key: cord-0889204-ht4qtmrc
authors: TYAGI, Kanika; GHOSH, Amerta; NAIR, Dipti; DUTTA, Koel; Singh BHANDARI, Prakash; Ahmed ANSARI, Irshad; MISRA, Anoop
title: Breakthrough COVID19 Infections after Vaccinations in Healthcare and Other Workers in a Chronic Care Medical Facility in New Delhi, India
date: 2021-05-03
journal: Diabetes Metab Syndr
DOI: 10.1016/j.dsx.2021.05.001
sha: f085202f95df997ccb9156aa6855c9a7ce51b513
doc_id: 889204
cord_uid: ht4qtmrc

BACKGROUND AND AIMS: Vaccinations are now open to all adults in India. However, spread of COVID19 infection continues unabated. We aimed to ascertain number of breakthrough infections after vaccinations in a chronic care, diabetes-centric healthcare facility. METHODS: We received rigorously maintained data of vaccinations, health status, symptoms of COVID19 & RT-PCR testing of all staff (doctors, nurses, paramedical workers, other staff) in our health care facility from January 16, 2021 till date. RESULTS: Out of 123 employees, 110 were vaccinated (Covaxin, 28, Covishield, 85). Second dose was completed in 107 (94.7%) and first dose in 6 persons (5.3%). Breakthrough infections occurred in 18 persons (15.9%), 17 of them had incurred it after the second dose. Except one (required hospitalization), all (94.5%) had mild COVID19 disease. CONCLUSIONS: High prevalence of mild breakthrough infection is seen in our health care facility. Research in breakthrough infections in India should be extended to other institutions and community to obtain larger data.

The vaccination campaign in India was started on January 16, 2021 using two vaccines Covishield (manufactures Astra Zeneca) & Covaxin (manufactured by Bharat Biotech). At present (1 st May 2021) about 268 million people in India have been fully vaccinated. The recipients of vaccines include health care workers, front line workers & people with more than 45 years of age with morbidities (like diabetes, coronary artery disease etc. 

Facility has 118 employees out of which 114 have received vaccinations. Our hospital has maintained detailed data regarding vaccinations and COVID19 infections of all employees. We received data of vaccinations, health status, symptoms of COVID19 & RT-PCR testing in our health care facility from January 16, 2021 till date. All data were double checked. Telephonic interviews with affected individuals were conducted. Descriptive statistics was used.

Results have been described in Table 1 . Out of 123 employees [males 75, females 48; mean age 42 (range 22-70y)], 110 were vaccinated (Covaxin, 28, Covishield, 85). Second dose was completed in 107 (94.7%) and first dose in 6 persons (5.3%). Breakthrough infections occurred in 18 persons (15.9%), 17 of them had incurred it after the second dose after a mean of 34.8 days (range 2-51 days). All were symptomatic with fever and half of them had sore throat and cough. Except one (required hospitalization), all (94.5%) had mild COVID19 disease.

Breakthrough infections after adequate vaccinations are matter of concern but adequate data regarding these infections are not available. Vaccines have effectiveness risk of getting COVID19 infections by 70-90%, and also shield from severe infection. It is possible, therefore, some people who are fully vaccinated against COVID-19 may get COVID19 infection.

Anecdotal report (unpublished) from India & published reports from other part of world indicate these infections are occurring but rare. In addition, it appears that these breakthrough infections are either asymptomatic or mild in nature. In a study in 75 skilled nursing care facilities in J o u r n a l P r e -p r o o f Chicago, among 627 persons with SARS-CoV-2 infection since vaccination began, 22 SARS-CoV-2 infections were identified among 22 residents and staff members ≥14 days after receiving their second vaccine dose. Further, nearly two thirds (14 of 22; 64%) of persons with breakthrough infections were asymptomatic 1 . Recent statement from Indian Council of Medical research states that 2-4 per 10,000 got infected with COVID19 after vaccinations in India 2 , however, this has not been published in an academic journal.

It is possible that in breakthrough infection could be ascribed to COVID19 variants which may bypass vaccine-induced immunity 3 . This important area clearly needs more research. It is reassuring that majority of breakthrough infection seen in our facility are mild. But a significant area of concern is that we may be missing asymptomatic infection since RT-PCR test was selectively done in symptomatic patients. These asymptomatic patients are likely to promote viral spread.

Limitations of this study is small sample size, and absence of data on obesity and co-morbid diseases which are important determinants of severity of COVID19 4 . Finally, we did not test asymptomatic infections.

High prevalence of breakthrough infection is seen in our health care facility. Breakthrough infection in India after complete vaccination should be prime area of research. 

Data regarding breakthrough infections after vaccination is needed in India

In our chronic care facility, breakthrough infections occurred in 15

Postvaccination SARS-CoV-2 Infections Among Skilled Nursing Facility Residents and Staff Members

Vaccine Breakthrough Infections with SARS-CoV-2 Variants

COVID-19 vaccination in patients with diabetes mellitus: Current concepts, uncertainties and challenges