Summary Delta breakthrough studies, Ct/viral load, vaccine effectiveness (VE)
Only 1 large study of Ct/viral load, shows some vaccine reduction
VE ranges 39-88%; it's likely ≤ 60% at best for mRNA
More data needed, but points to need for boosters for at least some people
Overall, these findings certainly are concordant w/ increased Delta breakthrough symptomatic infections we're seeing and a major decline in protection (~95% w/ mRNA) compared with previous strains, as reviewed here
Recall that 1-dose mRNA or AZ had little (30%) efficacy (1st study in Table). All of this reflects Delta's immune evasiveness. We're very lucky it's holding up for reduction of hospitalizations/deaths but this🦠is far more formidable for both transmission and our immune response
Other implications for the VE drop vs infections.
For awhile we wondered if the mRNA dosing schedule is Israel (3 weeks) vs UK (8-12 weeks) could account for 39-60% vs 88%, respectively. The new UK study doesn't break down vaccine %, but makes this explanation less likely
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T cells were supposed to be the "on-demand" reserves to kick in after the normal decline of neutralizing antibody (nAb) levels, providing protracted protection. But several new reports point to nAbs as key. 1. @NEJM report on breakthroughs w/ low nAbs
T cells were especially supposed to be helpful, relatively unaffected by variants, as this study and others support (pre-Delta) cell.com/action/showPdf…@CellRepMed
The data from Israel, for fully mRNA vaccinated reduced protection vs severe illness from Delta, in age > 60, down from 97% to 81%, is yet unpublished, but has led to a change in policy to offer booster shots for this age group ft.com/content/b6a804… by @MehulAtLarge@FT
If this holds up, it's the first sign of a significant dropdown of protection against hospitalizations and death for these vaccines. I hope all of the data will be shared ASAP as the implications are big.
When this first surfaced last night, I asked my friend @segal_eran about the lack of concordance with the UK @PHE_uk data. Here is our back and forth, with his key points
Why is Canada at 1.4 cases/100,000 people and the US at 20/100,000, heading towards its 4th wave?
Remarkably, Delta prevalence for new infections is 10% vs 93%, respectively.
And yes, there is also an ever-growing gap in vaccination coverage, favoring Canada's ability to defend against Delta as it inevitably rises
Very important @NEJM paper today on breakthrough infections (BTI) post-vaccination in Israeli health care workers.
5 key points: 1. Of ~1500 people, 0.4% had BIs, sequenced to be Alpha 85% (this was pre-Delta) nejm.org/?query=feature…
2. All these BTIs were mild (67%) or without symptoms (33%), done due to routine testing. No hospitalizations.
3. 7 of 36 (19% ) of BTIs had "persistent symptoms" > 6 weeks. Table below
An indicator for the potential of #LongCovid in BTIs in a few of these people at > 6 weeks, but that's a very limited and early time for assessment.
Why is "I'm vaccinated, I'm fully protected" wrong?
The pivotal clinical trials, such as with mRNA vaccines, showed a 95% reduction of symptomatic infections, the primary endpoint. Not 100%
That was pre-Delta nytimes.com/2021/07/22/hea…@apoorva_nyc /1
Now we have conflicting data for protection vs symptomatic infection post-mRNA vaccination for Delta
UK @NEJM 88% protection
We don't have an explanation for this glaring contradiction, which could include demographics, sample size, time from vax, all sorts of things. The delayed 2nd UK dose (8 wk) has been suggested by raising level of immunity. But we don't know yet /3 bbc.com/news/health-57…