Abstract Background Post-vaccination infections challenge the control of the COVID-19 pandemic. Methods We matched 119 cases of post-vaccination SARS-CoV-2 infection with BNT162b2 mRNA, or ChAdOx1 nCOV-19, to 476 unvaccinated patients with COVID-19 (Sept 2020-March 2021), according to age and sex. Differences in 60-day all-cause mortality, hospital admission, and hospital length of stay were evaluated. Phylogenetic, single nucleotide polymorphism (SNP) and minority variant allele (MVA) full genome sequencing analysis was performed. Results 116/119 cases developed COVID-19 post first vaccination dose (median 14 days, IQR 9 – 24 days). Overall, 13/119 (10∙9%) cases and 158/476 (33∙2%) controls died (p<0.001), corresponding to 4∙5 number needed to treat (NNT). Multivariably, vaccination was associated with 69∙3% (95%CI 45∙8 – 82∙6) relative risk (RR) reduction in mortality. Similar results were seen in subgroup analysis for patients with infection onset ≥14 days after first vaccination (RR reduction 65∙1%, 95%CI 27∙2 – 83∙2, NNT 4∙5), and across vaccine subgroups (BNT162b2: RR reduction 66%, 95%CI 34∙9 – 82∙2, NNT 4∙7, ChAdOx1: RR reduction 78∙4%, 95%CI 30∙4 – 93∙3, NNT 4∙1). Hospital admissions (OR 0∙80, 95%CI 0∙51 – 1∙28), and length of stay (-1∙89 days, 95%CI -4∙57 – 0∙78) were lower for cases, while Ct values were higher (30∙8 versus 28∙8, p = 0.053). B.1.1.7 was the predominant lineage in cases (100/108, 92.6%) and controls (341/446, 76.5%). Genomic analysis identified one post-vaccination case harboring the E484K vaccine escape mutation (B.1.525 lineage). Conclusions Previous vaccination reduces mortality when B.1.1.7 is the predominant lineage. No significant lineage-specific genomic changes during phylogenetic, SNP and MVA analysis were detected.
【저자키워드】 COVID-19, vaccination, Mutation, Mortality, Genomics, 【초록키워드】 Vaccine, SARS-COV-2 infection, COVID-19 pandemic, hospital, variant, Infection, polymorphism, risk, Relative risk, BNT162b2, Genome sequencing, Single nucleotide polymorphism, B.1.1.7, Patient, Lineage, Control, SNP, E484K, Genomic analysis, Hospital admission, single nucleotide, Admission, ChAdOx1, escape mutation, ChAdOx1 nCoV-19, BNT162b2 mRNA, nucleotide, Analysis, dose, Ct values, Phylogenetic, Hospital admissions, with infection, subgroup, 95%CI, all-cause mortality, treat, allele, subgroup analysis, first vaccination, B.1.525, reduction in mortality, RR reduction, difference, Result, died, evaluated, was performed, median, reduce, predominant, age and sex, genomic change, IQR, NNT, patients with COVID-19, 【제목키워드】 Breakthrough infection, case-control study, vaccinated individual,