Outbreak of SARS-CoV-2 B.1.1.7 Lineage after Vaccination in Long-Term Care Facility, Germany, February-March 2021.

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From: Emerging Infectious Diseases(Vol. 27, Issue 8)
Publisher: U.S. National Center for Infectious Diseases
Document Type: Report
Length: 2,633 words
Lexile Measure: 1450L

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One week after second vaccinations were administered, an outbreak of B.1.1.7 lineage severe acute respiratory syndrome coronavirus 2 infections occurred in a long-term care facility in Berlin, Germany, affecting 16/20 vaccinated and 4/4 unvaccinated residents. Despite considerable viral loads, vaccinated residents experienced mild symptoms and faster time to negative test results.

Outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in long-term care facilities (LTCF) are of great concern and have been reported to have high case-fatality rates (1). Consequently, national vaccination strategies prioritize residents of LTCFs (2).

The coronavirus disease (COVID-19) mRNA vaccine BNT162b2 (Pfizer-BioNTech, https://www.pfizer.com) has demonstrated high efficacy against COVID-19 (3). Protection has been observed [greater than or equal to] 12 days after the first vaccination, and reported vaccine efficacy is 52% between the first and second dose and 91% in the first week after the second dose (3). Although breakthrough infections have been reported, vaccinated persons were at substantially lower risk for infection and symptomatic disease (4,5).

The variant of concern (VOC) B.1.1.7 rapidly became the predominant lineage in Europe in 2021. Analyses estimated that B.1.1.7 has increased transmissibility and a [less than or equal to] 0.7 higher reproduction number (6). Neutralization activity of serum samples from BNT162b2-vaccinated persons has been shown to be slightly reduced against B.1.1.7 in cell culture (7), but observational data from Israel suggest BNT162b2 vaccination is effective against B.1.1.7 (8).

We investigated a SARS-CoV-2 B.1.1.7 outbreak in a LTCF, which involved 20 BNT162b2-vaccinated residents and 4 unvaccinated residents. We report on clinical outcomes, viral kinetics, and control measures applied for outbreak containment. The study was approved by the ethics committee of Charite-Universitatsmedizin Berlin (EA2/066/20) and conducted in accordance with the Declaration of Helsinki and guidelines of Good Clinical Practice (https://www.ema. europa.eu/en/documents/scientific-guideline/ich-e6-r2-guideline-good-clinical- practice-step- 5_en.pdf).

The Study

On February 4, 2021, daily SARS-CoV-2 screening of employees yielded a positive antigen point-of-care test (AgPOCT) result in 1 caregiver in a LTCF in Berlin, Germany. Among 24 residents of the unit under their responsibility, 20 (83%) residents had received the second dose of BNT162b2 on January 29 or 30, 2021 (Figure 1). Four residents had not been vaccinated for nonmedical reasons (i.e., personal refusal or delayed provision of consent by legal guardian). AgPOCTs and reverse transcription PCR (RT-PCR) testing of all residents on February 4 detected SARS-CoV-2 infections in 3/4 unvaccinated and 10/20 vaccinated residents (Figure 1). At the time of testing, 2 vaccinated patients exhibited mild fatigue and one of those also had diarrhea; all other patients were asymptomatic.

The next week, testing detected 7 additional infections, resulting in 4/4 unvaccinated infected residents and 16/20 vaccinated infected residents. The remaining 4 vaccinated residents tested negative throughout the 30-day observation period (Figure 1).

In addition to residents, 11/33 (33%) staff members from the unit tested positive for SARS-Cov-2 by February 18; of those, none were twice-vaccinated staff members, 2/8 (25%) had received 1 dose of BNT162b, and 9/22 (40.9%) had not been vaccinated. No infected staff required hospital treatment.

Respiratory symptoms, including cough and shortness...

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