Abstract
Objectives
While COVID-19 vaccination prevents severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analyzed 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 January 5 - September 30, 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 analyzed 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 (140/197, 71%) received mRNA 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 hospitalized (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 hospitalization were on BCDT or mycophenolate. Further risk mitigation strategies are likely needed to protect this selected high-risk population.
While COVID-19 vaccination prevents severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analyzed 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 January 5 - September 30, 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 analyzed 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 (140/197, 71%) received mRNA 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 hospitalized (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 hospitalization were on BCDT or mycophenolate. Further risk mitigation strategies are likely needed to protect this selected high-risk population.
| Original language | English |
|---|---|
| Journal | RMD Open |
| Publication status | Accepted/In press - 9 Feb 2022 |
