While vaccinations are one of our most effective strategies to significantly mitigate the spread and most severe health consequences of COVID-19, they’re not 100% effective. Since last year, we’ve seen spikes in breakthrough COVID-19 cases. Data is key to helping us better understand COVID-19 and be more proactive in preventing its serious complications. The Cerner Learning Health Network™(LHN) provides researchers with real-world, de-identified data from a nationwide network of diverse health systems.
ChristianaCare in Delaware is an LHN member. The Institute for Research on Equity and Community Health (iREACH) at ChristianaCare did a deep analysis of breakthrough COVID-19 cases from December 2020 through October 2021. A team of researchers led by iREACH’s Chief Scientific Officer, Mia Papas, MS, Ph.D, used Cerner Real-World DataTM to study information from more than 70 health systems across the U.S. representing almost 90 million de-identified patients. The study population includes adults ages 18 or older who contracted COVID-19 after receiving at least one vaccine dose.
Here are five factors that increase a person’s risk of a COVID-19 breakthrough infection based on the ChristianaCare findings.
- 1. You’re middle-aged
Although elderly people are most at risk for COVID-19, people between the ages of 35-44 and 45-54 are more likely to have a breakthrough infection than those who are 75-84. Further studies are needed, but the most likely reason for this finding is many middle-aged people have children who are not yet old enough to be vaccinated.
- 2. You live in the northeastern or southeastern US
When filtered by ZIP code, the highest COVID-19 breakthrough rates were found in northeastern states including Michigan, Indiana, Ohio and Kentucky and southeastern states including Florida, Tennessee, Mississippi, Alabama and Georgia.
- 3. You’re part of a vulnerable racial or ethnic group
The pandemic put a spotlight on the impact of social determinants of health. Unfortunately, there’s a lack of data examining race/ethnic disparities in the rate of breakthrough infection or in the risk of severe outcomes after breakthrough infections. The ChristianaCare study provides some much-needed information, which shows COVID-19 hospitalizations and deaths are more frequent among Hispanic, non-Hispanic Black and non-Hispanic American Indian or Alaska Native people than among non-Hispanic white people and Asians. This might be explained by higher levels of virus exposure, reduced access to care and higher rates of underlying health conditions in some underserved communities.
- 4. You have at least one of 34 underlying conditions
Certain underlying medical conditions can increase the risk for severe COVID-19 illness in adults. ChristianaCare researchers discovered 34 underlying conditions that put people at a greater risk of breakthrough infections.
- 5. You’re only partially vaccinated
The Centers for Disease Control and Prevention considers adults 18 or older to be fully vaccinated against COVID-19 two weeks after the second dose of the Moderna or Pfizer-BioNTech vaccines or two weeks after a single dose of Johnson & Johnson’s Jassen. The study data shows those who have only received one vaccine dose are more likely to experience a breakthrough infection. Although risk rises over time for fully vaccinated people, it’s at a much lower level than for those who are partially vaccinated. COVID-19 breakthrough infection rate was 4.2% for partially vaccinated individuals, and 1.2% for those who are fully vaccinated.
While the findings from the ChristianaCare study are a deep dive into the Delta variant, the healthcare community continues to analyze breakthrough infections in subsequent variants.
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