{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T11:00:46Z","timestamp":1780311646952,"version":"3.54.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["2022-ER2603-00"],"award-info":[{"award-number":["2022-ER2603-00"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT","doi-asserted-by":"publisher","award":["RS-2025-00523567"],"award-info":[{"award-number":["RS-2025-00523567"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002551","name":"Seoul National University","doi-asserted-by":"publisher","award":["326-20240027"],"award-info":[{"award-number":["326-20240027"]}],"id":[{"id":"10.13039\/501100002551","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Estimating infection risk from SARS-CoV-2 Omicron and post-Omicron sub-variants is challenging due to the high number of unconfirmed infections. We compared breakthrough infection risks among individuals with hybrid, vaccine-only, and infection-only immunity in South Korea, incorporating laboratory-confirmed and serology-inferred infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using nationwide surveillance data (August\u2013December 2022), immunity was classified by vaccination history and spike (S) and nucleocapsid (N) antibody profiles. Outcomes were assessed using two definitions: conservative (laboratory-confirmed cases) and inclusive (serology-inferred infections identified by changes in N-antibody titers). Infection dates for unconfirmed events were imputed via predictive mean matching, enabling Kaplan\u2013Meier analyses. Time-varying Cox models estimated log hazard ratios (log-HRs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Including serology markedly increased four-month cumulative infection risk estimates: hybrid immunity rose from 2% to 20%, infection-only from 4% to 24%, and vaccine-only from 30% to 40%. With these additional infections, the relative advantage of hybrid immunity narrowed. Under the conservative definition, log-HRs declined for vaccine-only vs hybrid (4.10\u20132.34) and infection-only vs hybrid (1.56\u20130.31). Under the inclusive definition, the vaccine-only log-HR fell from 3.44 to 0.13, and the infection-only log-HR shifted from 3.31 to \u22120.56, indicating greater protection for infection-only immunity by month four.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Because confirmed cases largely capture symptomatic disease, vaccination appears to provide added protection against severe outcomes, though this benefit wanes within months. The rapid decline of hybrid immunity and the large burden of unconfirmed infections highlight the need for routine serological surveillance to detect silent transmission and timely booster campaigns to mitigate severe disease during Omicron-driven waves.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag053","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T12:47:59Z","timestamp":1770209279000},"source":"Crossref","is-referenced-by-count":0,"title":["Protective Effectiveness of Sars-Cov-2 Infection Risk Among Hybrid, Vaccine, and Infection-induced Immunity Against the Omicron Variant, K-Serosmart"],"prefix":"10.1093","volume":"13","author":[{"given":"Yifan","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Statistics, University of Connecticut , Storrs, Connecticut 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National University , Seoul ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4649-0012","authenticated-orcid":false,"given":"Jina","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Ajou University School of Medicine , Suwon ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8900-5542","authenticated-orcid":false,"given":"Hye Jin","family":"Baek","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, Ajou University School of Medicine , Suwon ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9867-127X","authenticated-orcid":false,"given":"Eunbi","family":"Noh","sequence":"additional","affiliation":[{"name":"National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences , Seoul ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7017-1145","authenticated-orcid":false,"given":"Kyuhyun","family":"Yoon","sequence":"additional","affiliation":[{"name":"Institute of Health and Environment, Seoul National University , Seoul ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7715-5372","authenticated-orcid":false,"given":"Jung Ae","family":"Kim","sequence":"additional","affiliation":[{"name":"College of Nursing, Kyungbok University , Namyangju-si ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4856-3668","authenticated-orcid":false,"given":"Jaehun","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, School of Medicine, Korea University , Seoul ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7464-9780","authenticated-orcid":false,"given":"Kyong Ran","family":"Peck","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9819-2398","authenticated-orcid":false,"given":"Hye-Sook","family":"Jeong","sequence":"additional","affiliation":[{"name":"Division of Clinical Research for Vaccine, Center for Vaccine Research, National Institute of Infectious Diseases, National Institute of Health , CheongJu ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2923-5597","authenticated-orcid":false,"given":"June-Woo","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Clinical 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