SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: results from the COVID-19 Global Rheumatology Alliance provider registry. Issue 1 (6th April 2022)

• Record Type: Journal Article
• Authors: Liew, Jean; Gianfrancesco, Milena; Harrison, Carly; Izadi, Zara; Rush, Stephanie; Lawson-Tovey, Saskia; Jacobsohn, Lindsay; Ja, Clairissa; Hyrich, Kimme L; Gossec, Laure; Strangfeld, Anja; Carmona, Loreto; Schäfer, Martin; Frãzao-Mateus, Elsa; Bulina, Inita; Stafford, Frances; Tufan, Abdurrahman; Graver, Christine; Yardımcı, Gözde Kübra; Zepa, Julija; Al Emadi, Samar; Cook, Claire; Abutiban, Fatemah; Dey, Dfiza; Katigbak, Genevieve; Kaufman, Lauren; Kowalski, Emily; Martínez-Martínez, Marco Ulises; Patel, Naomi J; Reyes-Cordero, Greta; Salido, Evelyn; Smith, Ellison; Snow, David; Sparks, Jeffrey; Wise, Leanna; Bhana, Suleman; Gore-Massy, Monique; Grainger, Rebecca; Hausmann, Jonathan; Sirotich, Emily; Sufka, Paul; Wallace, Zachary; Machado, Pedro M; Robinson, Philip C; Yazdany, Jinoos;
• Is Part Of: RMD open. Volume 8:Issue 1(2022)
• Publication Date: 2022-04-06
• Subjects: COVID-19 -- vaccination -- antirheumatic agents; Musculoskeletal system -- Diseases -- Periodicals; Rheumatism -- Periodicals; 616.7005
• DOI: 10.1136/rmdopen-2021-002187
• Languages: English
• ISSNs: 2056-5933

Abstract

Abstract : Objective: While COVID-19 vaccination prevents severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analysed the clinical characteristics of patients with rheumatic disease who developed breakthrough COVID-19 after vaccination against SARS-CoV-2. Methods: We included people partially or fully vaccinated against SARS-CoV-2 who developed COVID-19 between 5 January and 30 September 2021 and were reported to the Global Rheumatology Alliance registry. Breakthrough infections were defined as occurring ≥14 days after completion of the vaccination series, specifically 14 days after the second dose in a two-dose series or 14 days after a single-dose vaccine. We analysed patients' demographic and clinical characteristics and COVID-19 symptoms and outcomes. Results: SARS-CoV-2 infection was reported in 197 partially or fully vaccinated people with rheumatic disease (mean age 54 years, 77% female, 56% white). The majority (n=140/197, 71%) received messenger RNA vaccines. Among the fully vaccinated (n=87), infection occurred a mean of 112 (±60) days after the second vaccine dose. Among those fully vaccinated and hospitalised (n=22, age range 36–83 years), nine had used B cell-depleting therapy (BCDT), with six as monotherapy, at the time of vaccination. Three were on mycophenolate. The majority (n=14/22, 64%) were not taking systemic glucocorticoids. Eight patients had pre-existing lung disease and five patients died. Conclusion: More than half of fully vaccinated individuals with breakthrough infections requiring hospitalisation were on BCDT or mycophenolate. Further risk mitigation strategies are likely needed to protect this selected high-risk population.