Long COVID Can Occur After Breakthrough Infection

A new study published yesterday in the peer-review Nature Medicine journal concluded, "COVID-19 vaccination partially reduces the risk of death and post-acute sequelae."

And, 'The burden of death and disease experienced by people with [breakthrough infection] is not trivial,' wrote these researchers on May 25, 2022.

The post-acute sequelae of severe acute respiratory SARS-CoV-2 infection, also referred to as Long COVID, have been described, but whether breakthrough SARS-CoV-2 infection (BTI) in vaccinated people results in post-acute sequelae was not apparent.

In this study, they used the US Department of Veterans Affairs national healthcare databases to build a cohort of 33,940 individuals with BTI and several controls of people without evidence of SARS-CoV-2 infection, including contemporary (n = 4,983,491), historical (n = 5,785,273) and vaccinated (n = 2,566,369) controls.

At six months after infection, these researchers showed that, beyond the first 30 days of illness, compared to contemporary controls, people with BTI exhibited a higher risk of death (hazard ratio (HR) = 1.75, 95% confidence interval (CI): 1.59, 1.93) and incident post-acute sequelae (HR = 1.50, 95% CI: 1.46, 1.54), including cardiovascular, coagulation and hematologic, gastrointestinal, kidney, mental health, metabolic, musculoskeletal and neurologic disorders.

The results were consistent in comparisons versus the historical and vaccinated controls.

Compared to people with SARS-CoV-2 infection who were not previously vaccinated (n = 113,474), people with BTI exhibited lower risks of death (HR = 0.66, 95% CI: 0.58, 0.74) and incident post-acute sequelae (HR = 0.85, 95% CI: 0.82, 0.89).

Altogether, these findings suggest that vaccination before infection confers only partial protection in the post-acute phase of the disease.

Hence, reliance on it as a sole mitigation strategy may not optimally reduce the long-term health consequences of SARS-CoV-2 infection stated these researchers.

This analysis suggests that this risk reduction (of post-acute sequelae) was most pronounced in recipients of BNT162b2 and mRNA-1273 vaccines compared to Ad26.COV2.S. 

'Although the absolute rates are smaller than those with SARS-CoV-2 infection without prior vaccination, given the scale of the pandemic and the potential for breakthrough cases to continue to accumulate, the overall burden of death and disease after BTI will likely be substantial.'

Note(s): This research was funded by the US Department of Veterans Affairs and two American Society of Nephrology and KidneyCure fellowship awards. No industry conflicts were disclosed. The funders had no role in the study design, data collection, analysis, publication decision, or manuscript preparation. The contents do not represent the views of the US Department of Veterans Affairs or the US government.

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