SARS-CoV-2 infection despite vaccination: an under-reported COVID-19 cohort

Editor – West et al note the potential challenges presented by SARS-CoV-2 reinfections.¹ We argue that there is a far commoner, yet under-reported, cohort of importance, namely those who have been infected with SARS-CoV-2 after COVID-19 vaccination.

The development of COVID-19 vaccines within an unprecedented short timeframe, resulting in the delivery of the first approved COVID-19 vaccine at University Hospitals Coventry and Warwickshire NHS Trust (UHCW) on the 08 December 2020, represents a step-change in our ability to tackle the current pandemic.^2–4 However, sensible caution is still essential.

We conducted a cross-sectional audit of all COVID-19 swab positive patients at UHCW on the weekend of the 13 February 2021 (excluding intensive care admissions). Remarkably, 27 of the 174 (16%) COVID-19 inpatients had previously received a COVID-19 vaccine. The mean age of these inpatients was 82.3 years (interquartile range (IQR) 11.75), with a mean duration between vaccination and positive COVID-19 swab of 18.19 days (IQR 13.25). Eleven patients (41%) had a positive swab within 14 days of vaccination, suggesting possible infection close to the time of vaccination.

Considering these findings in a tertiary NHS hospital, it is important that the public and all stakeholders acknowledge that developing immunity against SARS-CoV-2 following COVID-19 vaccination is not instant, and that vaccinated individuals may remain vulnerable to a SARS-CoV-2 infection particularly following the first COVID-19 vaccine dose. Furthermore, widespread collection of such data is important to support current Public Health England investigations into potentially vaccine-resistant SARS-CoV-2 variants. The use of automated inter-operable digital tools to track such cases is vital. Finally, ensuring that infection control procedures are optimised at vaccine centres is also pivotal to minimise the SARS-CoV-2 infection risk during the vaccination visits, while delivering a high throughput service. Overall, it is vital that we utilise such data/evidence to support public health policies and optimise the effectiveness of this vaccination programme over the coming crucial months.