Long COVID after breakthrough SARS-CoV-2 infection - s41591-022-01840-0.pdf
The post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection—also referred to as
Long COVID—have been described, but whether breakthrough SARS-CoV-2 infection (BTI) in vaccinated people results in
post-acute sequelae is not clear. In this study, we used the US Department of Veterans Affairs national healthcare databases to
build a cohort of 33,940 individuals with BTI and several controls of people without evidence of SARS-CoV-2 infection, includ-
ing contemporary (n = 4,983,491), historical (n = 5,785,273) and vaccinated (n = 2,566,369) controls. At 6 months after infec-
tion, we show that, beyond the first 30 days of illness, compared to contemporary controls, people with BTI exhibited a higher
risk of death (hazard ratio (HR) = 1.75, 95% confidence interval (CI): 1.59, 1.93) and incident post-acute sequelae (HR = 1.50,
95% CI: 1.46, 1.54), including cardiovascular, coagulation and hematologic, gastrointestinal, kidney, mental health, metabolic,
musculoskeletal and neurologic disorders. The results were consistent in comparisons versus the historical and vaccinated
controls. Compared to people with SARS-CoV-2 infection who were not previously vaccinated (n = 113,474), people with BTI
exhibited lower risks of death (HR = 0.66, 95% CI: 0.58, 0.74) and incident post-acute sequelae (HR = 0.85, 95% CI: 0.82,
0.89). Altogether, the findings suggest that vaccination before infection confers only partial protection in the post-acute phase
of the disease; hence, reliance on it as a sole mitigation strategy may not optimally reduce long-term health consequences of
SARS-CoV-2 infection. The findings emphasize the need for continued optimization of strategies for primary prevention of BTI
and will guide development of post-acute care pathways for people with BTI.