Breakthrough Infection

A breakthrough infection is a case of illness in which a vaccinated individual becomes sick from the same illness that the vaccine is meant to prevent. Simply, they occur when vaccines fail to provide immunity against the pathogen they are designed to target. Breakthrough infections have been identified in individuals immunized against a variety of different diseases including Mumps, Varicella (Chicken Pox), and Influenza. The character of breakthrough infections is dependent on the virus itself. Often, the infection in the vaccinated individual results in milder symptoms and is of a shorter duration than if the infection was contracted naturally.
Causes of breakthrough infections include improper administration or storage of vaccines, mutations in viruses and antibody blocking. For these reasons, vaccines are rarely 100% effective. The common flu vaccine is estimated to provide immunity to the flu in 58% of recipients. The measles vaccine fails to provide immunity to 2% of children that receive the vaccine. However, if herd immunity exists, it typically prevents individuals who are ineffectively vaccinated from contracting the disease. Accordingly, herd immunity reduces the number of breakthrough infections in a population.

COVID-19 vaccines are a critical tool for controlling the ongoing global pandemic. The Food and Drug Administration (FDA) has issued Emergency Use Authorizations for three COVID-19 vaccines for use in the United States.* In large, randomized-controlled trials, each vaccine was found to be safe and efficacious in preventing symptomatic, laboratory-confirmed COVID-19 (13). Despite the high level of vaccine efficacy, a small percentage of fully vaccinated persons (i.e. received all recommended doses of an FDA-authorized COVID-19 vaccine) will develop symptomatic or asymptomatic infections with SARS-CoV-2, the virus that causes COVID-19 (28).

CDC is working with state and territorial health departments to investigate SARS-CoV-2 infections among persons who are fully vaccinated and to monitor trends in case characteristics and SARS-CoV-2 variants identified from persons with these infections. For this surveillance, a vaccine breakthrough infection is 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 of an FDA-authorized COVID-19 vaccine. State health departments voluntarily report vaccine breakthrough infections to CDC. When possible, genomic sequencing is performed on respiratory specimens that test positive for SARS-CoV-2 RNA (9).

Weekly / May 28, 2021 / 70(21);792–793

On May 25, 2021, this report was posted online as an MMWR Early Release.

CDC COVID-19 Vaccine Breakthrough Case Investigations Team

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