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What is a breakthrough infection? Why is COVID-19 vaccine breakthrough occurring and how does its breakthrough frequency compare to that of other viruses and vaccines? Amidst encouraging real world data about the effectiveness of COVID-19 vaccines, and the CDC’s announcement last month that fully vaccinated individuals can engage in indoor and outdoor activities without a mask, reports of fully vaccinated people becoming infected with SARS-CoV-2 have raised questions about the frequency and cause of breakthrough infection. Why are some people who are fully vaccinated, still testing positive for the virus? TL;DW Unless a vaccine is 100% effective at preventing infection, a small percentage of breakthrough cases are expected and not overly concerning. At this time, the frequency of COVID-19 vaccine breakthrough is, very low, ~ 0.01%, which means, COVID-19 vaccines are highly effective at preventing COVID-19 particularly when it comes to severe disease. There are a number of reasons that breakthrough infections may occur, including a weak or ineffective immune response to vaccination, decreased immunity over time and/or evolution of the virus. Evidence suggests that certain mutations may be enriched in breakthrough SARS-CoV-2 infections. Deletions in the “NTD-antigenic supersite” are of particular interest and require further investigation. SOURCES: https://www.cdc.gov/mmwr/volumes/70/w... https://www.medrxiv.org/content/10.11... https://www.medrxiv.org/content/10.11... https://www.nejm.org/doi/full/10.1056... https://www.medrxiv.org/content/10.11...