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. 2023 Feb 27;41(13):2234–2242. doi: 10.1016/j.vaccine.2023.02.068

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© 2023 The Author(s)

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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Fig. 1 — Genomic epidemiology and study design. (A) Genomic epidemiology of SARS-CoV-2 variants or Omicron subvariants in Toyama Prefecture. The proportions of each variant or Omicron subvariant were determined by analyzing 0 to 178 SARS-CoV-2 positive samples in each month. (B) Flow chart of the nursing home cohort study. After the enrollment of 335 SARS CoV-2 naïve participants, participants with BTI were detected during epidemic periods of Alpha variant (n = 1), BA.1 subvariant (n = 14) and BA.5 subvariant (n = 36). Six participants had positive results for anti-N IgG 2 months (n = 2) and 5 months (n = 4) after the third dose. Seventy-seven study participants were excluded from the study because 49 received a fourth dose of mRNA vaccine before blood collection 5 months after the third dose. Fourteen staff members and seven residents declined blood collection 5 months after the third dose of mRNA vaccine, and seven residents died of old age. Abbreviations: V2, 1st and 2nd dose of vaccine; V3, 3rd dose of vaccine, V2 + 2 M, 2 months after the 2nd dose of vaccine; V2 + 5 M, 5 months after the 2nd dose of vaccine; V3 + 2 M, 2 months after the 3rd dose of vaccine; V3 + 5 M, 5 months after the 3rd dose of vaccine, BTI; breakthrough infection.