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
Medicine, Section of Rheumatology, Boston University, Boston, Massachusetts, USA
Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA.
RMD Open. 2022 Apr;8(1). doi: 10.1136/rmdopen-2021-002187.
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.
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.
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.
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.
虽然新冠病毒疫苗接种可预防严重感染，但免疫功能低下人群中较差的免疫原性会威胁疫苗效力。我们分析了接种严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗后发生突破性新冠病毒感染的风湿病患者的临床特征。
我们纳入了在2021年1月5日至9月30日期间接种了部分或全部SARS-CoV-2疫苗且发生新冠病毒感染并上报至全球风湿病联盟登记处的人群。突破性感染定义为在完成疫苗接种系列后≥14天发生，具体为两剂次系列中的第二剂后14天或单剂次疫苗接种后14天。我们分析了患者的人口统计学和临床特征以及新冠病毒感染的症状和结局。
报告了197例部分或全部接种疫苗的风湿病患者感染SARS-CoV-2（平均年龄54岁，77%为女性，56%为白人）。大多数（n = 140/197，71%）接种的是信使核糖核酸疫苗。在完全接种疫苗的人群（n = 87）中，感染发生在第二剂疫苗接种后平均112（±60）天。在完全接种疫苗且住院的人群（n = 22，年龄范围36 - 83岁）中，9人在接种疫苗时使用了B细胞耗竭疗法（BCDT），其中6人作为单一疗法。3人正在使用霉酚酸酯。大多数（n = 14/22，64%）未服用全身性糖皮质激素。8例患者有基础肺部疾病，5例患者死亡。
在因突破性感染而需要住院的完全接种疫苗个体中，超过一半正在接受BCDT或霉酚酸酯治疗。可能需要进一步的风险降低策略来保护这一特定的高危人群。
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