key: cord-0772349-k0s1d7wh
authors: Lange, Bettina; Gerigk, Marlis; Tenenbaum, Tobias
title: Breakthrough Infections in BNT162b2-Vaccinated Health Care Workers
date: 2021-08-18
journal: N Engl J Med
DOI: 10.1056/nejmc2108076
sha: 81c63e8e514fdb06597017224ab487ab6ff02cd1
doc_id: 772349
cord_uid: k0s1d7wh

nan

To the Editor: Hacisuleyman et al. 1 This failure rate is higher than that in the initial phase 3 trial, in which 0.05% of vaccinated participants (8 of 17,411) had a breakthrough infection 7 or more days after the second BNT162b2 vaccine dose, 3 but is lower than in other recent studies involving health care workers. 2, 4, 5 The health care workers at our institution had * Ct denotes cycle threshold, N1 nucleocapsid 1, N2 nucleocapsid 2, and PCR polymerase chain reaction. † Timing is relative to the time of diagnosis (diagnosis occurred on day 1). ‡ Material was not available for PCR testing in this patient; identification of the variant of concern is based on test results for the household contact.

only mild symptoms but high viral loads (cycle thresholds of <25) and prolonged viral shedding up to 32 days after diagnosis. We performed a genomic characterization of the spike protein variants (delHV69/70, N501Y, A570D, D614G, and P681H), and all strains were classified as the B.1.1.7 (or alpha) variant. Vaccinated health care workers can be infected with variants of concern transmitted from unvaccinated household contacts and may transmit SARS-CoV-2 in the hospital if not screened early enough. Finally, variants of concern may not only be more transmissible than the original SARS-CoV-2 but may also escape vaccine protection more frequently. This letter was published on August 18, 2021, at NEJM.org.

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