije Hofstra¹, Stefan Nierkens³, Steven F T Thijsen⁴, Michiel Heron⁴, Robert-Jan Lebbink¹, Jeffrey M Beekman^{5

6}, Monique Nijhuis¹, Annemarie M J Wensing¹

Affiliations

¹ Virology, Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands.
² Occupational Health Office, Department of Human Resources, University Medical Center Utrecht, Utrecht, the Netherlands.
³ Center for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands.
⁴ Department of Medical Microbiology & Immunology, Utrecht, the Netherlands.
⁵ Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, Utrecht, the Netherlands.
⁶ Regenerative Medicine Center Utrecht, University Medical Center, Utrecht University, Utrecht, the Netherlands.

Abstract

Severe acute respiratory syndrome coronavirus 2 infection after coronavirus disease 2019 vaccination raises concerns about the emergence of vaccine escape variants. Here we characterize 14 breakthrough infections among 5860 fully vaccinated Dutch health care workers ≥14 days after the final dose of vaccination with either BNT162b2, mRNA-1273, or Ad26.COV2.S. These breakthrough infections presented with regular B.1.1.7 (Alpha) and B.1.617.2 (Delta) variants and high viral loads, despite normal vaccine-induced B- and T-cell immune responses detected by live virus neutralization assays and ELISpot. High-risk exposure settings, such as in households, indicate a potential risk of viral transmission despite full vaccination.

Keywords: COVID-19; SARS-CoV-2; immunity; postvaccination infection; vaccine breakthrough.