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Kikuchi J, Kondo Y, Kojima S, Kasai S, Sakai Y, Takeshita M, Hiramoto K, Saito S, Fukui H, Hanaoka H, Suzuki K, Kaneko Y. Risk of disease flares after SARS-CoV-2 mRNA vaccination in patients with systemic lupus erythematosus. Immunol Med 2024; 47:76-84. [PMID: 38189429 DOI: 10.1080/25785826.2023.2300163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024] Open
Abstract
This study aims to elucidate the effectiveness and safety of SARS-CoV-2 mRNA vaccination in patients with systemic lupus erythematosus (SLE). We enrolled uninfected SLE patients who received two vaccine doses (BNT162b2 or mRNA-1273) and historical unvaccinated patients. Neutralizing antibodies, adverse reactions, and disease flares were evaluated 4 weeks after the second vaccination. Ninety patients were enrolled in each group. Among the vaccinated patients, SLE Disease Activity Index (SLEDAI), and prednisolone doses before vaccination were 2, and 5 mg/d, respectively. After the second vaccination, 19 (21.1%) had no neutralizing antibodies. Adverse reactions occurred in 88.9% within 3 d. Negative antibodies were associated with anemia and mycophenolate mofetil administration. SLEDAI increased modestly but significantly after vaccination, with 13 (14.4%) experiencing flares and 4 (4.4%) severe flares (nephritis in three and vasculitis in one). The flare rate was higher in vaccinated patients than unvaccinated controls. The mean duration between the second vaccination and flares was 35 d, and flares occurred at least 8 days after vaccination. Multivariable analysis showed that high SLEDAI and anti-dsDNA antibodies were associated with flares. The vaccine type, neutralizing antibody titer, and adverse reaction frequency did not affect flares. Therefore, residual disease activity before vaccination increases flare risk.
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Affiliation(s)
- Jun Kikuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Kondo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Shiho Kasai
- Keio University School of Medicine, Tokyo, Japan
| | - Yuma Sakai
- Keio University School of Medicine, Tokyo, Japan
| | - Masaru Takeshita
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuoto Hiramoto
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shuntaro Saito
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Fukui
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hironari Hanaoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Lakin KS, Wu Y, Gordon JK, Kwakkenbos L, Carrier ME, Henry RS, Denton CP, Mouthon L, Spiera RF, Thombs BD. COVID-19 vaccinations and infections among individuals with systemic sclerosis: A Scleroderma Patient-centered Intervention Network (SPIN) Cohort study. Semin Arthritis Rheum 2024; 67:152453. [PMID: 38851172 DOI: 10.1016/j.semarthrit.2024.152453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND/PURPOSE We previously surveyed adults with systemic sclerosis (SSc) regarding COVID-19 vaccination in April-May 2021. The objective of the present study was to update through June-July 2022 and assess self-reported (1) COVID-19 vaccination rates, including boosters; (2) vaccine-related adverse events; (3) peri‑vaccination immunosuppressive medication management; (4) vaccine hesitancy; and (5) prevalence and severity of COVID-19 infections. METHODS In April-May 2021 and June-July 2022, SPIN Cohort participants completed surveys on COVID-19 vaccination and infection. Primary vaccine series was defined according to the standard for each COVID-19 vaccine; additional vaccine administrations were considered booster doses. Fully vaccinated was defined as having completed a primary vaccine series and at least one booster dose. RESULTS 544 participants completed the 2021 survey only, 101 the 2022 survey only, and 388 both surveys. Among 489 participants with 2022 data, 437 (89 %) had received both primary and booster vaccines. Among all 1,033 participants, 960 (93 %) received at least one dose. At least one adverse reaction was reported by 34 % (330 of 960 participants) following first, 48 % (314 of 657 participants) following second, and 34 % (147 of 437 participants) following booster vaccine doses (primarily sore arm and fatigue); no severe adverse reactions were reported. SSc symptom worsening was reported in 6 % (53 of 960) after the first, 6 % after the second (39 of 657), and 4 % (17 of 437) after the booster dose. Of participants taking methotrexate or mycophenolate (including Cellcept or Myfortic), 34 of 266 (13 %) reported that they temporarily stopped or decreased their medication at the first dose, 32 of 215 (15 %) at the second dose, and 28 of 148 (19 %) for booster vaccination. Of 52 individuals not fully vaccinated with primary and booster doses in 2022, 29 (56 %) reported worry about vaccine related SSc flares. 172 of 489 (35 %) 2022 participants reported a history of at least one COVID-19 infection; 114 (66 %) occurred after receiving at least a primary vaccine series. Among initial COVID-19 infections, 9 (5 %) were asymptomatic, 66 (38 %) involved mild symptoms, 82 (48 %) moderate symptoms, and 15 (9 %) required hospitalization. CONCLUSION Most people with SSc in the study were fully vaccinated, and most continued their methotrexate or mycophenolate post-primary and booster vaccinations. Over half of vaccine-hesitant participants were concerned regarding risk of SSc flare; however, few vaccinated participants reported this. These data may be useful for counselling people with SSc regarding COVID-19 vaccine safety and outcomes.
