Original Article

COVID Infections Breakthrough Post‑Vaccination: Systematic Review

Syed Amaan Ali1, Shyamalima Bhattacharyya2, Faisal Noor Ahmad3, Rahul V. C. Tiwari4, Teerthesh Jain5,
Shrusti Rajendra Baad6, Heena Dixit Tiwari7

1
Department of Periodontics Introduction: Many new variants of the coronavirus are infecting the

Abstract
and Community Dentistry,
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Dr. Ziauddin Ahmed Dental
College and Hospital, Aligarh
Muslim University, Aligarh, UP,
India, 2Department of Public
Health Dentistry, Government
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already vaccinated people. There have been reports of deaths also among
the already vaccinated subjects. Hence, we conducted a systematic review
and meta‑analysis of the infection breakthrough after COVID vaccination.
Materials and Methods: We piloted a review of the healthcare workers who

Dental College, Dibrugarh,
Assam, India, 3Department of
Public Health Dentistry, I.T.S.
Dental College, Muradnagar,
Ghaziabad, UP, India, 4Executive
MHA Student, IIHMR
University, Jaipur, Rajasthan,
India, 5General Dentist, 7 Days
Family Dental, Indianapolis,
IN, USA, 6Vishwanth Katti
Institute of Dental Sciences, KLE
Belgaum, 7MPH Student, Parul
Univeristy, Limda, Waghodia,
Vadodara, Gujarat, India
completed the vaccination for COVID. The data were collected from the online
resources for the breakthrough infections after vaccination. We then enumerated
those subjects who had a breakthrough infection post‑vaccination. The data
collected were meta‑analyzed for the incidence of the infection among the
vaccinated individuals. Results: We observed that among nearly 2.3 lakh subjects,
less than 3% were infected with the various new strains of the virus. The ratio
of the breakthrough infection was different for the vaccinated (1.2%) and the
partially vaccinated (3.2%) individuals with greater infection among the partially
infected individuals. Discussion: The breakthrough infections are very low among
vaccinated individuals and even lower among fully vaccinated individuals. Hence,
vaccination is highly recommended to prevent the loss of life.

Submitted: 26‑Jan‑2022.
Revised: 30-Jan-2022
Accepted: 28‑Feb‑2022.
Published: 13-Jul-2022. Keywords: Breakthrough infections, coronavirus, vaccines

Introduction months, breakthrough infections have been commonly

T he world has to endure so much loss due to the
COVID pandemic. Vaccination drives have been
conducted across the countries at a great speed.[1‑4] The
desire and the need to get vaccinated among different
countries is different. Though the world health
authorities are urging to get vaccinated, many people
are apprehensive of the vaccination. Some countries are
even against vaccination drives. The most affected of the
people during this pandemic was the healthcare workers.
They were the most infected and had the highest death
rates compared to other workforces. Because they
were more prone to get infected due to continuous
exposure, the vaccination was also given to them at a
larger scale than the other groups. In the recent few
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reported among vaccinated individuals also.[5‑10] The
data available vary among different populations with
reinfections.[1‑18] Hence, we conducted a systematic
review and meta‑analysis of infections breakthrough
after COVID vaccination among healthcare workers.
Materials and Methods
We piloted a systematic review and meta‑analysis among
individuals who were vaccinated for the infection with
coronavirus and had the breakthrough infection after the
Address for correspondence: Dr. Heena Dixit Tiwari,
Parul Univeristy, Limda, Waghodia, Vadodara, Gujrat, India.
E‑mail: drheenatiwari@gmail.com
This is an open access article distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to remix, tweak,
and build upon the work non‑commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

How to cite this article: Ali SA, Bhattacharyya S, Ahmad FN, Tiwari RV,
DOI: 10.4103/jpbs.jpbs_132_22 Jain T, Baad SR, et al. COVID infections breakthrough post-vaccination:
Systematic review. J Pharm Bioall Sci 2022;14:S196-9.

