SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: results from the COVID-19 Global Rheumatology Alliance provider registry.
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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
Аннотация
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.