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

Liew J 1 , Gianfrancesco M 2 , Harrison C 3 , Izadi Z 4 , Rush S 5 , Lawson-Tovey S 6 Show all authors , Jacobsohn L 2 , Ja C 7 , Hyrich KL 8 , Gossec L 9 , Strangfeld A 10 , Carmona L 11 , Schäfer M 12 , Frãzao-Mateus E 13 , Bulina I 14 , Stafford F 15 , Tufan A 16 , Graver C 17 , Yardımcı GK 18 , Zepa J 14 , Al Emadi S 19 , Cook C 20 , Abutiban F 21 , Dey D 22 , Katigbak G 23 , Kaufman L 24 , Kowalski E 25 , Martínez-Martínez MU 26 , Patel NJ 27 , Reyes-Cordero G 28 , Salido E 29 , Smith E 30 , Snow D 31 , Sparks J 32 , Wise L 33 , Bhana S 34 , Gore-Massy M 35 , Grainger R 36 , Hausmann J 37 , Sirotich E 38 , Sufka P 39 , Wallace Z 27 , Machado PM 40 , Robinson PC 41 , Yazdany J 42

Affiliations 

  • 1 Medicine, Section of Rheumatology, Boston University, Boston, Massachusetts, USA liew.jw@gmail.com
  • 2 Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA
  • 3 LupusChat, New York, New York, USA
  • 4 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
  • 5 Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
  • 6 Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK
  • 7 Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA
  • 8 University of Manchester, Manchester, UK
  • 9 INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
  • 10 Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
  • 11 Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
  • 12 Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
  • 13 Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal
  • 14 Paul Stradins Clinical University Hospital, Riga, Latvia
  • 15 Blackrock Clinic, Blackrock, Ireland
  • 16 Gazi University, Ankara, Turkey
  • 17 Royal Hampshire County Hospital, Winchester, UK
  • 18 Department of Internal Medicine, Hacettepe University, Ankara, Turkey
  • 19 Hamad Medical Corporation, Doha, Qatar
  • 20 Rheumatology, Massachusetts General Hospital, Boston, Massachusetts, USA
  • 21 Jaber Al Ahmed Al Jaber Al Sabah Hospital, Surra, Kuwait
  • 22 University of Ghana Medical School, Accra, Ghana
  • 23 Makati Medical Center, Makati City, Philippines
  • 24 Rheumatology Associates Louisville, Louisville, Kentucky, USA
  • 25 Inflammation and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
  • 26 Rheumatology, Hospital Central "Dr Ignacio Morones Prieto", San Luis Potosí, Mexico
  • 27 Massachusetts General Hospital, Boston, Massachusetts, USA
  • 28 Autonomous University of Chihuahua, Chihuahua, Mexico
  • 29 University of the Philippines Manila, Manila, Philippines
  • 30 University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
  • 31 Cape Fear Arthritis Care, Leland, North Carolina, USA
  • 32 Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
  • 33 Department of Internal Medicine, Division of Rheumatology, University of Southern California, Los Angeles, California, USA
  • 34 Crystal Run Healthcare, Middletown, New York, USA
  • 35 Lupus Foundation of America, Washington, DC, USA
  • 36 Department of Medicine, University of Otago, Wellington, Wellington, New Zealand
  • 37 Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA
  • 38 Medicine, McMaster University, Hamilton, Ontario, Canada
  • 39 Healthpartners, St Paul, Minnesota, USA
  • 40 MRC Centre for Neuromuscular Diseases, University College London, London, UK
  • 41 Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
  • 42 Medicine/Rheumatology, University of California, San Francisco, California, USA
RMD Open, 2022 Apr;8(1).
PMID: 35387864 DOI: 10.1136/rmdopen-2021-002187

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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