COVID-19 Breakthroughs: mRNA Vaccines
The pandemic is almost two years old. Since the COVID-19 pandemic started, we have experienced several variants, different lockdown conditions, and maybe even lost loved ones in the process. The silver lining here is that we now know much more about this disease and have developed life-saving vaccines. These vaccines have drastically improved how we go about our day. In some parts of the world, life is pretty close to normal. Despite vaccination, however, people can still get sick with COVID-19. Enter the mRNA vaccines, which play a unique role in strengthening our immunity.
Key facts about COVID-19 Vaccinations
The World Health Organization and its partners continue to work together to ensure everyone has access to COVID-19 vaccination. Handwashing, avoiding crowds, and wearing a mask are simple measures everyone can take to help end the pandemic. Apart from these, here are the available vaccines known to be safe and effective:
- AstraZeneca/Oxford vaccine
- Johnson & Johnson
- Moderna
- Pfizer/BioNTech
- Sinopharm
- Sinovac
- COVAXIN
- Covovax
- Nuvaxovid
Achieving and maintaining a high vaccination coverage is paramount in this pandemic. All the vaccines mentioned above have demonstrably overwhelming prevention effects, substantially reducing hospitalization and critical illness. While Sars-Cov-2 infection can still cause COVID-19 in vaccinated patients, vaccination gives everyone a justifiable sense of security. After all, disease severity statistics have plummeted in regions where the population achieved vaccination coverage above 70%.
COVID-19 Breakthroughs: mRNA Vaccines
Pfizer-BioNTech and Moderna are mRNA vaccines. They initiate the creation of proteins that trigger an immune response in the body, thus creating antibodies. These antibodies then provide protection when the actual pathogen is encountered later on.
It is crucial to debunk any “myths” or misconceptions our patients may have regarding vaccines. We should let them know those mRNA vaccines cannot cause infection because they do not use live viruses. They also do not change or affect the body’s DNA in any way. Eventually, mRNA is broken down and cleared from the body a few days after vaccination. It is clear to the scientific and medical communities that the COVID-19 mRNA vaccines have been studied rigorously and evaluated thoroughly for safety.
Here’s a helpful infographic from the Centers for Disease Control and Prevention that you can post in your clinic. It will help educate your patients on how mRNA vaccines work.
Encouraging Patients to Get Vaccinated
We must encourage our patients to get vaccinated, ages 18 years old and above. However, those with comorbid conditions like hypertension, diabetes, asthma, liver, and kidney disease should be counseled carefully. The risk of an adverse reaction may outweigh the benefits in some cases. The candidates warranting a follow-up consultation includes patients who:
- Have an impaired immune system
- Are pregnant
- Are allergic, especially to vaccines
- Are frail or elderly
Before getting the vaccine, these special populations need clearance from us, their health providers. Otherwise, they should be encouraged to get vaccinated as soon as possible.
COVID-19 Breakthrough Infections
There have been some reports of people getting infected with COVID-19 after vaccination. This is known as a breakthrough infection. It is formally defined as the “detection of SARS-CoV-2 RNA or antigen in a respiratory specimen collected from a person 14 days after receipt of all recommended doses.” While none is 100% effective, vaccines effectively lessen the likelihood of hospitalization and death.
In the third quarter of last year, we saw the peak of the Delta variant. Breakthrough COVID-19 infections during that time were not very common. However, the rise of the highly infectious Omicron variant has affected the numbers. As time passes, immunity wanes due to the lessening of antibodies. Therefore, vaccines play a vital role in boosting our immunity. But, we should remember that some vaccines were created for different, earlier strains. This may explain why their real-world effectiveness varies depending on the leading variant, apart from individual factors.
The good news is that most breakthrough infections are mild. We should emphasize, to our patients, that vaccination bolsters immunity and produces more antibodies against COVID-19. This may be why a fully vaccinated person getting sick with COVID-19 after getting boosted usually has only mild or even no symptoms. However, some people may need hospitalization and aggressive care. Most of these patients in hospitals are now unvaccinated.
Overall, breakthrough infections are not new. Even before the pandemic, it was common knowledge that people could get sick even after completing their vaccinations. However, the pandemic strain has just added a layer of alarm. We should also remind our patients that no vaccine is perfect, which may be due to a host of reasons:
- The dominant variant can change.
- The study environment for the vaccines uses different populations.
- The person’s individual characteristics affect how the vaccines work.
Explaining the Numbers
Several organizations have been carefully monitoring the spread of COVID-19 and the occurrence of breakthrough infections. To get a better understanding of breakthrough infections, here are the numbers:
- Washington State identified 203,348 SARS-CoV-2 vaccine breakthrough cases
- 26% reported symptoms
- 3% were hospitalized
- 1,052 people died of COVID-related illness
Below, an epidemiologic curve shows non-breakthrough (gray) vs. breakthrough (blue) COVID-19 cases.
Several factors come into play in breakthrough infections:
- The most prevalent variant at the time affects the efficacy of available vaccines.
- The vaccination status of people also affects the incidence of breakthrough infections.
- It is also likely that immunity tends to wane over time.
- The recommendations from local government units (whether they tighten or loosen restrictions) also affect the incidence of breakthrough infections.
The South Carolina Department of Health and Environmental Control has also been crunching the numbers. The following table summarizes what they found on breakthrough infections.
Overall, these are very reassuring numbers. While the information we have continues to grow and change, these numbers tell us that COVID-19 breakthrough cases, especially hospitalizations and deaths, are rare among the fully vaccinated. The numbers show that those who are hospitalized or dying are among the unvaccinated people or partially vaccinated.
Risk Factors for Breakthrough Infections
People who are fully vaccinated can still get breakthrough COVID-19 infections. However, those at higher risk include people with compromised immune systems (organ transplant recipients, HIV-positive individuals, and cancer patients). Therefore, the Centers for Disease Control and Prevention recommend that this population receive an additional or third dose of the COVID-19 vaccine, given 28 days after their second booster, to increase their immunity.
Prevention of Breakthrough COVID-19 infections
Because it is still possible to get COVID-19 after a booster, here are some simple but effective recommendations we can give to our patients to help them prevent breakthrough infection:
- Frequent hand washing and good hygiene
- Observe cough etiquette by covering your nose and mouth or coughing into your elbow
- Wear a mask
- Dispose of used masks and tissue in appropriate bins
- Maintain good ventilation
- Disinfect items that are frequently touched, like doorknobs, handles, and your phone
- Avoid indoor gatherings where there are many people and ventilation is poor
- Contact your doctor right away if you experience any symptoms
Although we are still amid a pandemic, doing what we can go a long way in protecting public health. This goes for us as healthcare providers as well as our patients.
Track your COVID or post-COVID cough here.
