Voluntary Reporting By State Health Departments
When the United States began widespread COVID-19 vaccination, CDC put in place a system where state health departments could report COVID-19 breakthrough infections to CDC.; After collecting data on thousands of breakthrough infections, CDC changed the reporting system to improve data quality on breakthrough infections, and primarily focus on those among people who are hospitalized or die. This shift helped maximize the quality of the data collected on infections of greatest clinical and public health importance. Currently, 49 states are reporting data.
- Unexpected patterns, such as trends in age or sex.
- The specific types or brands of vaccine involved.
- Underlying health conditions in these persons.
- Which SARS-CoV-2 variants are observed in persons who are hospitalized or who die.
- Demographic cohorts .
So far, CDC has not observed any unexpected patterns in these reported breakthrough infections.
Covid Vaccines Slash Viral Spread But Delta Is An Unknown
A dose of the PfizerBioNTech COVID-19 vaccine is administered at the Sheba Medical Center near Tel Aviv, Israel.Credit: Jack Guez/AFP/Getty
Many vaccines have been shown to provide strong protection against COVID-19. Now, growing evidence finds that they also substantially reduce the risk of passing on the virus SARS-CoV-2 crucial information for governments making decisions about how best to control the pandemic.
However, the studies were done before the highly transmissible Delta variant became prevalent and scientists say it might be more easily spread by vaccinated people than are earlier variants.
Two studies, from Israel, posted as preprints on 16 July, find that two doses of the vaccine made by pharmaceutical company Pfizer, based in New York City, and biotechnology company BioNTech, based in Mainz, Germany, are 81% effective at preventing SARS-CoV-2 infections. And vaccinated people who do get infected are up to 78% less likely to spread the virus to household members than are unvaccinated people. Overall, this adds up to very high protection against transmission, say researchers.
The studies reflect population-level trends, say researchers. Its good news, says Natalie Dean, a biostatistician at Emory University in Atlanta, Georgia. But its not quite good enough, she notes, because it means that vaccinated people can still occasionally spread the infection.
Trials Focused On Infection Not On Transmission
How can it be that after conducting clinical trials that involved tens of thousands of people, there was still uncertainty about whether the three authorized COVID-19 vaccinesfrom Pfizer-BioNTech, Moderna, and Johnson & Johnsoncould prevent or reduce transmission?
In large part, its because the clinical trials for these vaccines were primarily focused on determining whether the vaccines protected against symptomatic COVID-19 infection. And though the trials showed that the vaccines are very effective in preventing severe disease, hospitalization, and death, none were found to be 100% protective against infection, meaning that some trial participants had mild or asymptomatic COVID-19 cases, even after vaccination.
With the initial coronavirus strain, or even with the Alpha variant, the post-vaccine immune response is usually fast and potent enough that it clears out the infection quicklybefore the virus can spread far in the body or serious symptoms have a chance to develop. But because infection could technically occur, transmission was still considered a possibilityalbeit a remote one.
The Delta variant is showing every day its willingness to outsmart us, said CDC director Rochelle Walensky, MD, MPH, at a recent news briefing.
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Surveillance To Inform Testing Strategies
- Leverage and enhance existing surveillance data and infrastructure and public health alerting systems to identify vaccine-escape VoCs and/or high risk settings/locations
- Maintain capacity to detect new VOCs through genomic sequencing, particularly when a vaccinated person has a positive test result
- Use targeted wastewater surveillance and rapid tests for asymptomatic screening to improve general surveillance information
- Monitor ongoing reporting of hospitalizations, ICU admissions and deaths of people with confirmed COVID-19 test results on a weekly basis to provide insight into the ongoing burden of COVID-19. Multiplex testing could also be useful in key sentinel surveillance sites
Confounding Factor Of Delta
But studies on Alpha and other variants cannot be easily generalized to Delta, says Steven Riley, an infectious-diseases researcher at Imperial College London.