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Affiliation(s)
| | - Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Linda Kwakkenbos
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands; Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Richard S Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Christopher P Denton
- University College London, Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes et Autoinflammatoires Systémiques Rares d'Ile de France, de l'Est et de l'Ouest, Hôpital Cochin, Paris, France; Assistance Publique Hôpitaux de Paris-Centre, Hôpital Cochin, Université Paris Cité, Paris, France
| | | | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada
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Rutskaya-Moroshan K, Abisheva S, Sarsenova M, Ogay V, Vinnik T, Aubakirova B, Abisheva A. Autoimmune rheumatic diseases and COVID-19 vaccination: a retrospective cross-sectional study from Astana. Reumatologia 2024; 62:26-34. [PMID: 38558898 PMCID: PMC10979372 DOI: 10.5114/reum/184335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has had an unprecedented impact on people around the world, particularly those who were suffering from autoimmune rheumatic diseases (AIRDs). The world community acknowledges the significance of COVID-19 vaccination in patients with autoimmune disorders and emphasizes the priority of this category to receive vaccination over the general population. Although many studies have been published since the first phases of vaccination all over the world, multiple related factors still need to be further investigated. Material and methods We investigated the COVID-19 vaccination status in patients with AIRDs, by performing a cross-sectional, interview-based study filled in by patients attending their clinics in the Astana city, capital of Kazakhstan, from April to July 2023. The survey questionnaire consisted of a set of questions, concerning patient characteristics, treatment details, accepted vaccines and characteristics of COVID-19 infection. The study objectives were to evaluate vaccine hesitancy, adverse effects, breakthrough infections and flare of underlying rheumatic disease in this population subgroup. Results There were 193 participants, with a median age of 50.3 ±12.9 years. Among them, 62 (32.1%) were vaccinated with at least single dose of vaccine, 16 (25.8%) of whom were fully vaccinated. The commonest (89; 68%) reason for vaccine hesitancy was a fear of autoimmune disease worsening. Vaccine-related adverse effects (AEs) were reported by 66.7% of patients. We found that vaccination provoked AIRD exacerbation in 19% of patients with AEs. Eight patients reported flare of pre-existing rheumatic disease after vaccination. The incidence of breakthrough infections was similar in the groups of vaccinated individuals (n = 12), 12.9% of whom were partially and 6.5% fully vaccinated. Conclusions The vaccination was found to be safe in patients with rheumatic diseases. Fear of autoimmune status was the major reason for vaccine reluctance. All reported adverse events were minor. The minority subgroup within the sample had subsequent breakthrough infections or autoimmune disease flare-ups.
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Affiliation(s)
| | - Saule Abisheva
- NJSC Astana Medical University, Department of Family Medicine No. 1, Astana, Kazakhstan
| | - Madina Sarsenova
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Vyacheslav Ogay
- Laboratory of Stem Cells, National Center for Biotechnology, Astana, Kazakhstan
| | - Tatyana Vinnik
- Department of Molecular Biology, Ariel University, Ariel, Israel
| | | | - Anilim Abisheva
- NJSC Astana Medical University, Department of Family Medicine No. 1, Astana, Kazakhstan
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4
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Holladay EE, Mudano AS, Xie F, Stewart P, Jackson LE, Danila MI, Gavigan K, Nowell WB, Venkatachalam S, Curtis JR. COVID-19 Vaccine Uptake, Hesitancy, and Flare in a Large Rheumatology Practice Network. Arthritis Care Res (Hoboken) 2024; 76:111-119. [PMID: 37750035 DOI: 10.1002/acr.25241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE The goal of this study was to ascertain COVID-19 vaccine uptake, reasons for hesitancy, and self-reported flare in a large rheumatology practice-based network. METHODS A tablet-based survey was deployed by 108 rheumatology practices from December 2021 to December 2022. Patients were asked about COVID-19 vaccine status and why they might not receive a vaccine or booster. We used descriptive statistics to explore the differences between vaccination status and vaccine and booster hesitancy, comparing patients with and without autoimmune and inflammatory rheumatic diseases (AIIRDs). We used multivariable logistic regression to examine the association between vaccine uptake and AIIRD status and self-reported flare and AIIRD status. We reported adjusted odds ratios (aORs). RESULTS Of the 61,158 patients, 89% reported at least one dose of vaccine; of the vaccinated, 68% reported at least one booster. Vaccinated patients were less likely to have AIIRDs (44% vs 56%). A greater proportion of patients with AIIRDs were vaccine hesitant (14% vs 10%) and booster hesitant (21% vs 16%) compared to patients without AIIRDs. Safety concerns (28%) and side effects (23%) were the main reasons for vaccine hesitancy, whereas a lack of recommendation from the physician was the primary factor for booster hesitancy (23%). Patients with AIIRD did not have increased odds of self-reported flare or worsening disease compared to patients without with AIIRD (aOR 0.99, 95% confidence interval [CI] 0.94-1.05). Among the patients who were vaccine hesitant and booster hesitant, 12% and 39% later reported receiving a respective dose. Patients with AIIRD were 32% less likely to receive a vaccine (aOR 0.68, 95% CI 0.65-0.72) versus patients without AIIRD. CONCLUSION Some patients who are vaccine and booster hesitant eventually receive a vaccine dose, and future interventions tailored to patients with AIIRD may be fruitful.
