@Article{info:doi/10.2196/38898,
author="Kshirsagar, Meghana
and Nasir, Md
and Mukherjee, Sumit
and Becker, Nicholas
and Dodhia, Rahul
and Weeks, William B
and Ferres, Juan Lavista
and Richardson, Barbra",
title="The Risk of Hospitalization and Mortality After Breakthrough SARS-CoV-2 Infection by Vaccine Type: Observational Study of Medical Claims Data",
journal="JMIR Public Health Surveill",
year="2022",
month="Nov",
day="8",
volume="8",
number="11",
pages="e38898",
keywords="breakthroughs; vaccines; Pfizer; Moderna; Janssen; SARS-CoV-2; COVID-19; coronavirus; infectious disease; viral infection; vaccination; breakthrough infection; public health; health policy; decision making; booster vaccine; mortality; hospitalization; healthcare system",
abstract="Background: Several risk factors have been identified for severe COVID-19 disease by the scientific community. In this paper, we focus on understanding the risks for severe COVID-19 infections after vaccination (ie, in breakthrough SARS-CoV-2 infections). Studying these risks by vaccine type, age, sex, comorbidities, and any prior SARS-CoV-2 infection is important to policy makers planning further vaccination efforts. Objective: We performed a comparative study of the risks of hospitalization (n=1140) and mortality (n=159) in a SARS-CoV-2 positive cohort of 19,815 patients who were all fully vaccinated with the Pfizer, Moderna, or Janssen vaccines. Methods: We performed Cox regression analysis to calculate the risk factors for developing a severe breakthrough SARS-CoV-2 infection in the study cohort by controlling for vaccine type, age, sex, comorbidities, and a prior SARS-CoV-2 infection. Results: We found lower hazard ratios for those receiving the Moderna vaccine (P<.001) and Pfizer vaccine (P<.001), with the lowest hazard rates being for Moderna, as compared to those who received the Janssen vaccine, independent of age, sex, comorbidities, vaccine type, and prior SARS-CoV-2 infection. Further, individuals who had a SARS-CoV-2 infection prior to vaccination had some increased protection over and above the protection already provided by the vaccines, from hospitalization (P=.001) and death (P=.04), independent of age, sex, comorbidities, and vaccine type. We found that the top statistically significant risk factors for severe breakthrough SARS-CoV-2 infections were age of >50, male gender, moderate and severe renal failure, severe liver disease, leukemia, chronic lung disease, coagulopathy, and alcohol abuse. Conclusions: Among individuals who were fully vaccinated, the risk of severe breakthrough SARS-CoV-2 infection was lower for recipients of the Moderna or Pfizer vaccines and higher for recipients of the Janssen vaccine. These results from our analysis at a population level will be helpful to public health policy makers. Our result on the influence of a previous SARS-CoV-2 infection necessitates further research into the impact of multiple exposures on the risk of developing severe COVID-19. ",
issn="2369-2960",
doi="10.2196/38898",
url="https://publichealth.jmir.org/2022/11/e38898",
url="https://doi.org/10.2196/38898",
url="http://www.ncbi.nlm.nih.gov/pubmed/36265135"
}