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Updated: Nov 7, 2025

Live Imaging and Quantification of Viral Infection in K18 hACE2 Transgenic Mice Using Reporter-Expressing Recombinant SARS-CoV-2
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Published on: November 5, 2021

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COVID-19 Outbreak Associated with a SARS-CoV-2 R.1 Lineage Variant in a Skilled Nursing Facility After Vaccination

Alyson M Cavanaugh, Sarah Fortier, Patricia Lewis

    MMWR. Morbidity and Mortality Weekly Report
    |April 29, 2021
    PubMed

    Insights

    COVID-19 mRNA vaccines significantly reduced symptomatic infections by 87% during an R.1 variant outbreak in a skilled nursing facility. Vaccination remains critical for protecting vulnerable populations and healthcare workers.

    Area of Science:

    • Epidemiology
    • Vaccinology
    • Infectious Diseases

    Background:

    • COVID-19 mRNA vaccines show high efficacy but are not 100% effective.
    • Limited data exist on vaccine effectiveness in skilled nursing facilities (SNFs) and against SARS-CoV-2 variants.
    • An outbreak occurred in a SNF after vaccination was offered to all residents and healthcare personnel (HCP).

    Purpose of the Study:

    • To investigate a COVID-19 outbreak in a SNF.
    • To assess vaccine effectiveness against the SARS-CoV-2 R.1 variant in a SNF setting.
    • To evaluate the impact of vaccination on symptomatic COVID-19 in residents and HCP.

    Main Methods:

    • Retrospective investigation of a COVID-19 outbreak in a SNF.
    • Analysis of vaccination status and SARS-CoV-2 test results for residents and HCP.
    • Whole genome sequencing (WGS) to identify the circulating SARS-CoV-2 variant.

    Main Results:

    • The outbreak involved 26 unvaccinated and vaccinated residents and 20 unvaccinated and vaccinated HCP.
    • An R.1 lineage variant with multiple spike protein mutations was detected.
    • Vaccinated residents and HCP were 87% less likely to have symptomatic COVID-19 compared to unvaccinated individuals.

    Conclusions:

    • Vaccination of SNF populations, including HCP, is crucial for reducing SARS-CoV-2 introduction, transmission, and severe outcomes.
    • Despite high vaccine efficacy, breakthrough infections can occur, necessitating continued infection prevention and control.
    • Vaccination provides significant protection against symptomatic COVID-19, even with emerging variants like R.1.

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