J Korean Med Sci.  2022 Aug;37(32):e252. 10.3346/jkms.2022.37.e252.

Breakthrough COVID-19 Infection During the Delta Variant Dominant Period: Individualized Care Based on Vaccination Status Is Needed

Affiliations
  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
  • 2Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
  • 3Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

Abstract

Background
The clinical features of coronavirus disease 2019 (COVID-19) patients in the COVID-19 vaccination era need to be clarified because breakthrough infection after vaccination is not uncommon.
Methods
We retrospectively analyzed hospitalized COVID-19 patients during a delta variantdominant period 6 months after the national COVID-19 vaccination rollout. The clinical characteristics and risk factors for severe progression were assessed and subclassified according to vaccination status.
Results
A total of 438 COVID-19 patients were included; the numbers of patients in the unvaccinated, partially vaccinated and fully vaccinated groups were 188 (42.9%), 117 (26.7%) and 133 (30.4%), respectively. The vaccinated group was older, less symptomatic and had a higher Charlson comorbidity index at presentation. The proportions of patients who experienced severe progression in the unvaccinated and fully vaccinated groups were 20.3% (31/153) and 10.8% (13/120), respectively. Older age, diabetes mellitus, solid cancer, elevated levels of lactate dehydrogenase and chest X-ray abnormalities were associated with severe progression, and the vaccination at least once was the only protective factor for severe progression. Chest X-ray abnormalities at presentation were the only predictor for severe progression among fully vaccinated patients.
Conclusion
In the hospitalized setting, vaccinated and unvaccinated COVID-19 patients showed different clinical features and risk of oxygen demand despite a relatively high proportion of patients in the two groups. Vaccination needs to be assessed as an initial checkpoint, and chest X-ray may be helpful for predicting severe progression in vaccinated patients.

Keyword

Breakthrough Infection; SARS-CoV-2; COVID-19; Severe Progression; Oxygen Therapy

Figure

  • Fig. 1 Study setting. A total of 438 patients were enrolled, 188 of whom were unvaccinated and 250 of whom were vaccinated. The vaccinated group was divided into the fully vaccinated group and the partially vaccinated group.

  • Fig. 2 Requirement for oxygen therapy at admission and during hospitalization among the unvaccinated (n = 188) and fully vaccinated groups (n = 133). The results are presented as the number of individuals in the UV group and the FV group. Among the 188 patients in UV group, 35 patients required oxygen at admission and 31 patients out of the other 153 patients (20.3%, 31/153) experienced clinical aggravation to need new oxygen requirement. Among the 133 patients in FV group, 13 patients required oxygen at admission and 13 patients out of the other 120 patients (10.8%, 13/120) experienced clinical aggravation to need new oxygen requirement.UV = unvaccinated, FV = fully vaccinated.


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