COVID-19 Breakthrough Report

Oregon’s Weekly Surveillance Summary

Novel Coronavirus (COVID-19)

Breakthrough case report - October 21, 2021

Background
Data for the weekly breakthrough case report will include data through the most recent Sunday and
the report will be published on Thursdays.1 Vaccine breakthrough cases are defined as instances in
which an individual tests positive for COVID-19 at least 14 days following the completion of any COVID-
19 vaccine series.2 Vaccine breakthrough cases that result in hospitalization or death are reported to
CDC.
This report includes only those vaccine breakthrough cases which are reported to public health
following a positive test result. Many vaccine breakthrough cases are believed to experience no
symptoms or minimal symptoms.3 These cases are unlikely to undergo testing for COVID-19 and be
reported to public health. Therefore, the true number of vaccine breakthrough cases is unknown.

COVID-19 cases in vaccinated and unvaccinated people

Weekly summary
During the week of October 10–October 16, there were 8,423 cases of COVID-19. 6,446 (76.5%) were
unvaccinated and 1,977 (23.5%) were vaccine breakthrough cases. The median age of breakthrough
cases was 48 years. 35 (1.8%) breakthrough cases were residents of care facilities, senior living
communities or other congregate living settings. 439 (22.2%) cases were 65 or older. There were 88
(4.5%) cases aged 12-17.
OHA publishes the most up-to-date information about cases from the most recently completed
MMWR week. However, not all information about a case’s vaccination status may be available at the

1 The weekly summary, Figure 1, and Figure 2 use the date that cases are reported to OHA, to provide
information on the most recently identified cases. All other dates in this report use specimen collection
date to align with the breakthrough case definition.
2This definition is consistent with the CDC’s definition, available here:
https://www.cdc.gov/vaccines/covid-19/downloads/COVID-vaccine-breakthrough-case-investigations-
Protocol.pdf
3Bergwerk, M., Gonen, T., Lustig, Y., Amit, S., Lipsitch, M., Cohen, C., Mandelboim, M., Gal Levin, E.,
Rubin, C., Indenbaum, V. and Tal, I., 2021. Covid-19 breakthrough infections in vaccinated health care
workers. New England Journal of Medicine.

Data are provisional and subject to change. 1

COVID-19 Breakthrough Report
Oregon’s Weekly Surveillance Summary
Novel Coronavirus (COVID-19)

time of publication. Table 1 includes updated totals of COVID-19 cases by vaccine breakthrough status
for the previous six weeks.

Table 1. COVID-19 cases by vaccine breakthrough status over the previous 6 weeks
Percent
MMWR week Breakthrough
Total cases breakthrough
ending cases
case

2021-09-11 13,978 2,944 21.1

2021-09-18 11,955 2,842 23.8

2021-09-25 11,540 2,606 22.6

2021-10-02 10,387 2,626 25.3

2021-10-09 9,126 2,556 28.0

2021-10-16 8,423 1,977 23.5

Cumulative summary
Overall, there have been 32,954 vaccine breakthrough cases identified in Oregon. The median age of
breakthrough cases is 48 years (range: 11-106). 1,219 (3.7%) breakthrough cases were residents of care
facilities, senior living communities or other congregate living settings. 8,199 (24.9%) cases were 65 or
older. There have been a total of 848 (2.6%) cases aged 12-17. Breakthrough cases have been reported
in all 36 counties.
Cases of COVID-19 are much more common in unvaccinated4 individuals than in vaccinated individuals
(Figure 1). The rate of COVID-19 cases among unvaccinated individuals in the most recent week was
more than 4 times the rate of COVID-19 cases among those who are fully vaccinated. Community
spread remains elevated throughout the state and is particularly high in areas with lower vaccination
rates. As COVID-19 cases have increased across Oregon, vaccine breakthrough cases have also
increased, but at a much lower rate than in the unvaccinated. Vaccination remains the most effective
tool to reduce the spread of COVID-19.

4Unvaccinated persons are defined as people who have not received an approved COVID-19 vaccine,
or who have not completed a COVID-19 vaccine series.

