Abstract
COVID-19 vaccine breakthrough infection surveillance helps monitor trends in disease incidence and severe outcomes in fully vaccinated persons, including the impact of the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19. Reported COVID-19 cases, hospitalizations, and deaths occurring among persons aged ≥18 years during April 4-July 17, 2021, were analyzed by vaccination status across 13 U.S. jurisdictions that routinely linked case surveillance and immunization registry data. Averaged weekly, age-standardized incidence rate ratios (IRRs) for cases among persons who were not fully vaccinated compared with those among fully vaccinated persons decreased from 11.1 (95% confidence interval [CI]=7.8-15.8) to 4.6 (95% CI=2.5-8.5) between two periods when prevalence of the Delta variant was lower (<50% of sequenced isolates; April 4-June 19) and higher (≥50%; June 20-July 17), and IRRs for hospitalizations and deaths decreased between the same two periods, from 13.3 (95% CI=11.3-15.6) to 10.4 (95% CI=8.1-13.3) and from 16.6 (95% CI=13.5-20.4) to 11.3 (95% CI=9.1-13.9). Findings were consistent with a potential decline in vaccine protection against confirmed SARS-CoV-2 infection and continued strong protection against COVID-19-associated hospitalization and death. Getting vaccinated protects against severe illness from COVID-19, including the Delta variant, and monitoring COVID-19 incidence by vaccination status might provide early signals of changes in vaccine-related protection that can be confirmed through well-controlled vaccine effectiveness (VE) studies.
Highlights
Age-standardized incidence rate ratios (IRRs) for cases among persons who were not fully vaccinated compared with those among fully vaccinated persons decreased from 11.1 (95% confidence interval [CI] = 7.8–15.8) to 4.6 between two periods when prevalence of the Delta variant was lower (
The IRR for cases among persons not fully vaccinated versus fully vaccinated decreased substantially; IRRs for hospitalizations and deaths changed less overall, but moderately among adults aged ≥65 years. Findings from this crude analysis of surveillance data are consistent with recent studies reporting decreased vaccine effectiveness (VE) against confirmed infection but not hospitalization or death, during a period of Delta variant predominance and potential waning of vaccine-induced population immunity [4,5,6].†††
Variable linkage of case surveillance, vaccination, hospitalization, and mortality data might have resulted in misclassifications that could influence IRR estimates; no substantial differences in ascertainment of outcomes by vaccination status were noted in jurisdictions that were able to assess this
Summary
Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status — 13 U.S Jurisdictions, April 4–July 17, 2021. April 4–June 19 and June 20–July 17, were designated, based on weeks with
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