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Volume 27, Number 8—August 2021
Dispatch

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

Pinkus Tober-Lau1, Tatjana Schwarz1, David Hillus, Jana Spieckermann, Elisa T. Helbig, Lena J. Lippert, Charlotte Thibeault, Willi Koch, Leon Bergfeld, Daniela Niemeyer, Barbara Mühlemann, Claudia Conrad, Stefanie Kasper, Friederike Münn, Frank Kunitz, Terry C. Jones, Norbert Suttorp, Christian Drosten, Leif Erik Sander2Comments to Author , Florian Kurth2Comments to Author , and Victor M. Corman2Comments to Author 
Author affiliations: Charité–Universitätsmedizin Berlin, Berlin, Germany (P. Tober-Lau, T. Schwarz, D. Hillus, E.T. Helbig, L.J. Lippert, C. Thibeault, W. Koch, L. Bergfeld, D. Niemeyer, B. Mühlemann, C. Conrad, S. Kasper, F. Münn, T.C. Jones, N. Suttorp, C. Drosten, L.E. Sander, F. Kurth, V.M. Corman); Paritätisches Seniorenwohnen gGmbH, Berlin (J. Spieckermann); German Centre for Infection Research (DZIF), Berlin (D. Niemeyer, B. Mühlemann, T.C. Jones, C. Drosten, V.M. Corman); Bezirksamt Lichtenberg von Berlin, Berlin (F. Kunitz); University of Cambridge, Cambridge, UK (T.C. Jones); German Center for Lung Research, Gießen, Germany (N. Suttorp, L.E. Sander); Bernhard Nocht Institute for Tropical Medicine (F. Kurth); University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (F. Kurth)

Main Article

Figure 2

Characteristics of outbreak of SARS-CoV-2 B.1.1.7 lineage infections after vaccination in long-term care facility, Germany, February–March 2021. A) After a positive test result in a healthcare worker, 16/20 (80.0%) vaccinated residents and 4/4 (100.0%) unvaccinated residents subsequently tested positive for SARS-CoV-2. Among infected patients, 5/16 (31.25%) vaccinated and all 4 (100.0%) unvaccinated patients exhibited respiratory symptoms (i.e., cough or shortness of breath) during the course of disease. All 4 unvaccinated patients required hospital treatment; 3 (75.0%) received supplemental oxygen therapy and a standard course of dexamethasone. Two (12.5%) vaccinated patients also required hospital treatment, including 1 patient who experienced hypertensive crisis and intracranial bleeding and died 4 days after admission, and 1 patient with secondary bacterial pneumonia and urinary tract infection. B) Peak SARS-CoV-2 RNA concentrations in infected vaccinated residents (n = 16) and infected unvaccinated residents (n = 4), as well as SARS-CoV-2 B.1.1.7 RNA concentrations of an independent group of age-matched persons (n = 48) without known vaccination status whose infections were diagnosed during routine care. C) Time between first positive and first negative reverse transcription PCR or antigen point-of-care test result in vaccinated (n = 16) and unvaccinated (n = 4) residents. In 3 residents (2 vaccinated and 1 unvaccinated), negativity was determined by antigen point-of-care test only. D) Anti-SARS-CoV-2 receptor binding domain–specific IgG. E) IFN-γ release assay of SARS-CoV-2 specific T cells measured in 10/20 (50.00%) vaccinated and 2/4 (50.00%) unvaccinated residents 5 weeks after initial testing. IFN-γ, interferon-γ; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; S/CO, signal-to-cutoff ratio.

Figure 2. Characteristics of outbreak of SARS-CoV-2 B.1.1.7 lineage infections after vaccination in long-term care facility, Germany, February–March 2021. A) After a positive test result in a healthcare worker, 16/20 (80.0%) vaccinated residents and 4/4 (100.0%) unvaccinated residents subsequently tested positive for SARS-CoV-2. Among infected patients, 5/16 (31.25%) vaccinated and all 4 (100.0%) unvaccinated patients exhibited respiratory symptoms (i.e., cough or shortness of breath) during the course of disease. All 4 unvaccinated patients required hospital treatment; 3 (75.0%) received supplemental oxygen therapy and a standard course of dexamethasone. Two (12.5%) vaccinated patients also required hospital treatment, including 1 patient who experienced hypertensive crisis and intracranial bleeding and died 4 days after admission, and 1 patient with secondary bacterial pneumonia and urinary tract infection. B) Peak SARS-CoV-2 RNA concentrations in infected vaccinated residents (n = 16) and infected unvaccinated residents (n = 4), as well as SARS-CoV-2 B.1.1.7 RNA concentrations of an independent group of age-matched persons (n = 48) without known vaccination status whose infections were diagnosed during routine care. C) Time between first positive and first negative reverse transcription PCR or antigen point-of-care test result in vaccinated (n = 16) and unvaccinated (n = 4) residents. In 3 residents (2 vaccinated and 1 unvaccinated), negativity was determined by antigen point-of-care test only. D) Anti-SARS-CoV-2 receptor binding domain–specific IgG. E) IFN-γ release assay of SARS-CoV-2 specific T cells measured in 10/20 (50.00%) vaccinated and 2/4 (50.00%) unvaccinated residents 5 weeks after initial testing. IFN-γ, interferon-γ; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; S/CO, signal-to-cutoff ratio.

Main Article

1These authors contributed equally to this article.

2These senior authors contributed equally to this article.

Page created: May 30, 2021
Page updated: July 18, 2021
Page reviewed: July 18, 2021
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