Becker's Clinical Quality & Infection Control

21 PATIENT SAFETY & OUTCOMES Long COVID symptoms rare, but possible in breakthrough cases, small study suggests By Mackenzie Bean I n rare instances, fully vaccinated people who ex- perience breakthrough COVID-19 infections may develop prolonged symptoms, according to a small Israel-based study published July 28 in The New England Journal of Medicine. Researchers analyzed breakthrough infections among 1,497 fully vaccinated healthcare workers at Sheba Medical Center — the largest medical center in Israel. The study ran from Jan. 20 to April 28, when the alpha variant was the country's most dominant strain. The study validated previous research showing break- through infections are rare. Just 39 workers experienced breakthrough infections, 85 percent of which involved the alpha variant first identified in the U.K. Most cases were mild or asymptomatic, though 19 percent had symptoms that lasted at least six weeks. Symptoms included a prolonged loss of smell, persistent cough, fatigue, weakness, difficulty breathing and muscle pain. "If this is what we're going to see with all of the even mildly symptomatic infections that we're seeing now, it's definitely worrisome," study author Gili Regev-Yochay, MD, director of the infection, prevention and control unit at Sheba Medical Center, told NPR. However, Dr. Regev-Yochay and her colleagues said fur- ther research that follows a larger number of patients for a longer time period is needed to confirm this prelimi- nary finding. Other medical researchers agreed the topic warrants future research. "We had hoped that when you get vaccinated and even if you did have a breakthrough infection you would have enough of an immune response that would block this protracted symptom complex now known as long COVID," Eric Topol, MD, founder and director of La Jolla, Calif.-based Scripps Research Translational Institute, told NPR. "This study is [really the] first to give us an indicator that there's some long-haulers among that small group of people that had breakthrough infections." n Researchers struggle to understand potential tie between COVID-19 vaccines, menstrual changes: 6 things to know By Gabrielle Masson T housands of Americans have reported unexpected menstrual cycle chang- es around the time they received a COVID-19 vaccine, though a causal link hasn't been scientifically established between the shot and the reported changes, according to NPR. Kate Clancy, PhD, human reproductive ecologist and associate professor of anthro- pology at the University of Illinois Urba- na-Champaign, and Katharine Lee, PhD, biological anthropologist at Washington University School of Medicine in St. Louis, have collected responses from more than 140,000 people reporting a change in their periods aer vaccination. Six things to know: 1. "We started hearing a lot about break- through bleeding, from people on long-act- ing reversible contraception, people on gender-affirming hormones and postmeno- pausal people who were years and years out from their last period, sometimes decades out," Dr. Lee told NPR, noting that individ- uals typically describe only brief disruptions to menstruation. 2. Even in large numbers, the individual sto- ries don't prove that COVID-19 vaccines are causing menstruation changes. e stories represent just a small portion of the millions vaccinated, and menstrual cycles vary wide- ly and are affected by many factors. Most women — including those in the clinical trials — haven't experienced changes to menstruation, according to statements from Pfizer, Moderna and Johnson & Johnson, as cited by NPR. 3. e FDA and all three vaccine manu- facturers said they haven't recorded any evidence that the vaccine causes menstrual irregularities or any related health problems. e American College of Obstetricians and Gynecologists still highly recommends the COVID-19 vaccine and said there's no reason to schedule vaccination around menstrual events. 4. e early studies didn't ask much about reproductive health, aside from questions around pregnancy, underscoring a blind spot in how clinical research was conducted. "It seeds doubt," said Dr. Lee. "It makes peo- ple feel like their bodies were not considered in part of the trial." 5. Both researchers said they are "pro-vac- cine," but are troubled by some people re- porting that their concerns were dismissed by physicians, which may be happening in part because menstruation changes aren't officially listed as a possible side effect. 6. e CDC is reviewing reports from its da- tabase to see if it's possible to detect how the vaccine may affect menstruation, an agency spokesperson told NPR. n

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