key: cord-1041569-9ud2m47n
authors: Sankary, Kendl M.; Sippel, Jennifer L.; Eberhart, Adam C.; Burns, Stephen P.
title: Breakthrough cases of COVID-19 in vaccinated United States Veterans with spinal cord injuries and disorders
date: 2021-08-17
journal: Spinal Cord
DOI: 10.1038/s41393-021-00690-w
sha: ec7dd3676e7d520d48041e2fd0610795c78ee557
doc_id: 1041569
cord_uid: 9ud2m47n

nan

diagnosis. All cases occurred in male patients, with an average age of 69 years (range 31-88). Of 16 cases with neurological level recorded in the registry, ten (63%) had tetraplegia, and six (37%) had paraplegia. Living setting at time of diagnosis was home for 12 cases and skilled nursing facility (SNF) for five cases. Of importance, three asymptomatic cases occurred during an outbreak involving staff and patients at a single SNF.

As of April 20, 2021, the CDC reported 7157 vaccine breakthrough cases out of 87,000,000 fully vaccinated individuals in the United States, resulting in a vaccine breakthrough rate of 0.0082% [2] . Although the breakthrough rate is 24 times lower than that seen in our review, the CDC data include few asymptomatic cases, whereas for the VA SCI/D population (which is subject to more frequent surveillance testing) asymptomatic cases made up the majority. A more appropriate comparison may be an investigation of breakthrough cases conducted by the CDC in residents and staff members from 78 SNF's in Illinois. Their analysis demonstrated 22 COVID-19 cases out of 14,765 vaccinated individuals, a rate of 0.15%. There was a similar rate of asymptomatic infections (64%) as in the Veteran SCI/D population and a similarly low rate of hospitalizations related to COVID-19 (two out of the 22 cases), and one death [4] . These similarities suggest that the increased breakthrough rate seen in our review may, in part, be related to increased congregate living and higher rate of surveillance testing in individuals with SCI/D, rather than due to the SCI/D itself. The CDC also recently investigated a COVID-19 outbreak in a single SNF in Kentucky, which demonstrated a high rate of COVID-19 breakthrough infection in the fully vaccinated SNF residents (25%), although these were similarly predominantly asymptomatic infections (67%) [5] . That investigation suggests reduced overall vaccine effectiveness during a widespread disease outbreak, but with protection against severe disease.

In summary, our preliminary review indicates a similar rate of COVID-19 Vaccine breakthrough in individuals with SCI/D compared to residents of SNFs in which frequent surveillance testing is occurring. Given the uncertainty about the completeness of the CDC data for the general population, and our relatively few symptomatic COVID-19 breakthrough cases, we are unable to draw definitive conclusions about the effectiveness of the vaccine in preventing COVID-19 in the SCI/D population. Our findings support ongoing efforts to minimize COVID-19 exposure and spread in fully vaccinated individuals with SCI/D, particularly in congregate living settings at high risk of COVID-19 outbreak. However, the predominance of asymptomatic cases in vaccinated individuals with SCI/D highlights the importance of vaccination in decreasing morbidity and mortality associated with COVID-19 infection in the SCI/D population.

Case-fatality with coronavirus disease 2019 (COVID-19) in united states veterans with spinal cord injuries and disorders

COVID-19 breakthrough Case investigations and reporting

Clinical Spectrum of SARS-CoV-2 Infection Web site

Postvaccination SARS-CoV-2 infections among skilled nursing facility residents and staff members

COVID-19 outbreak associated with a SARS-CoV-2 R.1 lineage variant in a skilled nursing facility after vaccination program-Kentucky

JLS led the design and build of the registry and operational reports that served as data sources for these analyses, with consultation on registry development provided by ACE and SPB. ACE led development of additional registry reports with data on COVID-19 infection and vaccinations used to identify breakthrough cases. KMS performed the validation chart reviews, and KMS and SPB performed the descriptive analyses. All authors participated in the interpretation of the results. KMS drafted the initial version of the correspondence, and SPB, JLS, and ACE revised the correspondence. All authors approved the final version of the correspondence. 

The authors declare no competing interests.

This work is based on operations report data and does not constitute a research activity per VHA Program Guide 1200.21. The contents of this work do not represent the views of Veterans Affairs or the United States Government.

Correspondence and requests for materials should be addressed to K.M.S.Reprints and permission information is available at http://www.nature.com/ reprintsPublisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.