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Clinical manifestations of COVID-19 breakthrough infections: A systematic review and meta-analysis

 Christine J Lee  ;  Wongi Woo  ;  Ah Young Kim  ;  Dong Keon Yon  ;  Seung Won Lee  ;  Ai Koyanagi  ;  Min Seo Kim  ;  Kalthoum Tizaoui  ;  Elena Dragioti  ;  Joaquim Radua  ;  Sungsoo Lee  ;  Lee Smith  ;  Jae Il Shin 
 JOURNAL OF MEDICAL VIROLOGY, Vol.94(9) : 4234-4245, 2022-09 
Journal Title
Issue Date
COVID-19 Vaccines ; COVID-19* ; Coronavirus Infections* ; Humans ; SARS-CoV-2
COVID-19 ; Delta variant ; breakthrough infection ; clinical manifestations ; vaccine effectiveness
To provide a comparative meta-analysis and systematic review of the risk and clinical outcomes of coronavirus 2019 (COVID-19) infection between fully vaccinated and unvaccinated groups. Eighteen studies of COVID-19 infections in fully vaccinated ("breakthrough infections") and unvaccinated individuals were reviewed from Medline/PubMed, Scopus, Embase, and Web of Science databases. The meta-analysis examined the summary effects and between-study heterogeneity regarding differences in the risk of infection, hospitalization, treatments, and mortality between vaccinated and unvaccinated individuals. he overall risk of infection was lower for the fully vaccinated compared to that of the unvaccinated (relative risk [RR] 0.20, 95% confidence interval [CI]: 0.19-0.21), especially for variants other than Delta (Delta: RR 0.29, 95% CI: 0.13-0.65; other variants: RR 0.06, 95% CI: 0.04-0.08). The risk of asymptomatic infection was not statistically significantly different between fully vaccinated and unvaccinated (RR 0.56, 95% CI: 0.27-1.19). There were neither statistically significant differences in risk of hospitalization (RR 1.06, 95% CI: 0.38-2.93), invasive mechanical ventilation (RR 1.65, 95% CI: 0.90-3.06), or mortality (RR 1.19, 95% CI: 0.79-1.78). Conversely, the risk of supplemental oxygen during hospitalization was significantly higher for the unvaccinated (RR 1.40, 95% CI: 1.08-1.82). Unvaccinated people were more vulnerable to COVID-19 infection than fully vaccinated for all variants. Once infected, there were no statistically significant differences in the risk of hospitalization, invasive mechanical ventilation, or mortality. Still, unvaccinated showed an increased need for oxygen supplementation. Further prospective analysis, including patients' risk factors, COVID-19 variants, and the utilized treatment strategies, would be warranted.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ah Young(김아영) ORCID logo https://orcid.org/0000-0002-0713-4461
Shin, Jae Il(신재일) ORCID logo https://orcid.org/0000-0003-2326-1820
Woo, Wongi(우원기) ORCID logo https://orcid.org/0000-0002-0053-4470
Lee, Sung Soo(이성수) ORCID logo https://orcid.org/0000-0001-8998-9510
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