S196 © 2022 Journal of Pharmacy and Bioallied Sciences | Published by Wolters Kluwer - Medknow
 Ali, et al.: COVID infections post‑vaccination

vaccination. The data were collected from online resources
including PubMed, Medline, and Embase. We included
original studies based on the Preferred Reporting Items
for Systematic reviews and Meta analyses guidelines,
the subjects were healthcare workers, the articles were in
English, the subjects received vaccinations and reported
breakthrough infections. We excluded case reports
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non‑vaccinated individuals was 16.4:1, whereas the ratio
of the fully vaccinated to partially vaccinated individuals
was 1.12:1. When the meta‑analysis was performed, we
observed that 2.145% of individuals had a breakthrough
infection. Among them, partially and fully vaccinated
individuals were 3.2% and 1.2%, respectively. Only
2.4% required hospital admission, and the death rate was

and reviews. The data thus collected were subjected to
meta‑analysis for the completion of vaccination (full/
partial), the incidence of the breakthrough infection
of the coronavirus among the various vaccinated
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1.0%. We found no publication bias in our study where
the “Egger’s 2‑tailed P value” was 0.4 [Figure 2].
Discussion

groups, and the percentage hospitalized; the mortality
rates were also calculated using the “Comprehensive
Meta‑Analysis (CMA) software, version 3 (BioStat,
Englewood, NJ)” [Figure 1].
Results
We finalized 18 studies from across the world[1‑18]
that fully filled all the inclusion criteria, with 2,30,000
healthcare workers as shown in the flow chart. All studies
were of high quality based on the “New‑Castle Ottawa
Scoring System.” The ratio of the vaccinated and the
The present study is one of the first to review the
breakthrough infection among vaccinated healthcare
workers. Our findings suggest that the incidence of
breakthrough infections was as low as less than 3%.[1‑18]
The incidence of the infection was even lower for those
who were fully vaccinated. The healthcare workers
while serving the patients may act as spreaders if they
are not vaccinated. Hence, vaccinating these workforces
is of prime significance. Though the acceptance of
the vaccine varies greatly among the common public,
we observed that almost all healthcare workers were

Figure 1: Comparisons of various vaccinated individuals for breakthrough infections

