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Open Access 09-07-2022 | Vaccination | Original Article

Clinical and Immunological Features of SARS-CoV-2 Breakthrough Infections in Vaccinated Individuals Requiring Hospitalization

Authors: Giulia Lamacchia, Alessio Mazzoni, Michele Spinicci, Anna Vanni, Lorenzo Salvati, Benedetta Peruzzi, Sara Bencini, Manuela Capone, Alberto Carnasciali, Parham Farahvachi, Arianna Rocca, Seble Tekle Kiros, Lucia Graziani, Lorenzo Zammarchi, Jessica Mencarini, Maria Grazia Colao, Roberto Caporale, Francesco Liotta, Lorenzo Cosmi, Gian Maria Rossolini, Alessandro Bartoloni, Laura Maggi, Francesco Annunziato

Published in: Journal of Clinical Immunology | Issue 7/2022

Abstract

Background and Purpose

Waning immunity and the surge of SARS-CoV-2 variants are responsible for breakthrough infections, i.e., infections in fully vaccinated individuals. Although the majority of vaccinated infected subjects report mild or no symptoms, some others require hospitalization. The clinical and immunological features of vaccinated hospitalized COVID-19 patients are currently unknown.

Methods

Twenty-nine unvaccinated and 36 vaccinated hospitalized COVID-19 patients were prospectively enrolled and clinical and laboratory data were gathered. Immunophenotyping of leukocytes’ subsets, T and B cell SARS-CoV-2-specific responses were evaluated via flow cytometry. Anti-IFN-α autoantibodies were measured via ELISA.

Results

Despite vaccinated patients were older and with more comorbidities, unvaccinated subjects showed higher levels of pro-inflammatory markers, more severe disease, and increased mortality rate. Accordingly, they presented significant alterations in the circulating leukocyte composition, typical of severe COVID-19. Vaccinated patients displayed higher levels of anti-Spike IgGs and Spike-specific B cells. Of all participants, survivors showed higher levels of anti-Spike IgGs and Spike-specific CD4+ T cells than non-survivors. At hospital admission, 6 out of 65 patients (9.2%) displayed high serum concentrations of autoantibodies targeting IFN-α. Remarkably, 3 were unvaccinated and eventually died, while the other 3 were vaccinated and survived.

Conclusion

Despite more severe pre-existing clinical conditions, vaccinated patients have good outcome. A rapid activation of anti-SARS-CoV-2-specific immunity is fundamental for the resolution of the infection. Therefore, prior immunization through vaccination provides a significant contribution to prevention of disease worsening and can even overcome the presence of high-risk factors (i.e., older age, comorbidities, anti-IFN-α autoantibodies).

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WHO Coronavirus (COVID-19) Dashboard. Available at https://covid19.who.int, accessed on May 6, 2022.

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Title: Clinical and Immunological Features of SARS-CoV-2 Breakthrough Infections in Vaccinated Individuals Requiring Hospitalization
Authors: Giulia Lamacchia
Alessio Mazzoni
Michele Spinicci
Anna Vanni
Lorenzo Salvati
Benedetta Peruzzi
Sara Bencini
Manuela Capone
Alberto Carnasciali
Parham Farahvachi
Arianna Rocca
Seble Tekle Kiros
Lucia Graziani
Lorenzo Zammarchi
Jessica Mencarini
Maria Grazia Colao
Roberto Caporale
Francesco Liotta
Lorenzo Cosmi
Gian Maria Rossolini
Alessandro Bartoloni
Laura Maggi
Francesco Annunziato
Publication date: 09-07-2022
Publisher: Springer US
Keywords: Vaccination
SARS-CoV-2
COVID-19
Published in: Journal of Clinical Immunology / Issue 7/2022
Print ISSN: 0271-9142
Electronic ISSN: 1573-2592
DOI: https://doi.org/10.1007/s10875-022-01325-2

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Clinical and Immunological Features of SARS-CoV-2 Breakthrough Infections in Vaccinated Individuals Requiring Hospitalization

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