Should the meaning of ‘breakthrough case’ change to account for COVID boosters?

RALEIGH, N.C. (WNCN) — Should the definition of a breakthrough case of COVID-19 be adjusted to include those with booster doses?

A person who hasn’t had a shot of vaccine since last spring has significantly less protection than someone who has gotten the booster — yet if they catch COVID, they’re both counted as breakthroughs.

Dr. David Weber, an infectious disease specialist at the University of North Carolina School of Medicine, says “I do think that we do” need to adjust the definition.

“I don’t know what terminology we want to use,” Weber said. “But we need to be clear whether we’re talking about people with natural infection, and if so, how long since that. People who’ve had one dose, two doses or now three doses, getting a new infection, because we need to look at how effective each of those additional doses is, so we need to be clear now.

“Now, how we’ll change the terminology so one word suffices is less clear to me, but whatever it is, it needs to be uniformly agreed upon,” he added.

That definition is an issue now with the omicron variant leading to more cases in vaccinated people. Weber says those breakthroughs are “more prevalent with omicron than previous waves.”

The state Department of Health and Human Services has counted nearly 136,000 cases in fully vaccinated people from the start of 2021 through Christmas, with 17,000 of those coming in from Dec. 12-25.

An even bigger number is anticipated Thursday in the next update, which will likely include the count from Dec. 26 through New Year’s Day — when the overall new case count began to climb due to omicron.

About 2.3 percent of the state’s 5.3 million fully vaccinated people have reported a breakthrough case.

But there’s one important number that remains unknown: How many of those breakthroughs have involved people who were boosted.

Spokeswoman Summer Tonizzo said in a statement that “the current process NCDHHS follows to report post-vaccination cases is not able to analyze whether someone with a post-vaccination case has received a booster or additional dose.”

Those definitions have become a big deal lately, with the Centers for Disease Control and Prevention declining to change the definition of “fully vaccinated” to include only those who have been boosted — but instead preferring the term “up to date,” which doesn’t have quite as much legal weight, Weber said.

The overriding point, he said, is that we “need to redefine how we look at the vaccine series.

“Two doses really is just not adequate,” he said.

Getting the booster is critical, he said — no matter how long it’s been since finishing the initial vaccine series.

He says a person who receives the booster six months later is likely no better or worse off than someone who waits longer.

“After a prolonged period of time, it probably doesn’t really matter whether it’s four months or 12 months,” he said. “You’ll still get a substantial rise. It’s a balance. You might say six months might be a little better than four months, and I don’t know that that’s true. 

“But the downside is, the longer you separate the second and the third dose, in that interim period, you’re not as well protected,” he said. “So we have to strike the balance of giving the optimal immune response but also protecting people as rapidly as possible.”