Influence of immunosuppressive medication, SARS-CoV-2 breakthrough infection, and hepatitis B response status on COVID-19 vaccine responses. Serum real-virus neutralization capacity for Delta (left column) and Omicron BA.1 (right column) was analyzed after the fourth vaccination in subgroups. Comparison of immunosuppressive drug treatment (A,B), the prevalence of SARS-CoV-2 infection before the second blood sampling (C,D), and hepatitis B vaccination non-response (E,F) on serum neutralization capacity. Statistical analysis was performed using the Mann-Whitney-U test, p values indicate statistical significance between groups.