Background While increasing coverage of effective vaccines against coronavirus disease 2019 (COVID-19), emergent variants raise concerns about breakthrough infection. Data are limited, however, whether breakthrough infection during the epidemic of the variant is ascribed to insufficient vaccine-induced immunogenicity. Methods We described incident COVID-19 in relation to the vaccination program among workers of a referral hospital in Tokyo. During the predominantly Delta epidemic, we followed 2,415 fully vaccinated staff (BNT162b2) for breakthrough infection and selected three matched controls. We measured post-vaccination neutralizing antibodies against the wild-type, Alpha (B.1.1.7), and Delta (B.1.617.2) strains using live viruses and anti-spike antibodies using quantitative assays, and compared them using the generalized estimating equation model between the two groups. Results No COVID-19 cases occurred 1–2 months after the vaccination program during the fourth epidemic wave in Japan, dominated by the Alpha variant, while 22 cases emerged 2–4 months after the vaccination program during the fifth wave, dominated by the Delta variant. In the vaccinated cohort, all 17 cases of breakthrough infection were mild or asymptomatic and had returned to work early. There was no measurable difference between cases and controls in post-vaccination neutralizing antibody titers against the wild-type, Alpha, and Delta, and anti-spike antibody titers, while neutralizing titers against the variants were considerably lower than those against the wild-type. Conclusions Post-vaccination neutralizing antibody titers were not decreased among patients with breakthrough infection relative to their controls under the Delta variant rampage. The result points to the importance of infection control measures in the post-vaccination era, irrespective of immunogenicity profile.

Objective: This study investigated the sex-associated difference in the impact of obesity on antibody response to a COVID-19 vaccine.Methods: This study included 2,435 health care workers who received two doses of the BioNTech, Pfizer (BNT162b2) vaccine and participated in a serological survey, during which they were tested for anti-SARS-CoV-2 spike immunoglobin G (IgG) antibodies and asked for information on height, weight, and vaccination history via a questionnaire. Multivariable linear regression analysis was used to estimate the geometric mean titers (GMT) of antibodies for each sex and BMI category. Results:The relationship between BMI and anti-SARS-CoV-2 spike IgG titers markedly differed by sex (p value for interaction = 0.04). Spike IgG antibody titers tended to decrease with increasing BMI in men (p value for trend = 0.03); GMT (95% CI) were 6,093 (4,874-7,618) and 4,655 (3,795-5,708) for BMI < 18.5 and ≥30 kg/m 2 , respectively. In contrast, spike IgG antibody titers did not significantly differ across BMI categories in women (p value for for trend = 0.62); GMT (95% CI) were 6,171 (5,714-6,665) and 5,506 (4,404-6,883) for BMI <18.5 and ≥30, respectively. Conclusions: Higher BMI was associated with lower titers of SARS-CoV-2 spike antibodies in men, but not in women, suggesting the need for careful monitoring of vaccine efficacy in men with obesity, who are at high risk of severe COVID-19 outcomes.

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every day, checked her body image in mirrors, engaged in discourse about weight gain, calculated calories, spent a lot of time on social media and the Internet (especially videos showing food recipes and people eating), and prepared food at home for family members. None of the patients had a premorbid psychiatric history, and their levels of academic success and peer relationships were described as good. Summaries of each case's background characteristics and clinical findings are given in Table 1. The insight about their symptoms and clinical courses of all patients was partial. They did not want to apply to the child and adolescent psychiatric outpatient unit due to worry about being infected with COVID-19 at the hospital. One of the cases was monitored in the pediatric inpatient unit and the other two were monitored in the pediatric emergency unit. Tube feeding was not needed as they each agreed to adapt to an oral diet with the help of a nutritionist. They were each diagnosed with anorexia nervosa according to the DSM-5 5 and were followed at Marmara University Pendik Research and Training Hospital Child and Adolescent Psychiatry Clinic. One of the patients had anxiety symptoms in addition to anorexia nervosa and the other two had major depression. Patients were followed up with olanzapine and fluoxetine/sertraline combination medication, individual cognitive behavioral therapy, and family interviews weekly. There was no history of contact with COVID-19 or having COVID-19 in patients or their family members. Follow-up of patients continues at the same child and adolescent psychiatry clinic. Chia et al. showed that dietary restriction for religious purposes, such as that observed during the practice of Ramadan, may not confer increased risk of eating disorder symptoms. 6 Also, there were no patients with these symptoms presenting to the Marmara University Pendik Research and Training Hospital Child and Adolescent Psychiatry Clinic during the 2019 Ramadan period. In another study, social isolation was associated with binge eating, not dietary restraint. 7 However, no study investigating the relation between social isolation and the onset of eating disorders has been observed in literature. Social isolation and quarantine may have important adverse psychological effects on the most vulnerable groups, such as adolescents, but it is not possible to say with three cases that social isolation and quarantine may cause eating disorders. Written consent was taken from the participants. This study fulfills the ethical provisions of the Declaration of Helsinki.