Resident Factors Associated With Breakthrough SARS-CoV-2 Infections

Ana Montoya; Katherine Wen; Jasmine L Travers; Maricruz Rivera-Hernandez; Elizabeth White; Vincent Mor; Sarah D Berry

doi:10.1016/j.jamda.2023.02.102

Resident Factors Associated With Breakthrough SARS-CoV-2 Infections

J Am Med Dir Assoc. 2023 Jun;24(6):901-905. doi: 10.1016/j.jamda.2023.02.102. Epub 2023 Mar 2.

Authors

Ana Montoya¹, Katherine Wen², Jasmine L Travers³, Maricruz Rivera-Hernandez⁴, Elizabeth White⁴, Vincent Mor⁴, Sarah D Berry⁵

Affiliations

¹ Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. Electronic address: amontoya@med.umich.edu.
² Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, USA.
³ Rory Meyers College of Nursing, New York University, New York, NY, USA.
⁴ Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
⁵ Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Medicine & Harvard Medical Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Abstract

Objective: To examine incidence of and resident characteristics associated with breakthrough infections (BTIs) and severe illness among residents with 2 messenger RNA (mRNA) vaccinations.

Design: Retrospective cohort study.

Setting and participants: Nursing home (NH) residents who completed their primary series of mRNA COVID-19 vaccination by March 31, 2021.

Methods: Electronic health records and Minimum Data Set assessments from a multistate NH data consortium were used to identify BTI and severe illness (a composite measure of hospitalization and/or death within 30 days of BTI) occurring prior to November 24, 2021. A t test for differences in means was used to compare covariates for residents with and without BTI. Finally, we estimated incidence rate ratios (IRRs) for BTI with 95% CIs using a modified Poisson regression approach, comparing residents with BTI vs residents without. We adjusted for facility fixed effects in our model.

Results: Our sample included 23,172 residents from 984 NHs who were at least 14 days past their second mRNA vaccine dose. Of those, 1173 (5%) developed an incident COVID-19 BTI (mean follow-up time: 250 days). Among residents with BTI, 8.6% were hospitalized or died within 30 days of BTI diagnosis. Factors associated with severe illness included age ≥85 years (IRR 2.08, 95% CI 1.08-4.02, reference age <65 years), bowel incontinence (IRR 1.73, 95% CI 1.01-2.99), coronary artery disease (IRR 1.96, 95% CI 1.31-2.94), chronic kidney disease (IRR 1.65, 95% CI 1.07-2.54), and schizophrenia (IRR 2.38, 95% CI 1.19-4.75).

Conclusions and implications: Among vaccinated NH residents, BTIs and associated severe illness are rare. Residents aged ≥85 years and with certain comorbidities appear to be the most vulnerable. Given that the pandemic continues and testing policies have relaxed, these data provide prognostic information for NH facilities faced with continued outbreaks.

Keywords: COVID-19; breakthrough infections; nursing homes.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

COVID-19 Vaccines
COVID-19*
Humans
Nursing Homes
Retrospective Studies
SARS-CoV-2

Substances

COVID-19 Vaccines

Grants and funding

U54 AG063546/AG/NIA NIH HHS/United States