Data are provisional and subject to change. 2

COVID-19 Breakthrough Report
Oregon’s Weekly Surveillance Summary
Novel Coronavirus (COVID-19)

Figure 1. COVID-19 cases per 100,000 per week, by vaccination status

Vaccine breakthrough cases and severity

The Pfizer, Moderna and Johnson & Johnson COVID-19 vaccines are all highly effective at preventing
severe COVID-19 illness and death. Table 2 includes totals of breakthrough cases by vaccine
manufacturer and severity. Relatively few breakthrough cases have been hospitalized, and even fewer
have died (Figure 2). 5

5 A death is considered to be related to COVID-19 in any of the following circumstances: a) death of a

confirmed or probable COVID-19 case within 60 days of the earliest available date among exposure to
a confirmed case, onset of symptoms, or date of specimen collection for the first positive test; b) death
from any cause in a hospitalized person during admission or in the 60 days following discharge AND a
COVID-19-positive laboratory diagnostic test at any time since 14 days prior to hospitalization; or c)
death of someone with a COVID-19-specific ICD-10 code listed as a primary or contributing cause of
death on a death certificate, regardless of the dates of diagnosis or death

Data are provisional and subject to change. 3

COVID-19 Breakthrough Report
Oregon’s Weekly Surveillance Summary
Novel Coronavirus (COVID-19)

Table 2. COVID-19 Breakthrough cases by vaccine manufacturer and severity6

Cases per
Vaccine Primary series
Cases Hospitalizations Deaths 100,000
manufacturer completed
vaccinated

Pfizer 1,437,259 16,352 613 158 1,137.7

Moderna 912,731 8,564 357 80 938.3

Johnson &
221,086 3,934 214 44 1,779.4
Johnson/Janssen

Figure 2. COVID-19 breakthrough cases, hospitalizations and deaths, by week

6 Table 2 provides the number of cases per 100,000 vaccinated individuals by vaccine manufacturer.
Because this figure does not account for the time that each person has been fully vaccinated, it is not a
true rate and should not be interpreted as such.

Data are provisional and subject to change. 4

COVID-19 Breakthrough Report
Oregon’s Weekly Surveillance Summary
Novel Coronavirus (COVID-19)

To date, 4.4% of all known breakthrough cases have been hospitalized (n=1,448), and only 1% have
died (n=325).7 The median age of the people who have died is 80 (range: 34-101). It is important to
note that not all vaccine breakthrough cases are reported to public health, which may cause the
proportions in the following section to appear higher than in reality. These figures are not vaccine
breakthrough hospitalization or death rates and should not be interpreted as such.
Tables 3, 4 and 5 provide detailed vaccine breakthrough severity data by age, race and ethnicity.

Table 3. COVID-19 breakthrough cases by age group and severity

Breakthrough Breakthrough Breakthrough
Age group
cases hospitalizations deaths

12-19 1,493 11 0

20-29 4,629 27 0

30-39 5,689 45 2

40-49 5,522 64 7

50-59 5,041 128 10

60-69 4,706 297 53

70-79 3,594 396 86

80+ 2,280 480 167

Total 32,954 1,448 325

7Cumulative deaths reported here reflect all breakthrough cases known to have died since January 1,
2021. There may be a lag of several weeks between when an individual dies and when their death
appears in this report. Increases in cumulative deaths between this and subsequent reports should not
be interpreted as individuals who have died within the past week.

Data are provisional and subject to change. 5

COVID-19 Breakthrough Report
Oregon’s Weekly Surveillance Summary
Novel Coronavirus (COVID-19)

Table 4. COVID-19 breakthrough case severity by race8

Race Cases Hospitalizations Deaths

> 1 race 312 12 2

American
Indian/Alaska 434 19 4
Native

Asian 756 29 5

Black 482 34 6

Not Available 8,412 185 67

Other 2,385 81 27

Pacific Islander 75 3 1

White 20,098 1,085 213

Total 32,954 1,448 325

Table 5. COVID-19 breakthrough case severity by ethnicity

Ethnicity Cases Hospitalizations Deaths

Hispanic 2,429 62 10

Not Hispanic 16,812 939 184

Unknown 13,713 447 131

Total 32,954 1,448 325

8During the case investigation, people are asked to self-report their race, ethnicity, tribal affiliation,
country of origin, or ancestry. As of October 2021, 42,423 (80.8%) of the 52,483 persons who identify
as “Other” race also self-identify as Hispanic or Latino.

