Time to reinfection and vaccine breakthrough SARS-CoV-2 infections: a retrospective cohort study

  1. Sevda Molani
  2. Andrew M. Baumgartner
  3. Yeon Mi Hwang
  4. Venkata R. Duvvuri
  5. Jason D. Goldman
  6. Jennifer J. Hadlock

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Abstract

Background

It is important to understand how BNT162b2, mRNA-1273, and JNJ-78436735 COVID-19 vaccines, as well as prior infection, protect against breakthrough cases and reinfections. Real world evidence on acquired immunity from vaccines, and from SARS-CoV-2 infection, can help public health decision-makers understand disease dynamics and viral escape to inform resource allocation for curbing the spread of pandemic.

Methods

This retrospective cohort study presents demographic information, survival functions, and probability distributions for 2,627,914 patients who received recommended doses of COVID-19 vaccines, and 63,691 patients who had a prior COVID-19 infection. In addition, patients receiving different vaccines were matched by age, sex, ethnic group, state of residency, and the quarter of the year in 2021 the COVID-19 vaccine was completed, to support survival analysis on pairwise matched cohorts.

Findings

Each of the three vaccines and infection-induced immunity all showed a high probability of survival against breakthrough or reinfection cases (mRNA-1273: 0.997, BNT162b2: 0.997, JNJ-78436735: 0.992, previous infection: 0.965 at 180 days). The incidence rate of reinfection among those unvaccinated and previously infected was higher than that of breakthrough among the vaccinated population (reinfection: 0.9%; breakthrough:0.4%). In addition, 280 vaccinated patients died (0.01% all-cause mortality) within 21 days of the last vaccine dose, and 5898 (3.1 %) died within 21 days of a positive COVID-19 test.

Conclusions

Despite a gradual decline in vaccine-induced and infection-induced immunity, both acquired immunities were highly effective in preventing breakthrough and reinfection. In addition, for unvaccinated patients with COVID-19, those who did not die within 90 days of their initial infection (9565 deaths, 5.0% all-cause mortality rate), had a comparable asymptotic pattern of breakthrough infection as those who acquired immunity from a vaccine. Overall, the risks associated with COVID-19 infection are far greater than the marginal advantages of immunity acquired by prior infection.

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  1. ScreenIT

    SciScore for 10.1101/2022.02.07.22270613: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: This study was approved by the Institutional Review Board (IRB) at PSJH with Study Number STUDY2020000196.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We use the python package scikit-learn v0.23.2 (20) to calculate and match propensity scores.
    python
    suggested: (IPython, RRID:SCR_001658)
    scikit-learn
    suggested: (scikit-learn, RRID:SCR_002577)

    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: We detected the following sentences addressing limitations in the study:
    Strengths and Limitations: In this study, we characterized both vaccine-induced immunity cohort and infection-induced immunity cohort. Direct comparison between vaccine-induced and infection-induced immunity cohorts is unreasonable because it is difficult to establish the time that the infection-induced immunity cohort recovered from COVID-19 and gained immunity. We instead conducted parallel analyses between vaccine-induced and infection-induced immunity cohorts. We analyzed a large sample that represents the general population of the U.S. west coast. Previous published studies in the U.S. (9,23–27) are limited to a cohort with specific characteristics, such as health-care workers (6,15,23,27), patients with specific comorbidities (28–30), veterans (9,24,29,31), patients of academic hospitals (32,33). PSJH is a community-served hospital that covers five states of the west coast in both rural and urban areas. As we observed consistent results regarding vaccine-induced immunity (mRNA-1273 > BNT162b2 > JNJ-78436735) from previous studies (9,10,15) conducted in a cohort with special characteristics, our result adds validity and increases generalizability of previous studies. To our knowledge, our study had the longest observed duration for time to breakthrough/reinfection, encompassing both waning vaccine- and infection-induced immunity (21,34,35) and evolving variants (36). We performed propensity score matching analysis pairwise between individual vaccines. We had a total of 2...

    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.

  2. Version published to 10.1101/2022.02.07.22270613 on medRxiv