Factors Associated With COVID-19 Breakthrough Infections: Correspondence : Journal of Occupational and Environmental Medicine

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Factors Associated With COVID-19 Breakthrough Infections: Correspondence

Mungmunpuntipantip, Rujitika; Wiwanitkit, Viroj

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Journal of Occupational and Environmental Medicine: November 2022 - Volume 64 - Issue 11 - p e793
doi: 10.1097/JOM.0000000000002638
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To the Editor:

We would like to correspond on the publication of the article “Factors associated with COVID-19 breakthrough infections in large Midwestern healthcare system: implications for vulnerable healthcare personnel.”1 The most vulnerable health care professionals (HCPs) are those who are younger, work in COVID-19 clinical units, and have received primary series vaccines from Pfizer-BioNTech, according to Rivelli et al.1 Supplemental immunity should better protect at-risk HCP groups, as evidenced by the decreased incidence of breakthrough infection in HCP who had COVID-19 before vaccination.1 We can all agree that COVID-19 is a serious illness with a broad range of clinical symptoms, and that immunization is crucial for the disease's efficient management. The campaign to immunize as many people as possible is still going strong, and success is still in sight. Effects of innate immunity in the current study may be anticipated. Even if it is found that the immunization is successful in preventing life-threatening clinical illnesses, asymptomatic infections continue to be a cause for concern. There is a potential that COVID-19 will emerge even after vaccination. In our environment, health care personnel frequently experience a breakthrough COVID-19, and a repeat breakthrough COVID-19 is possible.

It should be noted that, in our context, the background vaccine is an inactivated COVID-19 vaccine, which has been shown to be less efficacious than the mRNA vaccine. The kind of vaccine, the recipients' postvaccination preventive behavior, and the potential local COVID-19 outbreak scenario could all be variables in this. The HCP may ignore required protection if the vaccination is oversold and promoted in particular settings.2 In addition, through quality control of the vaccine and vaccination procedure, the best immunogenicity of immunization is guaranteed. The patient's medical history may have a big impact on how well the immunization works. A COVID-19 most certainly existed before the vaccine, and this may have affected the subsequent immunity. However, it is crucial to take into account the potential repercussions of asymptomatic COVID-19.3 An infection history by itself cannot exclude COVID-19 that is asymptomatic, and the findings might not be reliable. In rare circumstances, if the local epidemic situation is still serious (as in Southeast Asia), the background vaccine may only be an inactivated COVID-19 vaccine, necessitating booster injections. In addition, vaccine efficacy must be taken into account. Usually, extra doses of a top-notch vaccination are required to provide adequate protection.

Rujitika Mungmunpuntipantip
Private Academic Consultant
Bangkok, Thailand
Viroj Wiwanitkit
Joseph Ayobaalola University
Ikeji-Arakeji, Nigeria
Dr D.Y. Patil University
Pune, India
Faculty of Medicine
University of Niš
Niš, Serbia


1. Rivelli A, Fitzpatrick V, Copeland K, Richards J. Factors associated with COVID-19 breakthrough infections in large Midwestern healthcare system: implications for vulnerable healthcare personnel. J Occup Environ Med. 2022;64:635–641.
2. Mungmunpuntipantip R, Wiwanitkit V. Coronavirus disease 2019 (COVID-19) infection of healthcare personnel after complete COVID-19 vaccination. Infect Control Hosp Epidemiol. 2021;6:1.
3. Joob B, Wiwanitkit V. Letter to the editor: coronavirus disease 2019 (COVID-19), infectivity, and the incubation period. J Prev Med Public Health. 2020;53:70.
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