Maximo Claudia de Alvarenga, Pinto Jorge Francisco da Cunha, Pinto Fabiana Canedo, Brasil Patrícia
Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti - HEMORIO, Rio de Janeiro, State of Rio de Janeiro, Brazil.
Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Rio de Janeiro, State of Rio de Janeiro, Brazil.
Hematol Transfus Cell Ther. 2025 Apr-Jun;47(2):103824. doi: 10.1016/j.htct.2025.103824. Epub 2025 Apr 10.
Patients with sickle cell disease were presumed to be at high risk for severe COVID-19 outcomes due to their compromised immunity and chronic comorbidities. This study aimed to evaluate vaccination patterns, healthcare utilization, and clinical outcomes in a cohort of sickle cell disease patients during the COVID-19 pandemic in Rio de Janeiro.
A total of 289 over 18-year-old patients from the Epidemiology and Donor Evaluation Study (REDS-III) Brazil sickle cell disease cohort were followed between January 2021 and August 2023. Sociodemographic data, emergency department visits, hospitalizations, mortality rates, and COVID-19 vaccination status were collected. SARS-CoV-2 infection was confirmed by reverse transcription polymerase chain reaction testing for symptomatic or hospitalized patients.
Of the participants, 89.2% completed the primary vaccination schedule, 62.2% received the first booster, 30% the second booster, and 4.1% completed all five doses. Emergency visits increased slightly during the pandemic but were primarily due to vaso-occlusive crises. Of the 119 patients tested for SARS-CoV-2, six were positive, presenting mild symptoms with no COVID-19-related deaths. Vaccination rates in the cohort were similar to those in the general population, with Oxford/AstraZeneca and Pfizer being the most used vaccines.
The findings suggest that COVID-19 infection was not a significant trigger for vaso-occlusive crises or severe disease outcomes. High vaccination adherence likely played a key role in preventing severe COVID-19, alongside other factors such as social isolation and herd immunity. However, the overlap between symptoms of vaso-occlusive crises and COVID-19 may have caused diagnostic challenges. Importantly, the low morbidity and mortality observed emphasize the protective effect of vaccines, despite the presence of thromboplastic activity and pro-inflammatory states inherent to sickle cell disease. Addressing vaccine hesitancy remains crucial, particularly as booster doses show declining adherence.
COVID-19 had a limited clinical impact on this cohort, with no significant role in triggering vaso-occlusive crises or severe outcomes. High vaccination rates and potential environmental or biological factors may have contributed to this protective effect.
由于免疫功能受损和慢性合并症，镰状细胞病患者被认为发生重症 COVID-19 结局的风险很高。本研究旨在评估里约热内卢 COVID-19 大流行期间一组镰状细胞病患者的疫苗接种模式、医疗保健利用情况和临床结局。
2021 年 1 月至 2023 年 8 月期间，对巴西镰状细胞病队列“流行病学和供体评估研究（REDS-III）”中 289 名 18 岁以上患者进行了随访。收集了社会人口学数据、急诊科就诊情况、住院情况、死亡率和 COVID-19 疫苗接种状况。对有症状或住院患者通过逆转录聚合酶链反应检测确诊 SARS-CoV-2 感染。
在参与者中，89.2% 完成了初级疫苗接种程序，62.2% 接受了第一剂加强针，30% 接受了第二剂加强针，4.1% 完成了全部五剂接种。大流行期间急诊就诊略有增加，但主要是由于血管闭塞性危象。在 119 名接受 SARS-CoV-2 检测的患者中，6 人呈阳性，症状轻微，无 COVID-19 相关死亡病例。该队列中的疫苗接种率与普通人群相似，牛津/阿斯利康和辉瑞是使用最多的疫苗。
研究结果表明，COVID-19 感染并非血管闭塞性危象或严重疾病结局的重要触发因素。除社会隔离和群体免疫等其他因素外，高疫苗接种依从性可能在预防重症 COVID-19 方面发挥了关键作用。然而，血管闭塞性危象和 COVID-19 症状之间的重叠可能带来了诊断挑战。重要的是，尽管镰状细胞病存在促凝血活性和促炎状态，但观察到的低发病率和死亡率强调了疫苗的保护作用。解决疫苗犹豫问题仍然至关重要，尤其是随着加强针接种依从性下降。
COVID-19 对该队列的临床影响有限，在引发血管闭塞性危象或严重结局方面无显著作用。高疫苗接种率以及潜在的环境或生物学因素可能促成了这种保护作用。