So far, there are no published data on how vaccines affect infections and infectiousness with Delta, but a UK study published on 21 July shows that the PfizerBioNTech and OxfordAstraZeneca vaccines both protect slightly less well against symptomatic disease caused by Delta than against that caused by Alpha. This could also mean a drop in how well they protect against transmission of Delta, but there is still a lot of uncertainty, says Dean.
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Delta Variant Could Be Catastrophic In Some Communities
In communities with lower vaccination rates, particularly rural areas with limited access to care, the Delta variant could be even more damaging. This is already being seen around the world in poorer countries where the COVID-19 vaccine isn’t as accessible. Health experts say the impact could be felt for decades to come.
Vaccinated People Test Positive For Covid On A Carnival Cruise Ship
- Twenty-seven vaccinated people aboard a Carnival cruise ship that docked in Belize tested positive for Covid-19 this week.
- Only one of the positive cases was a passenger; the remaining 26 were crew members.
- All 27 people are experiencing mild or no symptoms.
In this article
Twenty-seven people tested positive for Covid-19 aboard the Carnival Vista cruise ship, which docked in Belize on Wednesday, according to the Belize Tourism Board.
Only one of the positive cases was a passenger; the remaining 26 were crew members. All 27 people were vaccinated and are experiencing mild or no symptoms, the country’s tourism board said.
Contact tracing was conducted, and no other positive cases were discovered.
There are 2,895 guests and 1,441 crew on the ship that sailed from Galveston, Texas, the tourism board said.
According to The Washington Post, Carnival said it announced last week that there were positive cases on board but did not disclose how many cases there were at that time.
“Carnival is managing a small number of positive COVID cases on Carnival Vista sailing out of Galveston. This despite all of our crew and almost all of our guests being vaccinated,” a spokesperson for Carnival Cruises said in a statement.
“We have managed the situation utilizing stringent health protocols which included placing those who tested positive in isolation and close contacts in quarantine.”
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How To Interpret These Data
The number of COVID-19 vaccine breakthrough infections reported to CDC are an undercount of all SARS-CoV-2 infections among fully vaccinated persons, especially of asymptomatic or mild infections. National surveillance relies on passive and voluntary reporting, and data are not complete or representative. These surveillance data are a snapshot and help identify patterns and look for signals among vaccine breakthrough cases.
Information on patients with vaccine breakthrough infection who were hospitalized or died will continue to be updated. Studies;are being conducted in multiple U.S. sites that will include information on all vaccine breakthrough infections regardless of clinical status to supplement the national surveillance.
Get Tested If You Have Symptoms
The only time you should be tested after being fully vaccinated against COVID is if you develop symptoms consistent with COVID, said Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security in Baltimore and an infectious disease expert. This includes a fever, cough, shortness of breath and muscle aches or chills.
This is consistent with the latest guidance from the U.S. Centers for Disease Control and Prevention. Even if you were directly exposed to someone with COVID, you dont need to get tested as long as you dont have symptoms, according to the guidelines.
What It Means To Be Fully Vaccinated
- People are fully vaccinated for COVID-19 if they have received two doses of either the Moderna or Pfizer COVID-19 vaccines or a single dose of the Janssen vaccine more than 14 days ago.
- This also applies to COVID-19 vaccines that have been authorized for emergency use by the World Health Organization .
Up Down Sideways: Around The World The Pandemic Defies Easy Description
On a global scale, the latest wave of the pandemic appears to be cresting at a lower level than those of the winter and spring, but the pattern differs markedly from place to place, as each nation endures its own particular drama.
The patchwork reflects the radically different paths the coronavirus takes from nation to nation, depending not only on vaccines, but on geographic isolation, the spread of the highly infectious Delta and other variants, social and economic restrictions, public compliance and an element of luck.
Conditions have improved substantially in places like India and South America that a few months ago were among the hardest-hit in the world, according to the Center for Systems Science and Engineering at Johns Hopkins University.
