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Introduction Destination: A1 Item: Title: Patients and methods Destination: A2 Children: Item: Title: Study population Destination: B1 Item: Title: Inclusion criteria, cohort selection and data check Destination: B2 Item: Title: Technical considerations and Definitions Destination: B3 Item: Title: Endpoints and statistical analysis Destination: B4 Item: Title: Results Destination: A3 Children: Item: Title: Patient characteristics Destination: B5 Item: Title: Incidence, severity, and risk factors of breakthrough SARS-CoV-2 infection Destination: B6 Item: Title: Antibody level titers and severity of breakthrough SARS-CoV-2 infection Destination: B7 Item: Title: Infection severity, number of vaccine doses, and type of SARS-CoV-2 VOC Destination: B8 Item: Title: Booster doses and breakthrough SARS-CoV-2 infection Destination: B9 Item: Title: Cause of death and all-cause mortality Destination: B10 Item: Title: Discussion Destination: A4 Item: Title: Conclusion Destination: A5 Item: Title: 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Lucia Villalon Gabriela Sanz-Linares Venancio Conesa-Garcia Andrés Sanchez-Salinas Beatriz Gago Ana Facal Irene Risco-Gálvez María T. 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