Revolutionary SARS-CoV-2 infections in prison after vaccination
For the publisher:
The 2019 coronavirus disease (Covid-19) pandemic has uniquely affected prisons and prisons across the country. The incidence of Covid-19 among incarcerated people is almost six times that among non-incarcerated community members.1 The Centers for Disease Control and Prevention, the National Academy of Medicine, and the American Medical Association have recommended prioritizing prison and prison populations for the deployment of Covid-19 vaccines, but vaccine deployment has varied according to these parameters,2 and few studies have been conducted on the effectiveness of vaccination efforts in collective dwellings. Most of these studies were performed in skilled nursing facilities, where vaccine effectiveness was measured between 63% and 64%.3.4
Rhode Island is one of six states that have a unified prison system. The Rhode Island Department of Corrections (RIDOC) operates six facilities that include a prison-like admission facility, buildings with three security levels (minimum, medium, and maximum), and a female building on the same campus. RIDOC has offered Covid-19 vaccines – two-dose BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) – to all inmates and staff. As of November 2020, the standard of care at RIDOC facilities includes weekly universal polymerase chain reaction (PCR) testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in all incarcerated and disabled persons. Staff.
We conducted a study to analyze the results of weekly PCR tests obtained in the RIDOC system from March 9 to May 6, 2021. The RIDOC policy includes a 10-day isolation period for all people with symptoms or a Covid-test. 19 positive. A testing-based end-of-isolation strategy was launched on March 10. According to this protocol, if negative results were obtained on two PCR tests which had been carried out 24 hours apart, the isolation could end prematurely.
Of the 27 vaccinated staff and inmates who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 8 (30%) had also tested positive for SARS- CoV-2 more than 3 months earlier.
Of the 4,638 people who were tested during the study period, 2,380 who had received at least one dose of a SARS-CoV-2 vaccine were included in the analysis (Figure 1). Of these people, 27 (1.13%) tested positive for SARS-CoV-2. Of the 8,847 tests administered to inmates during the study period, 20 (0.22%; 95% confidence interval [CI], 0.14 to 0.36) were positive. Of the 4140 tests administered to staff members who had been vaccinated, positive results were obtained on 7 tests (0.17%; 95% CI, 0.16 to 0.18). The incidence of positive tests per person tested was 20 of 1539 (1.3%; 95% CI, 0.8 to 2.0) among incarcerated persons and 7 of 841 (0.8%; CI to 95%, 0.3 to 1.7) among staff members. All of the Covid-19 cases were asymptomatic.
Of the 27 vaccinated people with positive test results, 5 had received a dose of vaccine, 5 had received a second dose within 2 weeks of infection and 17 had received a second dose at least 2 weeks before infection . Eight people (30%) had also tested positive for SARS-CoV-2 more than 3 months earlier (Table S1 in the Supplementary Annex, available with the full text of this letter on NEJM.org). Repeated PCR tests were performed in 11 of 27 people (41%) who tested positive; 9 people tested negative and 2 tested positive. The median interval between initial sample collection and follow-up testing was 2 days (range 2-7 days).
In this analysis, we found that breakthrough SARS-CoV-2 infections were only rarely identified after vaccination in a prison setting in Rhode Island. Thus, the vaccination of staff members and prisoners, as well as an extended incarceration policy,5 appears to be effective in preventing the transmission of SARS-CoV-2.
Lauren Brinkley-Rubinstein, Ph.D.
Meghan Peterson, MPH
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Rosemarie Martin, Ph.D.
Brown University, Providence, RI
Philip Chan, MD
Miriam Hospital, Providence, RI
Justin berk, md
Warren Alpert School of Medicine at Brown University, Providence, RI
Supported by a grant (UG1DA050072, to Drs. Brinkley-Rubinstein and Martin and Ms Peterson) from
Disclosure forms provided by the authors are available with the full text of this letter on NEJM.org.
This letter was posted on July 7, 2021 on NEJM.org.
1. Macmadu A, Yuck J, Kaplowitz E, Mercedes M, Rich JD, Brinkley Rubinstein L. COVID-19 and mass incarceration: a call to urgent action. Lancet Public Health 2020; 5 (11):e571–e572.
2. Peterson M, Behne F, Denget B, Nowtony K, Brinkley Rubinstein L. Uneven rollout of COVID-19 vaccinations in US prisons. Blog on health affairs. April 15, 2021 (https://www.healthaffairs.org/do/10.1377/hblog20210413.559579/full/).
3. Teran RA, Walblay KA, Shane EL, et al. SARS-CoV-2 post-immunization infections among residents and trained staff of nursing homes – Chicago, Illinois, December 2020-March 2021. MMWR Morb Mortal Wkly Rep 2021; 70:632–638.
4. Britton A, Jacobs Slifka KM, Edens C, et al. Effectiveness of Pfizer-BioNTech COVID-19 vaccine in residents of two skilled nursing facilities facing COVID-19 outbreaks – Connecticut, December 2020-February 2021. MMWR Morb Mortal Wkly Rep 2021; 70:396–401.
5. Vest N, Johnson O, Nowotny K, Brinkley Rubinstein L. Prison Population Cuts and COVID-19: A Latent Profile Analysis Synthesizing Recent Evidence from the State of Texas Prison System. J Urban Health 2021; 98:53–58.