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Affiliation(s)
| | | | | | | | | | - Maria I Danila
- University of Alabama at Birmingham and Birmingham Department of Veterans Affairs Medical Center, Birmingham, Alabama
| | - Kelly Gavigan
- Global Healthy Living Foundation, Upper Nyack, New York
| | | | | | - Jeffrey R Curtis
- University of Alabama at Birmingham and Illumination Health, Hoover, Alabama
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5
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Wroński J, Palej K, Stańczyk S, Łosoś M, Werońska-Tatara J, Stasiek M, Wysmołek M, Olech A, Felis-Giemza A. Do Not Leave Your Patients in the Dark-Using American College of Rheumatology and European Alliance of Associations for Rheumatology Recommendations for Vaccination in Polish Adult Patients with Autoimmune Inflammatory Rheumatic Diseases. Vaccines (Basel) 2023; 11:1854. [PMID: 38140256 PMCID: PMC10748174 DOI: 10.3390/vaccines11121854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Introduction: Patients with autoimmune inflammatory rheumatic diseases (AIIRD) face a higher infectious risk compared to the general population. As per the ACR and EULAR recommendations, vaccinations against influenza, COVID-19, pneumococci, and tetanus are recommended for most patients with AIIRD. (2) Objectives: This study aimed to assess vaccination coverage among Polish AIIRD patients and identify factors influencing it. (3) Patients and Methods: This study was conducted at the reference rheumatological center in Poland between May 2023 and October 2023. The study participants completed a questionnaire covering their knowledge of vaccination recommendations, actual vaccination status, factors affecting their decision to vaccinate, and their perspectives on immunization. (4) Results: This study involved 300 AIIRD patients and 60 controls. Both groups exhibited comparably low vaccination rates for all diseases (the highest for COVID-19-52% in both groups and the lowest for pneumococci-7.7% and 10%, respectively). Knowledge about recommended vaccinations was limited among patients in both groups. AIIRD patients were also not aware that they should avoid live vaccines. The primary motivators for vaccination among AIIRD patients were fear of infection (up to 75%) and medical advice (up to 74.6%). Conversely, the predominant reasons for non-vaccination were a lack of knowledge that vaccination is recommended (up to 74.7%) and concerns about potential adverse effects (up to 48.6%). Many patients reported not receiving vaccination recommendations from either primary care physicians or rheumatologists. (5) Conclusions: To enhance vaccination coverage among AIIRD patients in Poland, it is essential to educate them about vaccinations during routine medical consultations, emphasizing the increased risk of infection, informing them about recommended vaccinations, and clarifying doubts about adverse effects.
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Affiliation(s)
- Jakub Wroński
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland;
| | - Karolina Palej
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
| | - Sandra Stańczyk
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
| | - Marta Łosoś
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
| | - Joanna Werońska-Tatara
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
| | - Małgorzata Stasiek
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
| | - Marta Wysmołek
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
| | - Agnieszka Olech
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland;
| | - Anna Felis-Giemza
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland; (K.P.); (S.S.); (M.Ł.); (J.W.-T.); (M.S.); (M.W.); (A.F.-G.)
