S A Research
S A Research
Breakthrough infections One individual had received a full dose observation period (day 21). Blood
of CX-024414 (Spikevax, Moderna, oxygenation levels (SPO2) remained
with SARS-CoV-2 Cambridge, MA, USA) in early in the normal range (>94%) without Published Online
omicron despite mRNA October, 2021; this was not in line exception and none of the patients January 18, 2022
https://doi.org/10.1016/
with the European Medicines Agency required hospitalisation. Prevalence of
vaccine booster dose recommendations at that time, symptoms over time is provided in the
S0140-6736(22)00090-3
The most recent SARS-CoV-2 variant which suggested a half dose to boost appendix (p 4).
of concern to emerge has been healthy individuals. 5 The seventh All seven individuals were infected
named omicron.1 Its immune evasion individual received an initial dose of with omicron (PANGO lineage
potential was predicted by genomic ChAdOx1-S (Vaxzevria, AstraZeneca, B.1.1.529, Nextstrain clade 21K).
data and has been preliminarily Cambridge, UK), followed by a Viral loads ranged from 4·07 to 8·22
confirmed by observations of an dose of BNT162b2 for completion (mean 6·38) log10 viral RNA copies
increased incidence of reinfections of primary immunisation, and a per mL of swab eluate. Anti-spike
and breakthrough infections.2 This has booster dose of the same vaccine. antibody levels ranged from 15 000
triggered calls to intensify vaccination Except for the CX-024414 booster, all arbitrary units (AU) per mL to more
programmes including provision of vaccinations were in accordance with than 40 000 AU/mL, with a mean of
vaccine booster doses.3 European recommendations.4,5 The approximately 22 000 AU/mL of serum
A group of German visitors who had early timepoints of some individuals’ (appendix p 3).
received three doses of SARS-CoV-2 primary and booster vaccinations were Robust CD4 and CD8 T-cell responses
vaccines, including at least two doses due to their occupation in the medical to SARS-CoV-2 spike, nucleocapsid,
of an mRNA vaccine, experienced field. Nobody reported a history of and membrane proteins were detected
breakthrough infections with SARS-CoV-2 infection. in six of the participants tested after
omicron between late November During a marked increase in a minimum of 2 weeks after onset For SARS-CoV-2 infections in
and early December, 2021, while in incidence of SARS-CoV-2 infections of symptoms (appendix p 5), at the Western Cape province see
https://coronavirus.westerncape.
Cape Town, South Africa. The group in the Western Cape province, frequencies of 0·011–0·192% for CD4+ gov.za/covid-19-dashboard
consisted of five White women and these individuals observed onset and 0·004–0·079% for CD8+ T cells.
two White men) with an average age of respiratory symptoms between These were the first documented
of 27·7 years (range 25–39) and a Nov 30 and Dec 2, 2021. SARS-CoV-2 breakthrough infections with the
mean body-mass index of 22·2 kg/m2 infections were diagnosed by omicron variant in fully vaccinated
(range 17·9–29·4), with no relevant ISO 15189-accredited diagnostic individuals after receipt of booster
medical history. Four of the individuals laboratories using molecular assays vaccine doses. Some of these
were participating in clinical elective approved by the national regulator. individuals had received heterologous
training at different hospitals in The investigation was approved vaccine doses, in line with emerging
Cape Town, whereas the others were by the Health Research Ethics global practice. Booster doses
on vacation. The individuals were Committees of Stellenbosch University were administered 21–37 weeks
members of two unlinked social (C21/12/004_COVID-19) and the after the second vaccine doses, and
groups and participated in regular University of Cape Town (279/2021) breakthrough infections occurred
social life in Cape Town, in compliance and all participants provided informed 22–59 days thereafter. At the onset
with applicable COVID-19 protocols. consent. of their breakthrough infections, all
Upon arrival during the first half of We obtained swab and serum individuals had high levels of viral spike
November, 2021, each individual samples 2–4 days after onset of protein binding antibodies, similar
tested negative for SARS-CoV-2 by symptoms. Futher details of how to levels reported 4 weeks following
PCR and provided records of complete samples were processed are provided second vaccine doses6 and as expected
vaccination, including booster or third, in the appendix (p 2). All patients were after receipt of booster vaccine doses.7 See Online for appendix
doses administered via intramuscular placed in domestic isolation and used Viral RNA loads in omicron variant
injection using homologous (n=5) a daily symptom diary to document infections have yet to be reported.
and heterologous (n=2) vaccination the course of disease during the It remains unknown whether the For National Institutes of
Health COVID-19 Treatment
courses (appendix p 3).4 observation period of 21 days. viral loads observed in our group are
Guidelines see https://www.
Six individuals were fully vaccin Illness was classified as mild (n=4) or different from those in unvaccinated, covid19treatmentguidelines.nih.
ated with BNT162b2 (Comirnaty, moderate (n=3; shortness of breath) or differently vaccinated, individuals. gov
Pfizer–BioNTech, Mainz, Germany), according to National Institutes During wild-type SARS-CoV-2 Submissions should be
made via our electronic
five of whom received a third of Health COVID-19 Treatment infection, an average viral RNA load
submission system at
(booster) dose of BNT162b2 in Guidelines. Two individuals were of 5·83 log10 viral RNA copies per http://ees.elsevier.com/
October or early November, 2021. asymptomatic by the end of the swab was found in samples taken thelancet/
up to day after onset of symptoms,8 These findings support the need for 7 Demonbreun AR, Sancilio A, Vaught LA, et al.
Antibody titers before and after booster doses
with a maximum of 8·85 log10 viral updated vaccines to provide better of SARS-CoV-2 mRNA vaccines in healthy
RNA copies per swab. In this group of protection against symptomatic adults. medRxiv 2021; published online Nov 21.
individuals, an average of 6·38 log10 infection with omicron13 and emphasise https://doi.org/10.1101/2021.11.19.21266555
(preprint).
viral RNA copies per mL of eluted swab that non-pharmaceutical measures 8 Wölfel R, Corman VM, Guggemos W, et al.
was detected, with the highest viral should be maintained. Encouragingly, Virological assessment of hospitalized
patients with COVID-2019. Nature 2020;
load (8·22 log10) detected on day 4 early data from South Africa suggest 581: 465–69.
after onset of symptoms. This suggests maintained if reduced effectiveness of 9 Keeton R, Richardson SI, Moyo-Gwete T, et al.
that the individuals were infectious, the BNT162b2 vaccine against hospital Prior infection with SARS-CoV-2 boosts and
broadens Ad26.COV2.S immunogenicity in a
in keeping with the occurrence of admission.14 variant-dependent manner. Cell Host Microbe
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members of the two groups. competing interests. 10 Cele S, Jackson L, Khan K, et al. Omicron
extensively but incompletely escapes Pfizer
Specific T-cell responses were Constanze Kuhlmann, BNT162b2 neutralization. Nature 2021;
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with additional T-cell responses to Catherine Riou, Andrew D Sutherland, omicron variant by vaccine sera and
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[email protected] 12 Pfizer. Pfizer and BioNTech provide update on
The mild to moderate course of omicron variant. Press release. Dec 8, 2021.
illness suggests that full vaccination Division of Hand, Plastic and Aesthetic Surgery, https://www.pfizer.com/news/press-release/
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