Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2022; 10(36): 13216-13226
Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13216
Case series in Indonesia: B.1.617.2 (delta) variant of SARS-CoV-2 infection after a second dose of vaccine
Anis Karuniawati, Ari F Syam, Armand Achmadsyah, Fera Ibrahim, Yulia Rosa, Pratiwi Sudarmono, Fadilah Fadilah, Menaldi Rasmin
Anis Karuniawati, Fera Ibrahim, Yulia Rosa, Pratiwi Sudarmono, Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Jakarta Indonesia, Jakarta 10430, DKI Jaya, Indonesia
Ari F Syam, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Jakarta Indonesia, Jakarta PUsat 10430, DKI Jaya, Indonesia
Armand Achmadsyah, Faculty of Medicine, Universits Indonesia, Jakarta Pusat 10430, DKI Jaya, Indonesia
Fadilah Fadilah, Department of Medical Chemistry, Faculty of Medicine, Universitas Indonesia, Jakarta Indonesia , Faculty of Medicine, Universitas Indonesia, Jakarta 10430, DKI Jaya, Indonesia
Menaldi Rasmin, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia/Persahabatan Hospital, Jakarta Indonesia, Jakarta Pusat 10430, DKI Jaya, Indonesia
Author contributions: Syam AF and Achmadsyah A contributed equally to this work and wrote a draft of the paper; Achmadsyah A, Fadilah F, and Ibrahim F collected the patient’s clinical data; All authors analyzed the data and wrote the paper; Karuniawati A, Syam AF, Ibrahim F, Saharman YR, Sudarmono P, Fadilah F, and Rasmin M made important intellectual contributions and revised the paper; Syam AF and Achmadsyah A edited all drafts of the paper; and All authors approved the final version of the manuscript.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ari F Syam, FACG, FACP, MD, MSc, PhD, Full Professor, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Jakarta Indonesia, Jl. Salemba 6, Jakarta PUsat 10430, DKI Jaya, Indonesia. ari_syam@hotmail.com
Received: April 26, 2022
Peer-review started: April 26, 2022
First decision: May 30, 2022
Revised: June 9, 2022
Accepted: August 1, 2022
Article in press: August 1, 2022
Published online: December 26, 2022
Processing time: 244 Days and 4.1 Hours
Abstract
BACKGROUND

The B.1.617.2 (delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first discovered in Maharashtra in late 2020 and has rapidly expanded across India and worldwide. It took only 2 mo for this variant to spread in Indonesia, making the country the new epicenter of the delta variant as of July 2021. Despite efforts made by accelerating massive rollouts of current vaccines to protect against infection, cases of fully-vaccinated people infected with the delta variant have been reported.

AIM

To describe the demographic statistics and clinical presentation of the delta variant infection after the second dose of vaccine in Indonesia.

METHODS

A retrospective, single-centre case series of the general consecutive population that worked or studied at Faculty of Medicine, Universitas Indonesia with confirmed Delta Variant Infection after a second dose of vaccine from 24 June and 25 June 2021. Cases were collected retrospectively based on a combination of author recall, reverse transcription-polymerase chain reaction (RT-PCR), and whole genome sequencing results from the Clinical Microbiology Laboratory, Faculty of Medicine, Universitas Indonesia.

RESULTS

Between 24 June and 25 June 2021, 15 subjects were confirmed with the B.1.617.2 (delta) variant infection after a second dose of the vaccine. Fourteen subjects were vaccinated with CoronaVac (Sinovac) and one subject with ChAdOx1 nCoV-19 (Oxford-AstraZeneca). All of the subjects remained in home isolation, with fever being the most common symptom at the onset of illness (n = 10, 66.67%). The mean duration of symptoms was 7.73 d (± 5.444). The mean time that elapsed from the first positive swab to a negative RT-PCR test for SARS-CoV-2 was 17.93 d (± 6.3464). The median time that elapsed from the second dose of vaccine to the first positive swab was 87 d (interquartile range: 86-128).

CONCLUSION

Although this case shows that after two doses of vaccine, subjects are still susceptible to the delta variant infection, currently available vaccines remain the most effective protection. They reduce clinical manifestations of COVID-19, decrease recovery time from the first positive swab to negative swab, and lower the probability of hospitalization and mortality rate compared to unvaccinated individuals.

Keywords: COVID-19/SARS-CoV-2 infection; B.1.617.2 (delta) variant; Fully vaccinated; Case series

Core Tip: The emergence of the B.1.617.2 (delta) variant has been attributed to an unexpected increase in coronavirus disease 2019 cases. This variant exhibits a high transmission rate and presents evidence of a more severe disease. Despite efforts made by accelerating massive rollouts of current vaccines and increasing vaccination doses, this delta variant has quickly spread in various countries. Two months after it spread through India, Indonesia has become the new epicenter of the delta variant. Therefore, the effectiveness of currently available vaccines in Indonesia has remained unknown because fully-vaccinated individuals have been infected with the delta variant.