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6
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Butt IN, van Eeden C, Kovacs Burns K, Saxinger L, Clifford A, Redmond D, Cohen Tervaert JW, Yacyshyn E. Understanding COVID-19 vaccine hesitancy in vasculitis patients. Front Public Health 2023; 11:1301492. [PMID: 38111485 PMCID: PMC10726054 DOI: 10.3389/fpubh.2023.1301492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
Objective To identify the factors that impact COVID-19 vaccine decision-making in vaccine-hesitant vasculitis patients, and compare their perceptions with other rheumatology patients, given existence of data suggesting rheumatology patients may have disease-specific factors that influence their COVID-19 vaccine decision-making. Methods This cross-sectional study surveyed adult rheumatology patients from the Kaye Edmonton Clinic Rheumatology Clinic, in Canada, between June and August 2021, using an anonymous online questionnaire. Survey responses were analyzed for statistical differences using chi-square analysis. Results The COVID-19 Vaccine Perceptions Survey had a response rate of 70.9%. Of the total 231 respondents, 103 patients were diagnosed with vasculitis. At the time of the survey, 10.6% of vasculitis patients refused to receive a COVID-19 vaccine compared to 6.3% for other rheumatology patients. Compared to other rheumatology patients, vaccine-hesitant vasculitis patients were significantly more concerned about almost every aspect of available COVID-19 vaccines [e.g., safety (p < 0.001), components (p < 0.001)], and feared that they could contract SARS-CoV-2 from a vaccine (p < 0.001). These vaccine-hesitant patients were also significantly less pleased with the government's pandemic response, less confident in healthcare team-provided information (p < 0.001), and more likely to report that healthcare providers had no role in their COVID-19 vaccine decision-making (p < 0.001). Conclusion Vaccine-hesitant vasculitis patients may have multiple considerations influencing COVID-19 vaccine hesitancy, including vaccine and disease-specific concerns, along with unfavorable perceptions of the healthcare system (government and healthcare providers). Healthcare providers can address some of these concerns by initiating patient-centered discussions around immunizations to help support educated decision-making.
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Affiliation(s)
| | | | | | | | | | | | | | - Elaine Yacyshyn
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Feng CH, Kuo PC, Shih PC, Wei JCC. Illuminating the connection: Unearthing the mechanisms linking COVID-19 and rheumatoid arthritis. Int J Rheum Dis 2023; 26:2134-2136. [PMID: 37910027 DOI: 10.1111/1756-185x.14870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/02/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Chi-Hsiang Feng
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Pei-Cheng Kuo
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Po-Cheng Shih
- Division of Allergy, Immunology, Rheumatology, Changhua Christian Hospital, Changhua, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
- Division of Allergy, Immunology, Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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8
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Lucane Z, Kursite M, Sablinskis K, Gailite L, Kurjane N. COVID-19 Vaccination Coverage and Factors Influencing Vaccine Hesitancy among Patients with Inborn Errors of Immunity in Latvia: A Mixed-Methods Study. Vaccines (Basel) 2023; 11:1637. [PMID: 38005969 PMCID: PMC10675738 DOI: 10.3390/vaccines11111637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The European Society for Immunodeficiencies recommends that all patients with inborn errors of immunity (IEI) without contraindications should receive SARS-CoV-2 vaccination. The aim of this study was to investigate the reasons that discourage IEI patients from receiving the recommended vaccination and to assess vaccination coverage among IEI patients in Latvia. METHODS In this multicenter mixed-methods study, the vaccination status of all patients with IEI within two tertiary centers in Latvia was reviewed using electronic health records. Semi-structured interviews were conducted with 16 IEI patients who did not undergo vaccination, and a thematic analysis was performed. RESULTS A total of 341 patients (49.3% female; median age 19.7 years (IQR:17)) were included in the quantitative part. The proportion of fully vaccinated individuals aged ≥ 12 years was 66.8%-70.9% with patients with selective IgA deficiency and 58.8% with other IEI (χ² = 14.12, p < 0.001). The proportion of fully vaccinated individuals aged 5-11 years was 11.1%. Age was associated with vaccination status: younger patients were found to have a significantly lower likelihood of receiving vaccination (U = 8585, p < 0.001). The five main themes identified were as follows: (1) fear and uncertainty; (2) risk and benefit assessment: COVID-19 vaccine-is it worth it? (3) external influences: the dark horse of the decision-making-people around us; (4) individuals against the system; and (5) beliefs about vaccination and COVID-19. Under-representation of certain IEI groups and recall bias are possible limitations of this study. CONCLUSIONS While most reasons for hesitancy were similar to those previously described in the general population, disease-specific concerns were also identified.
