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

Tim Robbins, Sudhanshu Baitule, Ioannis Kyrou, Pijush Ray, Nina Morgan, Lisa Berry and Harpal Randeva
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DOI: https://doi.org/10.7861/clinmed.Let.21.2.6
Clin Med March 2021
Tim Robbins
NIHR clinical lecturer, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK and Warwick Medical School, Coventry, UK
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Sudhanshu Baitule
Clinical fellow, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Ioannis Kyrou
Clinical lecturer and endocrinologist, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, Warwick Medical School, Coventry, UK and Aston Medical School, Birmingham, UK
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Pijush Ray
Group clinical director medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Nina Morgan
Chief nursing officer, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Lisa Berry
Clinical scientist virology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Harpal Randeva
Director of research and development, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK, Warwick Medical School, Coventry, UK and Aston Medical School, Birmingham, UK
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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.

  • © Royal College of Physicians 2021. All rights reserved.

References

  1. ↵
    1. West J
    , Everden S, Nikitas N. A case of COVID-19 reinfection in the UK. Clin Med 2021;21:e52.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Polack FP
    , Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine. N Eng J Med 2020;383:2603–15.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Folegatti PM
    , Ewer KJ, Aley PK, et al. Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial. Lancet 2020;396:467–78.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Radford M
    , Prewitt E, A marathon, not a sprint: COVID-19 vaccine rollout in the UK. NEJM Catalyst 2021.
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SARS-CoV-2 infection despite vaccination: an under-reported COVID-19 cohort
Tim Robbins, Sudhanshu Baitule, Ioannis Kyrou, Pijush Ray, Nina Morgan, Lisa Berry, Harpal Randeva
Clinical Medicine Mar 2021, 21 (2) e243; DOI: 10.7861/clinmed.Let.21.2.6

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SARS-CoV-2 infection despite vaccination: an under-reported COVID-19 cohort
Tim Robbins, Sudhanshu Baitule, Ioannis Kyrou, Pijush Ray, Nina Morgan, Lisa Berry, Harpal Randeva
Clinical Medicine Mar 2021, 21 (2) e243; DOI: 10.7861/clinmed.Let.21.2.6
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