American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Clinical Updates

COVID-19 and Vaccine Update: Breakthrough Infections after Vaccination

by Kenneth W. Sharp, MD, FACS, ACS Regent

The vaccination campaign for prevention of COVID-19 is going smoothly, even if not as rapidly as many health care professionals would desire. As of April 30, 2021, approximately 101 million persons in the U.S. have received full vaccination against COVID-19. Read the Centers for Disease Control and Prevention report

The Centers for Disease Control and Prevention has reported a total of 10,262 SARS-CoV-2 breakthrough infections as of the same date—a very small fraction of those vaccinated (though this certainly is an underestimate of the true number, as asymptomatic cases are not likely to be captured accurately). The patients reported were a median age 58 and 63 percent female. Many infections were asymptomatic and 10 percent (995) were hospitalized. A total of 160 (2 percent) died—median age 82 and 28 (18 percent) of those who died were asymptomatic or died from causes unrelated to COVID-19. There were 555 cases for which genetic sequencing data were available and 356 (64 percent) of those were reported to be variants of concern. These included B.1.1.7 (56 percent, the “U.K.” variant), B.1.429 (25 percent, the “California” variant), B.1.427 (8 percent, the other “California” variant), P.1 (8 percent, the “Brazilian” variant) and B.1.351 (4 percent, the “South Africa” variant). These variants account for approximately 70 percent of COVID-19 cases occurring in the period March 29–April 10 in the U.S., so these are not variants with an unusually high prevalence for breakthrough infections after vaccination. 

The CDC began reporting only COVID-19 cases resulting in hospitalization or death on May 1, 2021. These are the cases of highest importance for public health, as asymptomatic cases are not accurately captured and have less clinical significance. The CDC will continue to collect reports of all breakthrough COVID-19 cases to continually monitor vaccine effectiveness. 

Current FDA authorized vaccines (under the Emergency Use Authorization) are recommended for all persons 12 years old or older. Fellows of the ACS and their patients should be reassured that the currently available COVID-19 vaccines are effective and safe.