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Affiliation(s)
- Zane Lucane
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Mirdza Kursite
- Department of Public Health and Epidemiology, Riga Stradiņš University, LV-1007 Riga, Latvia
| | - Kristaps Sablinskis
- Department of Internal Diseases, Riga Stradins University, LV-1007 Riga, Latvia
| | - Linda Gailite
- Scientific Laboratory of Molecular Genetics, Riga Stradins University, LV-1007 Riga, Latvia
| | - Natalja Kurjane
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
- Outpatient Clinic, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
- Outpatient Clinic, Children’s Clinical University Hospital, LV-1004 Riga, Latvia
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9
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Sen P, R N, Houshmand N, Moghadam Kia S, Joshi M, Saha S, Jagtap K, Agarwal V, Nune A, Nikiphorou E, Tan AL, Shinjo SK, Ziade N, Velikova T, Milchert M, Parodis I, Gracia-Ramos AE, Cavagna L, Kuwana M, Knitza J, Makol A, Patel A, Pauling JD, Wincup C, Barman B, Zamora Tehozol EA, Rojas Serrano J, García-De La Torre I, Colunga-Pedraza IJ, Merayo-Chalico J, Chibuzo OC, Katchamart W, Akawatcharangura Goo P, Shumnalieva R, Chen YM, Hoff LS, El Kibbi L, Halabi H, Vaidya B, Sazliyana Shaharir S, Hasan ATMT, Dey D, Gutiérrez CET, Caballero-Uribe CV, Lilleker JB, Salim B, Gheita T, Chatterjee T, Distler O, Saavedra MA, Day J, Chinoy H, Agarwal V, Aggarwal R, Gupta L. Vaccine hesitancy decreases in rheumatic diseases, long-term concerns remain in myositis: a comparative analysis of the COVAD surveys. Rheumatology (Oxford) 2023; 62:3291-3301. [PMID: 36734536 DOI: 10.1093/rheumatology/kead057] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE COVID-19 vaccines have a favorable safety profile in patients with autoimmune rheumatic diseases (AIRDs) such as idiopathic inflammatory myopathies (IIMs); however, hesitancy continues to persist among these patients. Therefore, we studied the prevalence, predictors and reasons for hesitancy in patients with IIMs, other AIRDs, non-rheumatic autoimmune diseases (nrAIDs) and healthy controls (HCs), using data from the two international COVID-19 Vaccination in Autoimmune Diseases (COVAD) e-surveys. METHODS The first and second COVAD patient self-reported e-surveys were circulated from March to December 2021, and February to June 2022 (ongoing). We collected data on demographics, comorbidities, COVID-19 infection and vaccination history, reasons for hesitancy, and patient reported outcomes. Predictors of hesitancy were analysed using regression models in different groups. RESULTS We analysed data from 18 882 (COVAD-1) and 7666 (COVAD-2) respondents. Reassuringly, hesitancy decreased from 2021 (16.5%) to 2022 (5.1%) (OR: 0.26; 95% CI: 0.24, 0.30, P < 0.001). However, concerns/fear over long-term safety had increased (OR: 3.6; 95% CI: 2.9, 4.6, P < 0.01). We noted with concern greater skepticism over vaccine science among patients with IIMs than AIRDs (OR: 1.8; 95% CI: 1.08, 3.2, P = 0.023) and HCs (OR: 4; 95% CI: 1.9, 8.1, P < 0.001), as well as more long-term safety concerns/fear (IIMs vs AIRDs - OR: 1.9; 95% CI: 1.2, 2.9, P = 0.001; IIMs vs HCs - OR: 5.4 95% CI: 3, 9.6, P < 0.001). Caucasians [OR 4.2 (1.7-10.3)] were likely to be more hesitant, while those with better PROMIS physical health score were less hesitant [OR 0.9 (0.8-0.97)]. CONCLUSION Vaccine hesitancy has decreased from 2021 to 2022, long-term safety concerns remain among patients with IIMs, particularly in Caucasians and those with poor physical function.
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Affiliation(s)
- Parikshit Sen
- Maulana Azad Medical College, New Delhi, Delhi, India
| | - Naveen R
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Nazanin Houshmand
- Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Siamak Moghadam Kia
- Myositis Center and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mrudula Joshi
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Sreoshy Saha
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - Kshitij Jagtap
- Seth Gordhandhas Sunderdas Medical College and King Edwards Memorial Hospital, Mumbai, Maharashtra, India
| | - Vishwesh Agarwal
- Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
| | - Arvind Nune
- Southport and Ormskirk Hospital NHS Trust, Southport, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon
- Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | | | - Marcin Milchert
- Department of Internal Medicine, Rheumatology, Diabetology, Geriatrics and Clinical Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Abraham Edgar Gracia-Ramos
- Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Lorenzo Cavagna
- Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli studi di Pavia, Pavia, Lombardy, Italy
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Johannes Knitza
- Medizinische Klinik 3-Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Aarat Patel
- Bon Secours Rheumatology Center and Division of Pediatric Rheumatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - John D Pauling
- Bristol Medical School Translational Health Sciences, University of Bristol, UK
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Chris Wincup
- Department of Rheumatology, Division of Medicine, Rayne Institute, University College London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH, GOSH, London, UK
| | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, India
| | - Erick Adrian Zamora Tehozol
- Rheumatology, Medical Care & Research, Centro Medico Pensiones Hospital, Instituto Mexicano del Seguro Social Delegación Yucatán, Yucatán, Mexcio
| | - Jorge Rojas Serrano
- Rheumatologist and Clinical Investigator, Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Ignacio García-De La Torre
- Departamento de Inmunología y Reumatología, Hospital General de Occidente and Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | - Javier Merayo-Chalico
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Okwara Celestine Chibuzo
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla/University of Nigeria, Enugu, Nigeria
| | - Wanruchada Katchamart
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Russka Shumnalieva
- Department of Rheumatology, Clinic of Rheumatology, University Hospital 'St. Ivan Rilski', Medical University-Sofia, Bulgaria
| | - Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Lina El Kibbi
- Rheumatology Unit, Internal Medicine Department, Specialized Medical Center, Riyadh, Saudi Arabia
| | - Hussein Halabi
- Department of Internal Medicine, Section of Rheumatology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Binit Vaidya
- National Center for Rheumatic Diseases (NCRD), Kathmandu, Nepal
| | | | - A T M Tanveer Hasan
- Department of Rheumatology, Enam Medical College & Hospital, Dhaka, Bangladesh
| | - Dzifa Dey
- Rheumatology Unit, Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | | | | | - James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Babur Salim
- Rheumatology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Tamer Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Tulika Chatterjee
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Miguel A Saavedra
- Departamento de Reumatología Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC , Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Latika Gupta
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre The University of Manchester, Manchester, UK
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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10
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Andreica I, Roman I, Redeker I, Baraliakos X, Braun J, Kiltz U. Facilitators and barriers for vaccination in patients with inflammatory rheumatic musculoskeletal diseases: a prospective cohort study. RMD Open 2023; 9:rmdopen-2022-002875. [PMID: 37295840 DOI: 10.1136/rmdopen-2022-002875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/02/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION To identify facilitators and barriers towards vaccination in general and specifically against pneumococci, influenza and SARS-CoV-2 in patients with rheumatic musculoskeletal diseases (RMD). METHODS Between February and April 2021, consecutive patients with RMD were asked to complete a structured questionnaire on general knowledge about vaccination, personal attitudes and perceived facilitators and barriers towards vaccination. General facilitators (n=12) and barriers (n=15) and more specific ones for vaccination against pneumococci, influenza and SARS-CoV-2 were assessed. Likert scales had four response options: from 1 (completely disagree) to 4 (completely agree). Patient and disease characteristics, their vaccination records and attitudes towards vaccination against SARS-CoV-2 were assessed. RESULTS 441 patients responded to the questionnaire. Knowledge about vaccination was decent in ≥70% of patients, but <10% of patients doubted its effectiveness. Statements on facilitators were generally more favourable than on barriers. Facilitators for SARS-CoV-2 vaccination were not different from vaccination in general. Societal and organisational facilitators were more often named than interpersonal or intrapersonal facilitators. Most patients indicated that recommendations of their healthcare professional would encourage them to be vaccinated-without preference for general practitioner or rheumatologists. There were more barriers towards SARS-CoV-2 vaccination than to vaccination in general. Intrapersonal issues were most frequently reported as a barrier. Statistically significant differences in response patterns to nearly all barriers between patients classified as definitely willing, probably willing and unwilling to receive SARS-CoV-2 vaccines were noted. DISCUSSION Facilitators towards vaccination were more important than barriers. Most barriers against vaccination were intrapersonal issues. Societal facilitators identified support strategies in that direction.
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Affiliation(s)
- Ioana Andreica
- Ruhr University Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Iulia Roman
- Ruhr University Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Imke Redeker
- Ruhr University Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Xenofon Baraliakos
- Ruhr University Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Juergen Braun
- Ruhr University Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Uta Kiltz
- Ruhr University Bochum, Bochum, Germany
- Rheumazentrum Ruhrgebiet, Herne, Germany
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11
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Zaccardelli A, Wallace ZS, Sparks JA. Acute and postacute COVID-19 outcomes for patients with rheumatoid arthritis: lessons learned and emerging directions 3 years into the pandemic. Curr Opin Rheumatol 2023; 35:175-184. [PMID: 36752280 PMCID: PMC10065912 DOI: 10.1097/bor.0000000000000930] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE OF REVIEW To summarize the findings of studies investigating patients with rheumatoid arthritis (RA) and risk of acute and postacute COVID-19 outcomes 3 years into the pandemic. RECENT FINDINGS Most studies early in the pandemic included all patients with systemic autoimmune rheumatic diseases (SARDs), not only those with RA, due to limited sample size. Many of these studies found that patients with SARDs were at higher risk of COVID-19 infection and severe outcomes, including hospitalization, hyperinflammation, mechanical ventilation, and death. Studies performed later were able to focus on RA and found similar associations, while also identifying RA-specific factors such as immunosuppressive medications, disease activity/severity, and interstitial lung disease as risk factors for severe COVID-19. After COVID-19 vaccination, the risks for COVID-19 infection and severity were reduced for patients with RA, but a gap between the general population persisted, and some patients with RA are susceptible to breakthrough infection after vaccination. Preexposure prophylaxis, effective treatments, and changes in viral variants have also contributed to improved COVID-19 outcomes throughout the pandemic. Emerging data suggest that patients with RA may be at risk for postacute sequelae of COVID-19 (PASC). SUMMARY Although COVID-19 outcomes have improved over the pandemic for patients with RA, some experience poor acute and postacute outcomes after COVID-19. Clinicians and patients should remain vigilant about risk mitigation for infection and consider early treatment for RA patients with COVID-19. Future studies are needed to investigate clinical outcomes and mechanisms of PASC among patients with RA.
