Impact of COVID‐19 vaccination on transmission risk of breakthrough infections: Lessons from adapted N95 mask sampling for emerging variants and interventions

  1. Kalpana Sriraman
  2. Ambreen Shaikh
  3. Smriti Vaswani
  4. Tejal Mestry
  5. Grishma Patel
  6. Shalini Sakthivel
  7. Vikas Oswal
  8. Pratibha Kadam
  9. Kayzad Nilgiriwala
  10. Daksha Shah
  11. Mangala Gomare
  12. Nerges Mistry

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Abstract

This study used an adapted N95 mask sampling to understand the effect of COVID‐19 vaccination in the context of circulating variants on infected individuals to emit the virus into the air, a key risk factor of transmission. Mask, swab, and blood samples were collected from 92 COVID‐19 patients vaccinated (Covishield/COVAXIN‐partial/fully) or unvaccinated between July and September 2021 during the Delta‐dominated period in Mumbai. Mask/swab samples were analyzed by reverse transcription polymerase chain reaction for viral RNA. Blood was evaluated for SARS‐CoV‐2 anti‐spike and nucleocapsid antibody responses. At <48 h of diagnosis, 93% of the patients emitted detectable viral RNA, with 40% emitting >1000 copies in 30 min (high emitters). About 8% continued to be high emitters even after 8 days of symptom onset. No significant difference was observed in emission patterns between partial, full, and unvaccinated patients. However, when vaccinated patients were stratified based on spike protein neutralization and nucleocapsid immunoglobulin G (IgG), the group with moderate/high neutralization showed a significantly lower proportion of high emitters and viral RNA copies than the group with no/low neutralization, which further reduced in the group having antinucleocapsid IgG. In conclusion, mask sampling showed that Delta infections were associated with greater virus emission in patients, which was significantly reduced only in vaccinated patients with moderate/high SARS‐CoV‐2 neutralization, especially with evidence of past infection. The study demonstrated that mask sampling could be useful for understanding the transmission risk of emerging variants, screening vaccine/booster candidates, and guiding control interventions.

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  1. Version published to 10.1002/jmv.28188
  2. ScreenIT

    SciScore for 10.1101/2022.03.02.22271385: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Patient Recruitment and Sample Collection: The study was undertaken between July - September 2021 after the approval by the Institutional Research Ethics Committee at the Foundation for Medical Research (
    Field Sample Permit: Patient enrolment involving written consent and first sample collection was carried out within 48 hours of the RT-PCR diagnosis.
    Consent: Patient enrolment involving written consent and first sample collection was carried out within 48 hours of the RT-PCR diagnosis.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power AnalysisWhere necessary, a power analysis was carried out to evaluate the impact of sample size on the reported results using the Openepi tool (15).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All samples with Ct value <33 (n=83) were subjected to whole-genome sequencing (WGS) by the Oxford Nanopore sequencing using MinION (13), and viral lineage was determined in 75/83 samples using the PANGOLIN tool (v3.1.17) (14).
    WGS
    suggested: None
    MinION
    suggested: (MinION, RRID:SCR_017985)
    Statistical analysis: Results were statistically analyzed using Graph Pad Prism software (version 9).
    Graph Pad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    Probit modelling was performed with MedCalc version 20.019 (
    MedCalc
    suggested: (MedCalc, RRID:SCR_015044)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2022.03.02.22271385 on medRxiv