BREAKING! Those Jabbed But With Diabetes, Chronic Kidney Or Lung Disease, Or Are Immunocompromised Have Higher Risk Of COVID-19 Breakthrough Infections!

A new study by researchers from Truveta Inc, a clinical data analytics company based in Washington-USA has found that fully vaccinated individuals with existing comorbidities such as diabetes, chronic kidney disease (CKD), chronic lung disease, or those with immunocompromising conditions have increased risk of COVID-19 breakthrough infections and also hospitalization!


 
The study team wanted to we estimate the elevated risks of breakthrough infection and hospitalization in fully vaccinated individuals with comorbidities.
 
Utilizing a population of fully-vaccinated patients in the de-identified Truveta Platform of electronic health records from January 1, 2019, to January 10, 2022, the study team used logistic regression to estimate risk of 1) a patient experiencing a breakthrough COVID-19 infection after being fully vaccinated, and 2) rate of hospitalization in those experiencing breakthrough infection.
 
For the study, potential confounding was adjusted with inverse probability weighting for each comorbidity by age, race, ethnicity, and sex. The team presented ORs and percentages of breakthrough infections by comorbidity status.
 
The study findings showed that out of 3,424,965 fully vaccinated patients, 2.79%, 2.63%, 2.38%, 1.83% with CKD, chronic lung disease, diabetes, and those in an immunocompromised state experienced breakthrough infection, respectively, compared to 1.95% in the overall population.
 
The study findings showed that all the listed comorbidities were associated with significantly increased odds of breakthrough infections and subsequent hospitalizations.
 
Breakthrough infection hospitalizations in populations with comorbidities ranged from 26.43% for CKD to 10.23% for chronic lung disease, with corresponding ORs of 2.22 (95% CI: 1.88 - 2.63) and 1.37 (95% CI: 1.21 - 1.55), respectively. The study found increased rates of breakthrough infections with all comorbidities, with CKD having the greatest risk. Individuals with chronic lung disease had the highest rate of breakthrough infection, but the lowest subsequent risk of hospitalization.
 
The study findings hence confirmed that fully-vaccinated individuals with certain comorbidities experienced increased risk of breakthrough COVID-19 infection and subsequent hospitalizations compared to the general population. Most importantly the study findings serve as warning that individuals with comorbidities should remain vigilant against infection even if vaccinated.
 
The study findings were published on a preprint server and are currently being peer reviewed. https://www.medrxiv.org/content/10.1101/2022.04.26.22271727v1
 
Numerous earlier studies indicated that many illnesses such as diabetes, chronic kidney/lung disease, or conditions (like solid organ transplant or cancer) that lead to immunocompromised states result in a higher risk of hospitalization following infection with the SARS-CoV-2 virus, the pathogen behind the ongoing COVID-19 pandemic.
 
To date, the use of booster doses of vaccination against COVID-19 has been avidly discussed given the continuing high rate of infection with this virus, following the emergence of the Omicron variant and its subvariants with extremely high transmissibility. Such boosters were offered in many countries because available evidence showed rapidly decreasing protective immunit y after two doses of the vaccines being used at present.
 
Many times, older adults with high-risk conditions, including those listed above, were prioritized for these boosters, but the degree of risk to younger people with the same indications is still unclear.
 
The study team aimed to understand both the risk of breakthrough infection and severe outcomes in this population.
 
Hence for this purpose, the study team developed a platform to evaluate this risk, called the Truveta platform.
 
The detailed research included over 2 million individuals, classified into cohorts based on the presence of four different illnesses and one control cohort. Some individuals were therefore assigned to more than one cohort.
 
The study findings show that the highest risk of breakthrough infection was found in those with chronic lung disease, with a 43% increase in risk, and individuals with diabetes, had a 30% increase.
 
Interestingly however, when it comes to hospitalization, patients with chronic kidney disease had a more than doubled risk even though their risk of infection was lower than those in other groups. The risk was increased by 80% and 50% in those with diabetes and immunocompromised states, respectively.
 
The study findings clearly showed that breakthrough infection with the virus occurs to a larger extent among individuals with some underlying medical conditions than the controls.
 
The greatest increase in risk over baseline is among those with diabetes, chronic lung disease, or chronic kidney disease, even after adjusting for age, sex, race, and ethnic origin. The reason for this higher risk could be the deterioration in the immune response as a result of these conditions.
 
It should be noted however that studies in unvaccinated individuals with these comorbidities have shown the same pattern. The results also corroborate an earlier report of reduced vaccine effectiveness in a population of US male veterans with a high prevalence of other underlying medical conditions. https://pubmed.ncbi.nlm.nih.gov/34280332/
 
Importantly, a doubling of the odds for hospitalization compared to the vaccinated population confirms earlier findings that individual’s conditions known to produce impaired immunity fare worse when infected with the virus. This also underlines the need to protect these groups with booster vaccines.
 
It was interestingly found that the group with the lowest increase in breakthrough infection was that with immunocompromised states, compared to other comorbidities. This could mean they protected themselves more carefully by behavioral modifications like mask-wearing or social distancing than individuals in the other groups.
 
It was also found that individuals with chronic lung disease were most likely to be infected by breakthrough infections but least likely to be hospitalized. This group already had greater access to steroids, and supplemental oxygen before COVID-19 or the disease designation included an overly broad range of diseases, so it did not help identify the actual increase in risk due to this condition.
 
More detailed research is warranted to look at how the presence of multiple such illnesses interact to produce a higher risk of breakthrough infection and adverse outcomes following COVID-19. Such data will help individuals, agencies, and governments to make better recommendations about booster doses of the vaccination for such groups.
 
Corresponding author, Dr Nicholas L Stucky from Truveta Inc told Thailand Medical News, “The study findings improve the evidence and support recommendations for individuals with comorbidities such as chronic kidney disease, chronic lung disease, diabetes or individuals who are immunocompromised to receive the primary vaccination sequence as well as a booster dose.”
 
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