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Affiliation(s)
| | - Zachary S. Wallace
- Division of Rheumatology, Allergy, and Immunology
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital
- Harvard Medical School
| | - Jeffrey A. Sparks
- Harvard Medical School
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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12
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McMaster C, Liew DFL, Lester S, Rischin A, Black RJ, Chand V, Fletcher A, Lassere MN, March L, Robinson PC, Buchbinder R, Hill CL. COVID-19 vaccine hesitancy in inflammatory arthritis patients: serial surveys from a large longitudinal national Australian cohort. Rheumatology (Oxford) 2023; 62:1460-1466. [PMID: 36069664 PMCID: PMC9494403 DOI: 10.1093/rheumatology/keac503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine COVID-19 vaccine hesitancy rates in inflammatory arthritis patients and identify factors associated with changing vaccine hesitancy over time. METHODS This investigation was a prospective cohort study of inflammatory arthritis patients from community and public hospital outpatient rheumatology clinics enrolled in the Australian Rheumatology Association Database (ARAD). Two surveys were conducted, one immediately prior to (pre-pandemic) and another approximately 1 year after the start of the pandemic (follow-up). Coronavirus disease 2019 (COVID-19) vaccine hesitancy was measured at follow-up, and general vaccine hesitancy was inferred pre-pandemic; these were used to identify factors associated with fixed and changing vaccine beliefs, including sources of information and broader beliefs about medication. RESULTS Of the 594 participants who completed both surveys, 74 (12%) were COVID-19 vaccine hesitant. This was associated with pre-pandemic beliefs about medications being harmful (P < 0.001) and overused (P = 0.002), with stronger beliefs resulting in vaccine hesitancy persistent over two time points (P = 0.008, P = 0.005). For those not vaccine hesitant pre-pandemic, the development of COVID-19 vaccine hesitancy was associated with a lower likelihood of seeking out vaccine information from health-care professionals (P < 0.001). COVID-19 vaccine hesitancy was not associated with new influenza vaccine hesitancy (P = 0.138). CONCLUSION In this study of vaccine beliefs before and during the COVID-19 pandemic, factors associated with COVID-19 vaccine hesitancy in inflammatory arthritis patients varied, depending on vaccine attitudes immediately prior to the start of the pandemic. Fixed beliefs reflected broader views about medications, while fluid beliefs were highly influenced by whether they sought out information from health-care professionals, including rheumatologists.
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Affiliation(s)
- Christopher McMaster
- Department of Rheumatology, Austin Health, Heidelberg, VIC, 3084
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, 3084
- The Centre for Digital Transformation of Health, University of Melbourne, Parkville, VIC, 3052
| | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg, VIC, 3084
- Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, VIC, 3084
- Department of Medicine, University of Melbourne, Parkville, VIC, 3052
| | - Susan Lester
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, 5011
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5000
| | - Adam Rischin
- Department of Rheumatology, The Alfred Hospital, Melbourne, VIC, 3004
| | - Rachel J Black
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, 5011
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5000
| | - Vibhasha Chand
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, 3144
| | - Ashley Fletcher
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, 3144
| | - Marissa N Lassere
- School of Population Health, UNSW Medicine, Sydney, New South Wales, Australia
- Department of Rheumatology, St George Hospital, Sydney, New South Wales, Australia
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Institute of Bone and Joint Research, University of Sydney, Sydney, New South Wales, Australia
| | - Philip C Robinson
- Faculty of Medicine, University of Queensland School of Clinical Medicine, Herston, Queensland, Australia
- Royal Brisbane & Women’s Hospital, Metro North Hospital & Health Service, Herston, Queensland, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, 3144
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville South, SA, 5011
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5000
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13
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Moon KW. Vaccination of patients with autoimmune inflammatory rheumatic disease: physicians' perspectives. JOURNAL OF RHEUMATIC DISEASES 2023; 30:69-71. [PMID: 37483482 PMCID: PMC10324938 DOI: 10.4078/jrd.2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Ki Won Moon
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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14
