Clinical features of patients with breakthrough infection after getting different kinds of vaccines against COVID-19

Abstract

Objective To compare the clinical features of patients with breakthrough infection after getting different kinds of COVID-19 vaccines, in order to provide reference for clinical diagnosis and treatment of such patients.

Methods Patients with breakthrough infection after the COVID-19 vaccination in Guangzhou Eighth People’s Hospital from June 1st to November 1st, 2021, were enrolled in the study. Patients were divided into nucleic (mRNA) vaccine group, adenoviral vector (Ad) vaccine group and inactivated (Vero cell) vaccine group. By comparing basic clinical information, clinical symptoms, blood test results, antibody, chest imaging, treatment, and prognosis, we summarize clinical features of patients with breakthrough infection after different kinds of COVID-19 vaccines.

Results Totally 46 cases of mRNA vaccine group, 28 cases of Ad vaccine group and 225 patients with inactivated vaccine was selected. All patients completed two doses of vaccination (except one dose of Janssen vaccine). The time intervals from the last vaccination to breakthrough infection were (44.60 ± 18.29), (50.83 ± 17.49) and (68.35 ± 38.43) days respectively. The inactivated vaccine group was the longest, and the difference was statistically significant ( P < 0.05). There was no statistical significance among clinical symptoms, white blood cells, lymphocytes, liver and kidney function, myocardial enzyme, oxygenation index, D-2 polymer, inflammatory indicators, titer of IgG antibody at admission and the variation of pulmonary imaging ( P > 0.05); But titers of IgG antibody at the first two weeks of hospitalization were significantly different ( P < 0.05), the inactivated vaccine group was the lowest. The average lengths with nucleic acid transferring negative of three groups were (11.15 ± 7.70), (10.87 ± 6.85) and (13.71 ± 9.36) days, showing that the inactivated vaccine group was the longest and the difference was statistically significant ( P < 0.05).

Conclusions COVID-19 patients with breakthrough infection after different vaccines in this hospital are mainly middle-aged males and manifested as asymptomatic infection. Clinical symptoms of most diagnosed patients included cough, sore throat and stuffy nose. Chest images showed single or multi-lesions with ground-class opacity shadows and (or) patchy shadows and fiber strip shadows. Oxygen therapy and traditional Chinese medicine remain effective. A higher titer of IgG antibody can be produced at the early stage in mRNA and adenoviral vector vaccine groups. Regardless of the kinds of vaccines, all patients have a good prognosis.

Abstract

摘要： 目的比较接种不同种类新冠疫苗后发生突破性感染患者的临床特征, 为临床中该类患者诊疗提供借鉴。 方法以2021年6月1日一2021年11月1日广州医科大学附属市八医院诊治的接种不同种类新冠疫苗后发生突破性 感染的患者为研究对象, 按照接种疫苗的种类, 分为核酸(mRNA)疫苗组、腺病毒载体(Ad)疫苗组和灭活(Ver。细胞)疫 苗组, 通过比较三组患者的人口学特点、临床表现、血检结果、新冠抗体、肺部影像学、治疗方案及病情预后等, 总结接 种不同种类新冠疫苗后感染新冠病毒患者的临床特征。 结果 共有mRNA疫苗组46例、Ad疫苗组28例和Vero疫苗组 225例患者纳人分析, 所有患者均完成全程2剂疫苗接种(除接种强生疫苗为1剂), 三组疫苗患者末次疫苗接种至发生 突破性感染的时间间隔分别为(44.60±18.29)、(50.83±17.49)及(68.35±38.43)d, Vero疫苗组患者第二针疫苗接种至发 生突破性感染的时间间隔最长, 差异有统计学意义( P<0.05)。三组患者的临床表现、白细胞、淋巴细胞、肝肾功能、心肌 酶学、D-2聚体、氧合指标、炎症指标和人院时IgG抗体滴度等指标以及肺部影像学改变, 差异均无统计学意义( P>0.05), 但病程1周及2周时IgG抗体滴度以灭活疫苗组最低, 差异有统计学意义( P<0.05); 三组患者平均核酸转阴时间 分别为(11.15±7.70)、(10.87±6.85)和(13.71±9.36)d, Vero疫苗组核酸转阴时间最长, 差异有统计学意义( P<0.05)。 结论接种不同种类新冠疫苗的COVID-19患者, 以中年男性为主, 临床分型以无症状感染者居多, 而确诊型患者中常 见有咳嗽咳痰、咽喉不适、鼻塞流涕等临床症状, 肺部影像学可见单发或多灶性的位于胸膜下或血管束周围的磨玻璃 渗出和(或)实变影病灶及纤维条索影等, 氧疗及中医中药等常规治疗方案仍持之有效。接种mRNA及腺病毒载体疫 苗后发生突破性感染的患者, 比接种灭活疫苗的突破性感染患者, 在病程早期产生更髙滴度的IgG抗体, 但不论接种何 种疫苗, 患者均预后良好。