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.

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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. 

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