Evidence map›Paper›PMID 42487117›Full record

ArticleJournal of biomedical science2026

Hidden asymptomatic breakthrough infection in a proof-of-concept longitudinal study on SARS-CoV-2 vaccine recipients.

Chiaho Shih, You-Zhen Liao, Che-Yu Hsu, Ying-Chen Tsai, Ming-Yen Lin, Hsin-Ying Clair Chiou, Wen-Hui Kuan, Chih-Hsu Chang, An-Ting Liou, Yu-Chi Chou and 13 more

Abstract read
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In one paragraph

Article in Journal of biomedical science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Chiaho ShihGraduate Institute of Medicine, Graduate Institute of Clinical Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan. cshih@kmu.edu.tw.
You-Zhen Liao *Graduate Institute of Medicine, Graduate Institute of Clinical Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Che-Yu Hsu *Graduate Institute of Medicine, Graduate Institute of Clinical Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Ying-Chen Tsai *Graduate Institute of Medicine, Graduate Institute of Clinical Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Ming-Yen Lin *Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Hsin-Ying Clair ChiouGenomics and Proteomics Core Laboratory, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833, Taiwan.
Wen-Hui KuanGraduate Institute of Medicine, Graduate Institute of Clinical Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Chih-Hsu ChangInstitute of Biomedical Sciences, Academia Sinica, Taipei, 112, Taiwan.
An-Ting LiouGraduate Institute of Medicine, Graduate Institute of Clinical Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Yu-Chi ChouBiomedical Translation Research Center, Academia Sinica, Taipei, 11529, Taiwan.
Jih-Jin TsaiTropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.
Ping-Chang LinTropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.
Ming-Lung YuHepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital and Hepatitis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Wan-Long ChuangHepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital and Hepatitis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Jia-Jung LeeDivision of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Jer-Ming ChangDivision of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Shang-Jyh HwangDivision of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Justin ShihIndependent Researcher, New York, USA.
Wen-Chun HungNational Institute of Cancer Research, National Health Research Institutes, Tainan, 704, Taiwan.
Ming-Feng HouDepartment of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Inn-Wen ChongDepartment of Internal Medicine and Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Yuh-Jyh JongGraduate Institute of Clinical Medicine, Kaohsiung Medical University; Departments of Pediatrics and Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Jung-San ChangDivision of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan.

Funding

National Science and Technology Council, Taiwan NSTC 113 -2320-B-037-030
6 · The paper itself

Abstract

backgroundIndividuals with asymptomatic SARS-CoV-2 infection can unknowingly transmit the virus, yet identifying such subclinical infections in post-vaccinated populations remains challenging.

methodsWe conducted a longitudinal study of 129 infection-naïve vaccine recipients immunized with various combinations of SARS-CoV-2 spike (S) protein vaccine platforms. Sera were collected before the first dose (v1), at 2 weeks (v7) and 6 months (v8) after the third dose. Taiwan's first major COVID-19 outbreak occurred between v7 and v8. We measured anti-nucleocapsid (anti-N) and anti-S IgG antibody titers by ELISA and assessed virus-neutralizing activity using live virus and pseudovirus assays.

resultsBy developing an iterative serial screening method, we identified asymptomatic breakthrough (post-vaccination) infections among unconfirmed cases. Our v7-v8 paired cohort resolved into three distinct groups: confirmed cases (21%), asymptomatic breakthrough infections (17%), and uninfected subjects (62%). In normalized v8 sera, confirmed cases exhibited an anti-S

conclusionsThis approach may enable more accurate estimates of vaccine efficacy and infection prevalence. In a spike-vaccinated population, anti-N antibody is more a potential specific marker for COVID-19 symptomatic disease than an ideal marker for SARS-CoV-2 infection. To our knowledge, this is the first preliminary report of identification of asymptomatic breakthrough infection from a well-vaccinated population using self-matched longitudinal pairs of serum samples.

Indexed as

Asymptomatic InfectionsCOVID-19COVID-19 VaccinesSARS-CoV-2AdultAntibodies, NeutralizingAntibodies, ViralBreakthrough InfectionsFemaleHumansLongitudinal StudiesMaleMiddle AgedProof of Concept StudySpike Glycoprotein, CoronavirusTaiwanAntibodies, NeutralizingAntibodies, ViralCOVID-19 VaccinesSpike Glycoprotein, Coronavirusspike protein, SARS-CoV-2Anti-nucleocapsid (N) antibodyAnti-spike (S) neutralizing antibody (nAb)Asymptomatic breakthrough infectionCOVID-19SARS-CoV-2Vaccine

Identifiers

PMID42487117
PMCPMC13393500

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.