Clinical characteristics and outcomes of COVID-19 breakthrough infections among vaccinated patients with systemic autoimmune rheumatic diseases

Two fatal breakthrough infections reported for sufferers of Systemic Autoimmune Rheumatic Diseases (SARDs). They were 57 (vaccinated with Pfizer/Biontech) and 78 (Moderna) per supplementary table.  

Among the 16 SARD patients who had breakthrough COVID-19 infections, 93% presented with symptoms. The most common symptoms reported by these individuals included fever, cough, and malaise, which affected 56%, 44%, and 38% of the patients, respectively. Six of the 16 patients were hospitalized, of which four required supplemental oxygen and one required mechanical ventilation. Two (13%) patients died; both deceased patients had received rituximab and had interstitial lung disease


Clinical characteristics and outcomes of COVID-19 breakthrough infections among vaccinated patients with systemic autoimmune rheumatic diseases

Claire Cook 1, Naomi J Patel 1 2, Kristin M D'Silva 1 2, Tiffany Y-T Hsu 2 3, Michael DiIorio 2 3, Lauren Prisco 3, Lily W Martin 3, Kathleen Vanni 3, Alessandra Zaccardelli 3, Derrick Todd 2 3, Jeffrey A Sparks 2 3, Zachary Scott Wallace 4 2

Affiliations

  • 1Division of Rheumatology, Allergy, and Immunology and Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
  • 2Harvard Medical School, Boston, Massachusetts, USA.
  • 3Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • 4Division of Rheumatology, Allergy, and Immunology and Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA zswallace@partners.org.

READ MORE

Cook C, Patel NJ, D’Silva KM, Hsu TY, DiIorio M, Prisco L, Martin LW, Vanni K, Zaccardelli A, Todd D, Sparks JA. Clinical characteristics and outcomes of COVID-19 breakthrough infections among vaccinated patients with systemic autoimmune rheumatic diseases. Annals of the Rheumatic Diseases. 2021 Sep 6. 


Rheumatic diseases patients receiving Rituximab had severe COVID-19 disease. Although they had impaired humoral immune responses following COVID-19 vaccine, they had preserved cellular immune responses. Waning of COVID-19 antibody responses was observed within six months post vaccination among immunocompromised patients. Recent reports showed fatal outcome of breakthrough SARS-CoV-2 infections among vaccinated high-risk rheumatic diseases patients receiving Rituximab. SAR-CoV-2 serological tests were not performed.

A case series of 19 fully vaccinated patients with rheumatic diseases were followed to determine post vaccine SARS-CoV-2 neutralizing antibody titers and to monitor the development of breakthrough infections up to eight months post vaccine at our tertiary care center in Jeddah, Saudi Arabia from 1st April until 30th November 2021.


Table 2. Demographics, clinical and serological characteristics of patients.

NumberAgeGenderDays between vaccine and serologyNeutralizing SARS-CoV-2 Antibody resultsTiterPost-vaccine COVID 19 infectionPre-vaccine COVID 19 infectionDiagnosisMedication
142Female21Positive1280NoNoRAMXT, HQ
231Female21Positive1280NoNoSAADL
350Female16Positive1280NoYesSLEPRD
453Female20Positive640NoNoRAPRD, TCZ
554Female20Positive640NoNoSLEHQ
652Male55Positive320YesNoPASKB
753Male47Positive320YesNoSLEHQ
836Female25Positive160NoNoSLEMXT
955Female47Positive160NoNoGCAPRD, MXT
1047Female25Positive160NoNoRAETC
1155Female52Positive80NoNoSLENone
1241Female56Positive80NoNoBDPRD, AZN
1325Female19Positive40NoNoSLEPRD, MXT, RXB
1460Female92Positive40NoNoRATCZ
1560Female34NegativeNANoNoRARXB
1649Female14NegativeNANoNoRPMMF
1760Female24NegativeNANoNoPAMXT
1839Female22NegativeNANoNoRAPRD, TCZ
1970Female92NegativeNANoNoRAPRD, MXT, ADL


REFERENCE

Alshukairi AN, Al-Omari A, Albeity A, Alandijany TA, Hassan AM, El-Kafrawy SA, Dada A, Al Hroub MK, El-Saed A, Bissar LS, Daghmush RM. COVID-19 breakthrough infections in Rheumatic diseases patients after vaccination. Journal of Infection and Public Health. 2022 May 13.


Patients with rheumatic diseases are also at risk of developing Long COVID with mental health symptoms. 

Comments

Post a Comment

Popular posts from this blog

A New Onset of Ulcerative Colitis post-2nd-breakthrough-COVID-19

Image
A 21-year-old non-smoking Caucasian male with a history of acute pancreatitis but no other medical issues or family history had two doses of the BNT162b2 mRNA COVID-19 vaccine.  Four months after the second dose he had his first episode of COVID-19. Although not hypoxic, he felt pretty unwell for a week, with a severe cough, fever, generalized body ache, headache, and loss of taste. He received the third dose of the vaccine two months after recovering from COVID. Nine months after the third dose, he had the second episode of COVID-19, during which he was mildly unwell for three days, recovered, and did not require any anti-viral medication or antibiotics. One week post the second episode of COVID-19, he developed diarrhea and abdominal pain. It then progressed to bloody diarrhea. Ulcerative colitis was diagnosed based on his clinical symptoms, biopsy changes, and the exclusion of other causes.  There are ten published case reports about the newly diagnosed ulcerative colitis associate
Read more

COVID in May

Image
Concerns about a potential resurgence of COVID-19 are mounting as summer 2024 approaches.  This is driven by several indicators, including social media posts, healthcare data, and wastewater surveillance across different regions. Our study findings corroborate this trend.  While many forecasters anticipate a surge, others expect a gradual increase through the end of May, and then a decline again around early June. Reports from social media suggest emerging clusters of COVID-19 in Texas, several Canadian provinces, the UK, and on cruises in northern regions such as a Norwegian cruise to Alaska.  Data from Alberta's Respiratory virus dashboard   (total weekly laboratory-confirmed COVID-19 cases) and wastewater surveillance in Calgary indicate an uptick in COVID-19 cases starting April 2024. The most recent statistics from Alberta Health reveal a significant increase in hospitalizations due to COVID-19, with 114 individuals currently hospitalized—an increase of more than 20% over two
Read more

Chronic SARS-CoV-2 Shedding

Image
Chronic viral shedding, a condition where the virus continues to be released from an individual's body long after the initial infection, has been observed in many infectious diseases, including COVID-19.  In such cases, individuals may remain asymptomatic or experience only mild symptoms while the virus persists. It remains detectable in repeated tests over an extended period and can still infect others even in nasal swab is negative (which happens quite often ). This was evident in our study.    Recent research by Conway et al. (2024) highlights the possibility of chronic SARS-CoV-2 infection, extending over several months and potentially years. Other studies have documented prolonged asymptomatic infections and extended viral shedding in moderate to severe beyond hospital discharge. Analysis of sequencing data on UK samples taken between 2 November 2020 and 15 August 2022 lead to estimates that 0.1–0.5% of infections may become persistent with typically rebounding high viral load
Read more