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Article

Incidence and Risk Factors of COVID-19 Vaccine Breakthrough Infections: A Prospective Cohort Study in Belgium

1
Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
2
Department of Public Health and Primary Care, Ugent, 9000 Gent, Belgium
*
Author to whom correspondence should be addressed.
Academic Editors: Guy Baele and Emmanuel André
Viruses 2022, 14(4), 802; https://doi.org/10.3390/v14040802
Received: 10 March 2022 / Revised: 7 April 2022 / Accepted: 8 April 2022 / Published: 13 April 2022
(This article belongs to the Special Issue SARS-CoV-2 Research in Belgium)
The objective of this study was to investigate the incidence and risk factors associated with COVID-19 vaccine breakthrough infections. We included all persons ≥18 years that had been fully vaccinated against COVID-19 for ≥14 days, between 1 February 2021 and 5 December 2021, in Belgium. The incidence of breakthrough infections (laboratory confirmed SARS-CoV-2-infections) was determined. Factors associated with breakthrough infections were analyzed using COX proportional hazard models. Among 8,062,600 fully vaccinated adults, we identified 373,070 breakthrough infections with an incidence of 11.2 (95%CI 11.2–11.3)/100 person years. Vaccination with Ad26.COV2.S (HR1.54, 95%CI 1.52–1.56) or ChAdOx1 (HR1.68, 95%CI 1.66–1.69) was associated with a higher risk of a breakthrough infection compared to BNT162b2, while mRNA-1273 was associated with a lower risk (HR0.68, 95%CI 0.67–0.69). A prior COVID-19-infection was protective against a breakthrough infection (HR0.23, 95%CI 0.23–0.24), as was an mRNA booster (HR0.44, 95%CI 0.43–0.45). During a breakthrough infection, those who had a prior COVID-19 infection were less likely to have COVID-19 symptoms of almost all types than naïve persons. We identified risk factors associated with breakthrough infections, such as vaccination with adenoviral-vector vaccines, which could help inform future decisions on booster vaccination strategies. A prior COVID-19 infection lowered the risk of breakthrough infections and of having symptoms, highlighting the protective effect of hybrid immunity. View Full-Text
Keywords: vaccination; SARS-CoV-2; breakthrough infection; hybrid immunity; viral vector vaccines; mRNA vaccines; symptoms; COVID-19; mRNA booster vaccine vaccination; SARS-CoV-2; breakthrough infection; hybrid immunity; viral vector vaccines; mRNA vaccines; symptoms; COVID-19; mRNA booster vaccine
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MDPI and ACS Style

Stouten, V.; Hubin, P.; Haarhuis, F.; van Loenhout, J.A.F.; Billuart, M.; Brondeel, R.; Braeye, T.; Van Oyen, H.; Wyndham-Thomas, C.; Catteau, L. Incidence and Risk Factors of COVID-19 Vaccine Breakthrough Infections: A Prospective Cohort Study in Belgium. Viruses 2022, 14, 802. https://doi.org/10.3390/v14040802

AMA Style

Stouten V, Hubin P, Haarhuis F, van Loenhout JAF, Billuart M, Brondeel R, Braeye T, Van Oyen H, Wyndham-Thomas C, Catteau L. Incidence and Risk Factors of COVID-19 Vaccine Breakthrough Infections: A Prospective Cohort Study in Belgium. Viruses. 2022; 14(4):802. https://doi.org/10.3390/v14040802

Chicago/Turabian Style

Stouten, Veerle, Pierre Hubin, Freek Haarhuis, Joris A.F. van Loenhout, Matthieu Billuart, Ruben Brondeel, Toon Braeye, Herman Van Oyen, Chloé Wyndham-Thomas, and Lucy Catteau. 2022. "Incidence and Risk Factors of COVID-19 Vaccine Breakthrough Infections: A Prospective Cohort Study in Belgium" Viruses 14, no. 4: 802. https://doi.org/10.3390/v14040802

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