Background Incidence rate of covid-19 infection in people vaccinated with 4th dose of RNA covid-19 vaccine remain subject of debate and is not clearly known Objective Estimate the incidence rate of covid-19 in vaccinated 4th dose people in general practitioner care level. Methodology An incidence rates epidemiological analysis of covid-19 infection in people with 4th dose of bivalent mRNA vaccines based in a longitudinal study from October, 2022 to October, 2023, in a general practice setting in Toledo, Spain. Results 21 cases of covid-19 infection in vaccinated people with 4th dose were included. Incidence rate of covid-19 infection in total vaccinated people with 4th dose from October 2022 to October 2023 was 2%; it was greater in > = 65 years vs. < 65 years (3% vs. 1%), and in women vs. men (2% vs. 1%). Regarding incidence rate of covid-19 infection in vaccinated people with 4th dose in general population of the office was 1%; It was again older at > = 65 years vs. < 65 years (1% vs. 0.5%), but without differences between women and men (1% vs. 1%). Conclusion In general practice setting in Toledo, Spain, crude incidence rate of covid-19 infection in vaccinated people with 4th dose and in general population of the office was low. However, the population segments of >= 65 years and women, even with fourth vaccine dose, have a higher risk of covid-19 infection, and consequently should continue receiving booster vaccine. But these results should be interpreted with caution since the number of tests carried out in the community was low