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 Ali, et al.: COVID infections post‑vaccination
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Figure 2: Flow chart for the selection of studies
vaccinated. In our study, partially and fully vaccinated
individuals were compared and we observed that partially
vaccinated subjects were more prone to infection than
fully vaccinated subjects.[1‑18] We also observed that the
ratio of hospitalization and mortality was also similarly
distributed. Our findings are comparable to other studies
that were conducted in the general public.[19,20]
The limitations of our study were that we included
only healthcare workers and compared the vaccinated
individuals. Hence, the ratio of infections presented in
our study may not be compared to general populations.
Furthermore, we did not consider the type of vaccine
administered.
Conclusion
Within the limitations of our study, we can conclude that
vaccinated individuals have a lower infection rate, and
even if they were reinfected, they have lower hospital
admission and death rates. Further comparative studies
are suggested to corroborate our findings.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Amit S, Beni SA, Biber A, Grinberg A, Leshem E,
Regev‑Yochay G. Postvaccination COVID‑19 among healthcare
workers, Israel. Emerg Infect Dis 2021;27:1220‑2.
2. Angel Y, Spitzer A, Henig O, Saiag E, Sprecher E, Padova H,
S198 Journal of Pharmacy and Bioallied Sciences ¦ Volume 14 ¦ Supplement 1 ¦ July 2022
et al. Association between vaccination with BNT162b2 and
incidence of symptomatic and asymptomatic SARS‑CoV‑2
infections among health care workers. JAMA 2021;325:2457‑65.
3. Azamgarhi T, Hodgkinson M, Shah A, Skinner JA,
Hauptmannova I, Briggs TWR, et al. BNT162b2 vaccine uptake
and effectiveness in UK healthcare workers–A single centre
cohort study. Nat Commun 2021;12:3698.
4. Bouton TC, Lodi S, Turcinovic J, Weber SE, Quinn E, Korn C,
et al. COVID‑19 vaccine impact on rates of SARS‑CoV‑2 cases
and post vaccination strain sequences among healthcare
workers at an urban academic medical center: A prospective
cohort study. medRxiv 2021;2021.03.30.21254655. doi:
10.1101/2021.03.30.21254655.
5. Cucunawangsih C, Wijaya RS, Lugito NPH, Suriapranata I.
Post‑vaccination cases of COVID‑19 among healthcare workers
at Siloam Teaching Hospital, Indonesia. Int J Infect Dis
2021;107:268‑70.
6. Hall VJ, Foulkes S, Saei A, Andrews N, Oguti B, Charlett A,
et al. COVID‑19 vaccine coverage in health‑care workers in
England and effectiveness of BNT162b2 mRNA vaccine against
infection (SIREN): A prospective, multicentre, cohort study.
Lancet 2021;397:1725‑35.
7. Issac A, Kochuparambil JJ, Elizabeth L. SARS‑CoV‑2
breakthrough infections among the healthcare workers
post‑vaccination with ChAdO×1 nCoV‑19 vaccine in the South
Indian State of Kerala. medRxiv 2021:2021.08.07.21261587.
8. Jacobson KB, Pinsky BA, Montez Rath ME, et al.
Post‑vaccination SARS‑CoV‑2 infections and incidence of
presumptive B.1.427/B.1.429 variant among healthcare personnel
at a northern California academic medical center. Clin Infect Dis
2021;ciab554. doi: 10.1093/cid/ciab554.
9. Keehner J, Horton LE, Pfeffer MA, Longhurst CA,
Schooley RT, Currier JS, et al. SARS‑CoV‑2 infection after
vaccination in health care workers in California. N Engl J Med
2021;384:1774‑5.
10. Maroof S, Bakht N, Saleem S, Nisar S, Rashid Z, Mansoor E,
et al. Covid‑19 vaccine breakthrough infections among health
care workers in military institutes of pakistan–till 30th june 2021.
PAFMJ 2021;71:1471‑5.
11. Mathema B, Chen L, Chow KF, Zhao Y, Zody MC,
Mediavilla JR, et al. Postvaccination SARS‑COV‑2 among
health care workers in new jersey: A genomic epidemiological
study. Microbiol Spectr 2021;9:e0188221.
12. North CM, Barczak A, Goldstein RH, Healy BC, Finkelstein DM,
Ding DD, et al. Determining the incidence of asymptomatic
SARS‑CoV‑2 among early recipients of COVID‑19 vaccines:
A prospective cohort study of healthcare workers before, during
and after vaccination [DISCOVER‑COVID‑19]. Clin Infect Dis
2021;ciab643. doi: 10.1093/cid/ciab643.
13. Pandurangaiah R, Jose M. Post vaccination COVID‑19 infection
among health care workers in secondary medical care centre. Int
J Clin Obstetr Gynaecol 2021;5:163‑5.
14. Sabnis R, Patil A, Shete N, Rastogi AK. Break‑through
COVID‑19 infection rate with Indian strain in single‑center
healthcare workers – A real world data. medRxiv 2021. doi:
10.1101/2021.07.02.21258881.
15. Sharma P, Mishra S, Basu S, Tanwar N, Kumar R. Breakthrough
infection with SARS‑CoV‑2 and its predictors among healthcare
workers in a medical college and hospital complex in Delhi,
India. medRxiv 2021. doi: 10.1101/2021.06.07.21258447.
16. Tang L, Hijano DR, Gaur AH, Geiger TL, Neufeld EJ,
Hoffman JM, et al. Asymptomatic and symptomatic SARS‑CoV‑2
infections after BNT162b2 vaccination in a routinely screened
workforce. JAMA 2021;325:2500‑2.
 Ali, et al.: COVID infections post‑vaccination

17. Tyagi K, Ghosh A, Nair D, Dutta K, Bhandari PS,
Ansari IA, et al. Breakthrough COVID19 infections after
vaccinations in healthcare and other workers in a chronic care
medical facility in New Delhi, India. Diabetes Metab Syndr
2021;15:1007‑8.
18. Vaishya R, Sibal A, Malani A, Kar S, Prasad K H, Sv K,
et al. Symptomatic post-vaccination SARS-CoV-2 infections
in healthcare workers- A multicenter cohort study. Diabetes
Downloaded from http://journals.lww.com/jpbs by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
dsx.2021.102306. Epub 2021 Oct 4. PMID: 34619430; PMCID:
PMC8489275.
19. Malhotra S, Mani K, Lodha R, Bakhshi S, Mathur VP, Gupta P,
et al. SARS‑CoV‑2 reinfection rate and estimated effectiveness of
the inactivated whole virion vaccine BBV152 against reinfection
among health care workers in New Delhi, India. JAMA Netw
Open 2022;5:e2142210.
20. Cohen JI, Burbelo PD. Reinfection with SARS‑CoV‑2:

Metab Syndr. 2021 Nov-Dec;15(6):102306. doi: 10.1016/j. Implications for vaccines. Clin Infect Dis 2021;73:e4223‑8.
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 05/08/2024

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