Vaccination breakthrough: sick despite vaccination

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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Millions of people around the world have already been vaccinated. This also increases the number of people who get sick again from the virus despite full vaccination protection - some of them seriously.

According to the Robert Koch Institute RKI, Germany, for example, has so far counted more than 5,300 such breakthroughs in vaccination - without any information on the severity of the disease (as of July 14, 2021). According to the Federal Office for Safety in Health Care, the BASG, there were up to 314 in Austria. In Switzerland, the BAG (Federal Office of Public Health) reports 391 infections despite complete immunization. But that is no reason to doubt the vaccinations.

There is no such thing as 100 percent protection

Because one thing was clear from the start: Even a complete vaccination does not guarantee 100 percent safety. Even a double injection of mRNA vaccines from BioNTech or Moderna offers a very high level of protection against disease - but not a perfect one.

Even in the studies that were necessary for the approval of the vaccines, some of the vaccinated participants fell ill. But not a single participant became seriously ill - and none of them died from a Sars-CoV-2 infection.

Depending on how high their proportion of the sick was, the manufacturers calculated efficacy of 95 to 66 percent. However, depending on the study, these numbers only related to a few thousand to a few tens of thousands of participants. It is obvious that in view of the many millions of people who have been vaccinated, it does not always turn out so lightly, and that some of them still get seriously ill.

In addition, the approval studies have predominantly recruited participants of "middle to medium-high" age. They cannot depict the real diversity of the population. The various individual factors that influence the success of the vaccination - such as age, general physical condition, previous illnesses and social influencing factors - are too diverse.

The influence of the mutants

Above all, however, the beta and now the much more contagious delta variant have increasingly displaced the original pathogen.

The world was relieved to note that the vaccines also provide excellent protection against these variants. But compared to the original virus, the effectiveness is still somewhat reduced. This may increase the risk of severe disease and death despite double vaccinations - especially in the risk groups.

And another factor could come into play: people who have been infected with the Delta variant, for example, usually harbor larger amounts of viruses in their throats.Not only is the probability of infecting others higher, but also that they will become seriously ill. Because the greater the amount of virus someone inhales, the more likely a severe course is. It cannot therefore be ruled out that breakthroughs in vaccination could occur more frequently for this reason as well.

Who does a breakthrough vaccination hit?

A recent Israeli study provides valuable information on which groups are particularly affected by disease breakthroughs. Around 60 percent of the population there has already been vaccinated twice with BioNTech (as of July 21, 2021).

Around 300 of them are still so seriously ill with Covid-19 that they had to be treated in hospital. A group of scientists from the University Hospital in Ashdod evaluated 152 cases. 38 of them had to be ventilated, 34 died. In view of more than 5.1 million fully vaccinated Israelis (as of July 21, 2021) with simultaneous extensive easing, this is a very small number for all the tragedy. However, these findings are a reminder to continue prudent behavior.

Old people, the sick - and men

But which people did these serious vaccine breakthroughs hit? Even if one of the people concerned was only 22 years old, the rest were mostly elderly. The average age of those affected was 71 years. Around two thirds of them were men.

In addition, 96 percent suffered from previous illnesses: high blood pressure, diabetes, heart failure, chronic kidney and lung diseases, dementia or cancer. Only six of the patients had no previous illness.

A weak immune system is also risky for those who have been vaccinated

Particularly noticeable: the immune system was weakened in 40 percent of the patients. Some took corticosteroids, others received chemotherapy or antibody therapy (anti-CD20) because of cancer. Still others had to take immunocompromising medication due to an organ transplant to avoid a rejection reaction.

The study thus highlights an important factor that must be taken into account when considering the protective effect: Just as among the unvaccinated, three groups are particularly at risk among the vaccinated: the previously ill, the elderly and the immunocompromised.

80-year-olds who have been vaccinated twice are as at risk as unvaccinated 50-year-olds

The British statistician David Spiegelhalter commented on this in a guest article in the online edition of the British magazine The Guardian. According to him, a person over 80 who was double-vaccinated has a similar risk of death as an unvaccinated 50-year-old.

In fact, the already weaker immune protection of the elderly, especially against the virus variants, could fall a little further. In this case, older people are additionally protected if the younger ones around them are also vaccinated.

It could look even more critical for people with pronounced immune deficiency. For safety reasons, they had not taken part in the admission studies. They are now considering giving them a third immunization.

Masks can also be useful for vaccinated people

Conclusion: Complete immunizations significantly reduce the risk of disease - but they are not "infallible". The more people are vaccinated, the better everyone is protected from breakthroughs in the vaccination - especially the group of those at particular risk.

At the latest in times with highly contagious variants and high incidences - as expected for the coming autumn - additional protection by keeping your distance and wearing a mask can continue to be important - not only for people at increased risk.

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