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Breakthrough COVID-19 Infection During the Delta Variant Dominant Period: Individualized Care Based on Vaccination
Chan Mi Lee1,2, Eunyoung Lee1,2, Wan Beom Park1
1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Insights
COVID-19 vaccination reduced severe progression in hospitalized patients, even during the Delta variant surge. Vaccinated individuals had different clinical features, and chest X-rays can predict severe outcomes in this group.
Area of Science:
- Infectious Diseases
- Vaccinology
- Pulmonology
Background:
- Clinical features of COVID-19 in vaccinated individuals require clarification due to frequent breakthrough infections.
- Understanding post-vaccination COVID-19 is crucial in the ongoing pandemic.
Purpose of the Study:
- To clarify clinical features and identify risk factors for severe COVID-19 progression in vaccinated versus unvaccinated patients.
- To assess the impact of vaccination status on COVID-19 severity during a Delta variant-dominant period.
Main Methods:
- Retrospective analysis of 438 hospitalized COVID-19 patients during the Delta variant surge.
- Stratification of patients based on vaccination status (unvaccinated, partially vaccinated, fully vaccinated).
- Assessment of clinical characteristics and risk factors for severe progression.
Main Results:
- Vaccinated patients were older, less symptomatic, and had more comorbidities.
- Severe COVID-19 progression occurred in 20.3% of unvaccinated and 10.8% of fully vaccinated patients.
- Vaccination was the sole protective factor against severe progression; chest X-ray abnormalities predicted severity in vaccinated individuals.
Conclusions:
- Hospitalized COVID-19 patients show distinct clinical profiles based on vaccination status.
- Vaccination status is a key factor in assessing COVID-19 severity and risk.
- Chest X-ray findings are valuable for predicting severe outcomes in vaccinated COVID-19 patients.
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 variant-dominant 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.
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