In May, India reached about 400,000 new infections and 4,000 Covid-19 deaths officially reported per day, though experts said the true toll was much higher. On Monday, the daily tally of new cases in India dipped below 30,000 for the first time in more than four months, and the country is now reporting fewer than 1,000 deaths a day.
The most troubled countries now are a scattered assortment, not concentrated in any one region. Botswana, Kazakhstan, Malaysia and Spain have among the highest infection rates in the world, with numbers still climbing. Indonesia, which was recording more cases than any other country this month, remains badly affected, but the pace there has eased somewhat.
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What Can You Do To Stay Safe
In light of the rapid rise in COVID-19 cases, largely driven by the Delta variant, in late July, the CDC updated its COVID-19 prevention guidance. The CDC is now recommending that everyone, including the fully vaccinated, wear a mask in indoor public spaces in areas where COVID-19 transmission is substantial or high.
The new recommendations emphasize that certain populations should continue masking, for instance those who have or live with someone who has a suppressed immune system or an underlying medical condition that puts them at risk for severe disease.;
The agency has also urged universal masking for teachers, staff, students, and visitors in K-12 schools, regardless of their vaccination status and the intensity of community transmission in their area.
Another substantial change to the CDC guidelines is the recommendation that fully vaccinated people who have been exposed to someone who has COVID-19 get tested. These people should also wear a mask when indoors in public areas for two weeks after exposure or until test results are negative.
Importantly, says Dr. Meyer, theyre not recommending quarantine after exposure if youre fully vaccinatedjust to wear a mask and get tested. And thats because we think post-vaccination infections are so rare.
But if fully vaccinated people test positive for COVID-19, the CDC recommends they isolate for 10 days.
All Of New York City Falls Under The Cdc Guidelines For Indoor Masking
All of New York City currently exceeds the threshold for coronavirus transmission outlined by the Centers for Disease Control and Prevention on Tuesday in its guidance recommending that vaccinated people resume wearing masks in public indoor spaces in areas where the virus is raging.
Agency officials said that Americans should wear masks indoors in parts of the country that have recorded more than 50 new infections per 100,000 residents over the previous week, or where more than 8 percent of tests are positive for infection over that period.
All five counties in New York City fall under those parameters. Staten Island, which has again become a virus hot spot and has some of the lowest vaccination rates in the city, recorded 109 cases per 100,000 residents last week, according to the C.D.C. In Brooklyn and Manhattan, 78.1 and 70.4 cases were recorded, respectively, while the Bronx and Queens are both closer to the 50-case benchmark set by the C.D.C.
The agencys recommendations are not binding, and on Wednesday, it remained unclear whether New York City would alter its mask requirements to reflect the new guidelines.
Mayor Bill de Blasio said at a news conference that the city was still evaluating the guidance and the research and data that underpinned it.
We got it less than 24 hours ago, and it is complicated information, Mr. de Blasio said. So our health team is reviewing and well have more to say on it in the next few days.
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What We Know About Vaccine Breakthrough Infections
- Breakthrough infections are expected. COVID-19 vaccines are effective at preventing most infections. However, like most vaccines, they are not 100% effective.
- Fully vaccinated people with a breakthrough infection are less likely to develop serious illness than those who are unvaccinated and get COVID-19.
- Even when fully vaccinated people develop symptoms, they tend to be less severe symptoms than in unvaccinated people. This means they are much less likely to be hospitalized or die than people who are not vaccinated.
- People who get vaccine breakthrough infections can be contagious.
CDC is collecting data on vaccine breakthrough infections and closely monitors the safety and effectiveness of all Food and Drug Administration -authorized COVID-19 vaccines.;Because vaccines are not 100% effective, as the number of people who are fully vaccinated goes up, the number of breakthrough infections will also increase. However, the risk of infection remains much higher for unvaccinated than vaccinated people. Vaccines remain effective in protecting most people from COVID-19 infection and its complications.
