Prior vaccination prevents overactivation of innate immune responses during COVID-19 breakthrough infection

Sci Transl Med. 2025 Jan 29;17(783):eadq1086. doi: 10.1126/scitranslmed.adq1086. Epub 2025 Jan 29.

Abstract

At this stage in the COVID-19 pandemic, most infections are "breakthrough" infections that occur in individuals with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure. To refine long-term vaccine strategies against emerging variants, we examined both innate and adaptive immunity in breakthrough infections. We performed single-cell transcriptomic, proteomic, and functional profiling of primary and breakthrough infections to compare immune responses from unvaccinated and vaccinated individuals during the SARS-CoV-2 Delta wave. Breakthrough infections were characterized by a less activated transcriptomic profile in monocytes and natural killer cells, with induction of pathways limiting monocyte migratory potential and natural killer cell proliferation. Furthermore, we observed a female-specific increase in transcriptomic and proteomic activation of multiple innate immune cell subsets during breakthrough infections. These insights suggest that prior SARS-CoV-2 vaccination prevents overactivation of innate immune responses during breakthrough infections with discernible sex-specific patterns and underscore the potential of harnessing vaccines in mitigating pathologic immune responses resulting from overactivation.

MeSH terms

  • Adaptive Immunity
  • Adult
  • Breakthrough Infections
  • COVID-19 Vaccines* / immunology
  • COVID-19* / immunology
  • COVID-19* / prevention & control
  • Female
  • Humans
  • Immunity, Innate* / immunology
  • Killer Cells, Natural / immunology
  • Male
  • Middle Aged
  • Monocytes / immunology
  • Proteomics
  • SARS-CoV-2* / immunology
  • Transcriptome
  • Vaccination*

Substances

  • COVID-19 Vaccines

Supplementary concepts

  • COVID-19 breakthrough infections