Original Investigation

Association of Prior SARS-CoV-2 Infection With Risk of Breakthrough Infection Following mRNA Vaccination in Qatar

Laith J. Abu-Raddad, PhD; Hiam Chemaitelly, MSc; Houssein H. Ayoub, PhD; Hadi M. Yassine, PhD; Fatiha M. Benslimane, PhD; Hebah A. Al Khatib, PhD; Patrick Tang, MD, PhD; Mohammad R. Hasan, PhD; Peter Coyle, MD; Zaina Al Kanaani, PhD; Einas Al Kuwari, MD; Andrew Jeremijenko, MD; Anvar Hassan Kaleeckal, MSc; Ali Nizar Latif, MD; Riyazuddin Mohammad Shaik, MSc; Hanan F. Abdul Rahim, PhD; Gheyath K. Nasrallah, PhD; Mohamed Ghaith Al Kuwari, MD; Adeel A. Butt, MBBS, MS; Hamad Eid Al Romaihi, MD; Mohamed H. Al-Thani, MD; Abdullatif Al Khal, MD; Roberto Bertollini, MD, MPH
Original Investigation

Association of COVID-19 mRNA Vaccination With Hospitalizations and Disease Severity

Mark W. Tenforde, MD, PhD; Wesley H. Self, MD, MPH; Katherine Adams, MPH; Manjusha Gaglani, MBBS; Adit A. Ginde, MD, MPH; Tresa McNeal, MD; Shekhar Ghamande, MD; David J. Douin, MD; H. Keipp Talbot, MD, MPH; Jonathan D. Casey, MD, MSci; Nicholas M. Mohr, MD, MS; Anne Zepeski, PharmD; Nathan I. Shapiro, MD, MPH; Kevin W. Gibbs, MD; D. Clark Files, MD; David N. Hager, MD, PhD; Arber Shehu, MD; Matthew E. Prekker, MD, MPH; Heidi L. Erickson, MD; Matthew C. Exline, MD, MPH; Michelle N. Gong, MD; Amira Mohamed, MD; Daniel J. Henning, MD, MPH; Jay S. Steingrub, MD; Ithan D. Peltan, MD, MSc; Samuel M. Brown, MD, MS; Emily T. Martin, PhD; Arnold S. Monto, MD; Akram Khan, MD; Catherine L. Hough, MD; Laurence W. Busse, MD; Caitlin C. ten Lohuis, ACNP-BC; Abhijit Duggal, MD; Jennifer G. Wilson, MD; Alexandra June Gordon, MD; Nida Qadir, MD; Steven Y. Chang, MD, PhD; Christopher Mallow, MD, MHS; Carolina Rivas, BS; Hilary M. Babcock, MD, MPH; Jennie H. Kwon, DO, MSci; Natasha Halasa, MD, MPH; James D. Chappell, MD, PhD; Adam S. Lauring, MD, PhD; Carlos G. Grijalva, MD, MPH; Todd W. Rice, MD, MSci; Ian D. Jones, MD; William B. Stubblefield, MD, MPH; Adrienne Baughman, BS; Kelsey N. Womack, PhD; Jillian P. Rhoads, PhD; Christopher J. Lindsell, PhD; Kimberly W. Hart, MA; Yuwei Zhu, MD, MS; Samantha M. Olson, MPH; Miwako Kobayashi, MD; Jennifer R. Verani, MD, MPH; Manish M. Patel, MD; Influenza and Other Viruses in the Acutely Ill (IVY) Network

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Waning serum antibodies against SARS-CoV-2 have raised questions about long-term immunity. Lower antibody levels to SARS-CoV-2 spike protein are associated with breakthrough infections after vaccination, prompting consideration of booster doses.¹^,2 Prior infection may enhance protection from vaccination, stimulating inquiry about hybrid immunity.³ Our objective was to examine SARS-CoV-2 spike IgG antibodies in a longitudinal cohort, comparing antibody durability in individuals who received an mRNA SARS-CoV-2 vaccine with or without prior SARS-CoV-2 infection.

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Article Information

Corresponding Author: Diana Zhong, MD, Department of Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, Baltimore, MD 21205 (dzhong5@jhmi.edu).

Accepted for Publication: October 21, 2021.

Published Online: November 1, 2021. doi:10.1001/jama.2021.19996

Author Contributions: Dr Milstone had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Zhong and Xiao contributed equally as co–first authors.

Concept and design: Zhong, Debes, Egbert, Milstone.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Zhong, Xiao, Debes, Colantuoni.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Xiao, Debes, Colantuoni.

Obtained funding: Milstone.

Administrative, technical, or material support: Zhong, Debes, Egbert.

Supervision: Debes, Colantuoni, Milstone.

Conflict of Interest Disclosures: Dr Milstone reported receiving grant support from Merck outside the submitted work. No other disclosures were reported.

Funding/Support: Research reported in this publication was supported in part by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under awards T32AI007291 (Dr Zhong) and K24AI141580 (Dr Milstone) and the generosity of the collective community of donors to the Johns Hopkins University School of Medicine and the Johns Hopkins Health System for COVID-19 research.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank members of the Johns Hopkins Hospital Clinical Immunology Laboratory, Danielle Koontz, MAS, and Ani Voskertchian, MPH (Johns Hopkins University School of Medicine), for study coordination; Shaun Truelove, PhD (Johns Hopkins University Bloomberg School of Public Health), for intellectual contribution; Avinash Gadala, PhD (Johns Hopkins Health System), for data management; and Benjamin Mark Landrum, MD, Morgan Katz, MD, S. Sonia Qasba, MD, MPH, and Pooja Gupta, MD (Johns Hopkins University School of Medicine), for help with study recruitment. We thank Kirsten Vannice, PhD, MHS (Bill and Melinda Gates Foundation), for providing contribution to the analysis. None of the contributors above received compensation for their roles.

References

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Debes AK , Xiao S , Colantuoni E , et al. Association of vaccine type and prior SARS-CoV-2 infection with symptoms and antibody measurements following vaccination among health care workers. JAMA Intern Med. 2021. doi:10.1001/jamainternmed.2021.4580 PubMed Google Scholar

Parry H , Bruton R , Stephens C , et al. Extended interval BNT162b2 vaccination enhances peak antibody generation in older people. MedRxiv. Preprint posted May 17, 2021. doi:10.1101/2021.05.15.21257017

Durability of Antibody Levels After Vaccination With mRNA SARS-CoV-2 Vaccine in Individuals With or Without Prior Infection

Association of Prior SARS-CoV-2 Infection With Risk of Breakthrough Infection Following mRNA Vaccination in Qatar

Association of COVID-19 mRNA Vaccination With Hospitalizations and Disease Severity

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