Fully Vaccinated Supreme Court Justice Tests Positive For Covid
WASHINGTON The Supreme Court says Justice Brett Kavanaugh has tested positive for COVID-19. The high court said in a press release Friday that Kavanaugh has no symptoms and has been fully vaccinated since January. Kavanaugh and all the other justices had a routine coronavirus test ahead of Fridays ceremonial investiture for Justice Amy Coney Barrett.
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Can A Vaccinated Person Spread Coronavirus
Immunologists expect vaccines that protect against viral illnesses to also reduce transmission of the virus after vaccination. But its actually tricky to figure out for sure if vaccinated people are not spreading the germ.
COVID-19 poses a particular challenge because people with asymptomatic and pre-symptomatic infections can spread the disease and insufficient contact tracing and testing mean those without symptoms are rarely detected. Some scientists estimate that the number of asymptomatic COVID-19 infections in the overall population could be 3 to 20 times higher than the number of confirmed cases. Research suggests that undocumented cases of COVID-19 in people who either were asymptomatic or experienced very mild disease could be responsible for up to 86% of all infections, though other studies contradict the high estimates.
In one study, the CDC tested volunteer health care personnel and other front-line workers at eight U.S. locations for SARS-CoV-2 infections weekly for three months, regardless of symptoms or vaccination status. The researchers found that fully immunized participants were 25 times less likely to test positive for COVID-19 than were those who were unvaccinated. Findings like this imply that if vaccinated people are so well protected from getting infected at all, they are also unlikely to spread the virus. But without contact tracing to track transmission in a larger population, its impossible to know if the assumption is true.
Recommendations For Outdoor Settings
Current data suggest the risk of transmission of SARS-CoV-2 in outdoor settings is minimal. In general, fully vaccinated people do not need to wear a mask outdoors. Fully vaccinated people might choose to wear a mask in crowded outdoor settings if they or someone in their household is immunocompromised.
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Can People Vaccinated Against Covid
When the U.S. Centers for Disease Control and Prevention changed its guidelines about mask-wearing on May 13, 2021, plenty of Americans were left a little confused. Now anyone who is fully vaccinated can participate in indoor and outdoor activities, large or small, without wearing a mask or physical distancing.
Anthony Fauci, chief medical adviser to President Biden, said the new guideline is based on the evolution of the science and serves as an incentive for the almost two-thirds of Americans who are not yet fully vaccinated to go ahead and get the shot.
But some people cannot be vaccinated because of underlying conditions. Others with weakened immune systems, from cancer or medical treatments, may not be fully protected. Children aged 12 to 15 became eligible for the Pfizer-BioNTech vaccine only on May 10, 2021. And no COVID-19 vaccines are yet authorized for the nearly 50 million children in the U.S. younger than 12.
As restrictions are lifted and people start to leave their masks at home, some people worry: Can you catch COVID-19 from someone whos vaccinated?
Breakthrough Cases And Delta: Background
Until recently, scientists were unsure whether fully vaccinated people who became infected with COVID-19 could transmit it to others. But the CDC report released in late July made it clear that some vaccinated people can get Delta in a breakthrough infectionand may be contagious.; ;
The CDC added that breakthrough infections occur in only a small proportion of vaccinated people and of the breakthrough infections, transmission by the vaccinated appears to only be a small part of overall spread of the virus. But the CDC says it does not yet have data on the likelihood of asymptomatic spread among vaccinated people.
So, where does that leave us?
What we do know, says Dr. Meyer, is that there is less circulating virus in the community as a result of vaccination. When we look at vaccinations compared to cases on a population levelwe see that as the number of people vaccinated rises, the number of cases decreases, she says. This is likely due to the fact that people who are vaccinated are not becoming infected as often, but also that they are not forward-transmitting the virus as often.
But more research is needed. The CDC says that “studies are underway to understand the level and duration of transmissibility from Delta vaccine breakthrough infections.”
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