Data are provisional and subject to change. 6

COVID-19 Breakthrough Report
Oregon’s Weekly Surveillance Summary
Novel Coronavirus (COVID-19)

Table 6 provides the proportion of vaccine breakthrough cases who have died with COVID-19.
More than 80% of vaccine breakthrough deaths have occurred in patients 70 years and older. The
proportion of vaccine breakthrough cases who have died with COVID-19 has increased over time.
This trend is likely multifactorial and may be associated with increased COVID-19 transmission in
our communities, increased disease severity associated with infection caused by the Delta variant
and waning immunity over time in elderly populations.

Table 6. COVID-19 deaths by month, by breakthrough case status9

Vaccine Percent vaccine
Total COVID-19
Month breakthrough breakthrough
deaths
deaths deaths

March 2021 118 4 3.4

April 2021 105 6 5.7

May 2021 183 15 8.2

June 2021 94 13 13.8

July 2021 81 16 19.8

August 2021 418 96 23.0

September 2021 633 126 19.9

9 Data in Table 6 will be updated monthly and will reflect cases from the previous month.

Data are provisional and subject to change. 7

COVID-19 Breakthrough Report
Oregon’s Weekly Surveillance Summary
Novel Coronavirus (COVID-19)

COVID-19 variants
Table 7. COVID-19 breakthrough cases associated with variants of concern10
Overall, approximately 6.5% of positive specimens in Oregon have been sequenced. Delta is currently
the dominant variant circulating in Oregon. At this time, vaccine breakthrough cases appear to reflect
the variants circulating in the community. Additional information on variants can be found here:
https://public.tableau.com/app/profile/oregon.health.authority.covid.19/viz/GISAIDVariantDashboard
Updated/OregonVariantDashboard

Subtype Cases

Delta (B.1.617.2) 1,162

Table 8. COVID-19 breakthrough cases associated with variants being monitored

Subtype Cases

Alpha (B.1.1.7) 148

Beta (B.1.351) 16

Gamma (P.1) 62

Epsilon
38
(B.1.427/B.1.429)

Iota (B.1.526) 29

10 As of September 29, OHA will align with CDC’s classification of SARS-CoV-2 variants. Variant
classification scheme defines four classes of SARS-CoV-2 variants: variants of concern, variants of
interest, variants being monitored, and variants of high consequence. Delta is currently the only variant
of concern in the United States.

Data are provisional and subject to change. 8

COVID-19 Breakthrough Report
Oregon’s Weekly Surveillance Summary
Novel Coronavirus (COVID-19)

Figure 3. Map of COVID-19 breakthrough case cumulative counts, by county of

residence11
In general, cumulative breakthrough case counts correspond with the population size of each county.
Additional information on cumulative case counts can be found here:
https://public.tableau.com/app/profile/oregon.health.authority.covid.19/viz/OregonCOVID-
19TestingandOutcomesbyCounty/OregonsCOVID-19TestingandOutcomesbyCounty

11 Counties that have a total of fewer than 10 cases will appear grey without a data label.

Data are provisional and subject to change. 9

COVID-19 Breakthrough Report
Oregon’s Weekly Surveillance Summary
Novel Coronavirus (COVID-19)

Table 9. COVID-19 breakthrough cases by county of residence12

County Cumulative cases

Baker 138

Benton 652

Clackamas 2782

Clatsop 236

Columbia 295

Coos 366

Crook 244

Curry 100

Deschutes 2572

Douglas 1062

Gilliam 1-9

Grant 48

Harney 82

Hood River 269

Jackson 1721

Jefferson 226

Josephine 1031

Klamath 463

Lake 49

12 Counties that have a total of fewer than 10 cases will be reported as 1-9 cases.

Data are provisional and subject to change. 10

COVID-19 Breakthrough Report
Oregon’s Weekly Surveillance Summary
Novel Coronavirus (COVID-19)

County Cumulative cases

Lane 3807

Lincoln 400

Linn 1042

Malheur 261

Marion 3305

Morrow 103

Multnomah 5327

Polk 702

Sherman 1-9

Tillamook 243

Umatilla 772

Union 199

Wallowa 90

Wasco 298

Washington 3253

Wheeler 12

Yamhill 786

Data are provisional and subject to change. 11