CDC: COVID-19 Breakthrough Case Investigations and Reporting

 

#15,914

This weekend marks two weeks since my second COVID vaccination, and in the eyes of the CDC, I'm considered `fully vaccinated' and can relax some (but not all) of the pandemic precautions we have all been living under for the past year (see CDC Guidelines on How Fully Vaccinated People Can Visit Safely with Others).

As with everything in life, all of this comes with a caveat; fully vaccinated doesn't mean `fully protected'. 

While early data suggests that `fully vaccinated' individuals are far less likely to become infected, or if they do become infected - to develop serious disease - that protection isn't absolute.  No vaccine is 100% protective in 100% of the recipients.  

There is still a possibility that I could become infected, and even become ill enough to be hospitalized, or even die from COVID-19.  Not a strong possibility, perhaps. But a real one. 

So I won't be ditching the face covers and hand sanitizer anytime soon. I'll continue to avoid crowded, particularly indoor, spaces.  And I accept that between waning immunity and the likely introduction of new variants, I'll probably need a booster shot within a year. 

As time goes by, we should get a much clearer picture on how effective the COVID vaccines are in real-world settings, how long their protection lasts, and the impact that rising variants may have on them. 

Yesterday the CDC published their first weekly update on COVID-19 Breakthrough cases in fully vaccinated individuals, as reported by state and local health departments.   I'll have a brief postscript after the break.

COVID-19 Breakthrough Case Investigations and Reporting

 This page provides information and resources to help public health departments and laboratories investigate and report COVID-19 vaccine breakthrough cases.

• Vaccine breakthrough cases are expected. COVID-19 vaccines are effective and are a critical tool to bring the pandemic under control. However no vaccines are 100% effective at preventing illness. There will be a small percentage of people who are fully vaccinated who still get sick, are hospitalized, or die from COVID-19.
• More than 75 million people in the United States had been fully vaccinated as of April 14, 2021. Like with other vaccines, symptomatic vaccine breakthrough cases will occur, even though the vaccines are working as expected. Asymptomatic infections among vaccinated people also will occur.
• There is some evidence that vaccination may make illness less severe.
• Current data suggest that COVID-19 vaccines authorized for use in the United States offer protection against most SARS-CoV-2 variants circulating in the United States. However, variants will cause some of these vaccine breakthrough cases.

What CDC is doing

CDC is leading multiple vaccine effectiveness studies to ensure COVID-19 vaccines are working as expected. In addition, CDC is coordinating with state and local health departments to investigate SARS-CoV-2 infections among people who received COVID-19 vaccine and identify patterns or trends in:

• Patient characteristics, such as age or underlying medical conditions
• The specific vaccine that was administered
• Specific SARS-CoV-2 variants that causes the infection

Establishing a vaccine breakthrough case definition

A person who has SARS-CoV-2 RNA or antigen detected on a respiratory specimen collected ≥14 days after completing the primary series of a U.S. Food and Drug Administration (FDA)-authorized COVID-19 vaccine.

Identifying and investigating COVID-19 vaccine breakthrough cases

State health departments report vaccine breakthrough cases to CDC. CDC monitors reported cases for clustering by patient demographics, geographic location, time since vaccination, vaccine type or lot number, and SARS-CoV-2 lineage.

To the fullest extent possible, respiratory specimens that test positive for SARS-CoV-2 RNA are collected for genomic sequencing to identify the virus lineage that caused the infection.

In the coming weeks, CDC will transition from monitoring all reported vaccine breakthrough cases to focus on identifying and investigating only vaccine breakthrough infections that result in hospitalization or death. This shift will help maximize the quality of the data collected on cases of greatest clinical and public health importance.

Developing a data access and management system for COVID-19 vaccine breakthrough cases

• CDC has developed a national COVID-19 vaccine breakthrough REDCap database where designated state health department investigators can enter, store, and manage data for cases in their jurisdiction. State health departments have full access to data for cases reported from their jurisdiction.
• Ultimately, CDC will use the National Notifiable Diseases Surveillance System (NNDSS) to identify vaccine breakthrough cases. Once CDC has confirmed that a state can report vaccination history data to NNDSS, CDC will identify vaccine breakthrough cases through that system. At that time, the state health department will stop reporting cases directly into the national COVID-19 vaccine breakthrough REDCap database. CDC will upload the available data reported to NNDSS into the COVID-19 vaccine breakthrough REDCap database for further review and confirmation by the state health department.
  

COVID-19 vaccine breakthrough infections reported to CDC

• As of April 13, 2021, more than 75 million people in the United States had been fully vaccinated against COVID-19 since December 14, 2020.

• During the same time, CDC received 5,814 reports of vaccine breakthrough infections from 43 U.S. states and territories.

• Vaccine breakthrough infections were reported among people of all ages eligible for vaccination.

• 2,622 (45%) of the reported infections were among people ≥60 years of age. 

• 3,752 (65%) of the people experiencing a breakthrough infection were female.

• 1,695 (29%) of the vaccine breakthrough infections were reported as asymptomatic.

• 396 (7%) people with breakthrough infections were known to be hospitalized and 74 (1%) died.

• Of the 396 hospitalized patients, 133 (34%) were reported as asymptomatic or hospitalized for a reason not related to COVID-19.

• Of the 74 fatal cases, 9 (12%) were reported as asymptomatic or the patient died due to a cause not related to COVID-19.

• Hospitalizations and deaths that are not a direct result of COVID-19 are still considered vaccine breakthrough cases if the person was fully vaccinated and subsequently tested positive for COVID-19.

How to interpret these data

It is important to note that reported vaccine breakthrough cases will represent an undercount. This surveillance system is passive and relies on voluntary reporting from state health departments which may not be complete. Also, not all real-world breakthrough cases will be identified because of lack of testing. This is particularly true in instances of asymptomatic or mild illness. These surveillance data are a snapshot and help identify patterns and look for signals among vaccine breakthrough cases.

As CDC and state health departments shift to focus only on investigating vaccine breakthrough cases that result in hospitalization or death, those data will be regularly updated and posted every Friday.

COVID-19 Vaccines are Effective

• Vaccine breakthrough cases occur in only a small percentage of vaccinated persons. To date, no unexpected patterns have been identified in the case demographics or vaccine characteristics among people with reported vaccine breakthrough infections.
• COVID-19 vaccines are effective. CDC recommends that all eligible people get a COVID-19 vaccine as soon as one is available to them.
• CDC recommends that fully vaccinated people continue take steps to protect themselves and others in many situations, like wearing a mask, maintaining an appropriate social distance from others, avoiding crowds and poorly ventilated spaces, and washing their hands often.

(Continue . . . )

 

Despite the caveats and likely limitations of the vaccine, I'm quite happy to have received mine, and hope the roll out and uptake continues to be strong.  

Whether COVID vaccines can get us back to a pre-2020 state of normalcy is uncertain - particularly given whatever new threats may emerge - but we stand a much better chance of achieving an acceptable `new normal' with them, than we do without them.