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COVID-19 Vaccination Intention in Patients with Autoimmune Diseases in Indonesia: An Application of the Integrated Behavioural Model. Trop Med Infect Dis 2023; 8:tropicalmed8020109. [PMID: 36828525 PMCID: PMC9967126 DOI: 10.3390/tropicalmed8020109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Vaccine hesitancy can be a challenge for those with autoimmune diseases. This study investigated the acceptance of COVID-19 vaccination by patients with autoimmune diseases in Indonesia using the integrated behavioral model (IBM). This cross-sectional study was conducted from December 2021 to February 2022. A total of 404 patients with autoimmune diseases completed the survey. The majority of respondents (57.9%) said they intended to get vaccinated against COVID-19. The IBM model with added demographic variables explained 54.1% of the variance of vaccination intention (R2 = 0.541). Self-efficacy, perceived norms, experiential attitude, and instrumental attitude are significantly correlated with vaccination intention in components of health behavior theories. Self-efficacy is the most critical factor influencing vaccination intention in patients with autoimmune diseases (F(2, 401) = 96.9, p < 0.001, R2 = 0.326). In the multivariate analysis, vaccine intention was found to be positively associated with patients' occupation as health-care workers (β = 0.105). Meanwhile, having a personal history of contracting COVID-19 and having co-morbidities other than autoimmune diseases were negatively correlated to the willingness to be vaccinated against COVID-19. This study confirms the viability of the IBM model for predicting the COVID-19 vaccination intention of patients with autoimmune diseases. It is essential to provide patients with autoimmune diseases with information that is clear and supported by evidence-based medicine.
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15
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Social Media for Research Discourse, Dissemination, and Collaboration in Rheumatology. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2022; 3:169-179. [PMID: 36879836 PMCID: PMC9984924 DOI: 10.2478/rir-2022-0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/24/2022] [Indexed: 02/09/2023]
Abstract
Social media has become an important venue for rheumatologists, patients, organizations, and other stakeholders to discuss recent research advances in diagnosis and management of rheumatic disorders. In this article, we describe the current state of how social media may enhance dissemination, discourse, and collaboration in rheumatology research. Social media may refer to social platforms like Twitter and Instagram or digital media like podcasts and other websites that are operated for providing as free, open-access medical education (FOAM). Twitter has been one of the most active social media venues and continues to host a vibrant rheumatology community. Examples of research discussions on Twitter include organic user tweets, educational threads ("tweetorials"), live-tweeting academic conferences, and journals posting recently-accepted articles. Some research collaborations have been initiated through social media interactions. Social media may also directly contribute to research by facilitating the recruitment of study participants and the collection of survey-based data. Thus, social media is an evolving and important tool to enhance research discourse, dissemination, and collaboration in rheumatology.
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16
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Pan CX, Goldman N, Kim DY, Rowley R, Schaefer M, LaChance AH, Nambudiri VE. Disease flare in patients with dermatomyositis following COVID-19 vaccination. J Am Acad Dermatol 2022; 87:1373-1374. [PMID: 35817330 PMCID: PMC9270178 DOI: 10.1016/j.jaad.2022.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/19/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Catherina X. Pan
- Harvard Medical School, Boston, Massachusetts,Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Nathaniel Goldman
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts,New York Medical College, Valhalla, New York
| | - Daniel Y. Kim
- Harvard Medical School, Boston, Massachusetts,Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Rachael Rowley
- Harvard Medical School, Boston, Massachusetts,Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Morgan Schaefer
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Avery H. LaChance
- Harvard Medical School, Boston, Massachusetts,Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Vinod E. Nambudiri
- Harvard Medical School, Boston, Massachusetts,Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts,Correspondence and reprint requests to: Vinod E. Nambudiri, MD, MBA, Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Ave, Boston, MA 02115
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17
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Shaw YP, Hustek S, Nguyen N, Starlin M, Wipfler K, Wallace BI, Michaud K. Rheumatic disease patient decision-making about COVID-19 vaccination: a qualitative analysis. BMC Rheumatol 2022; 6:76. [PMID: 36443813 PMCID: PMC9706890 DOI: 10.1186/s41927-022-00307-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although patients with rheumatic and musculoskeletal diseases (RMDs) are at increased risk for adverse outcomes of COVID-19 illness compared to healthy controls, they also have lower rates of willingness to be vaccinated. Previous research has identified reasons for vaccine hesitancy among patients with RMDs (such as concerns about side effects and flares), but little is known about what these reasons mean in the context of patients' lives, or how vaccine decision making is experienced from a patient perspective. Our objective was to describe decision-making about COVID-19 vaccination among RMD patients. METHODS Participants in a RMD registry were invited to complete monthly online surveys regarding COVID-19 vaccination from March-June 2021. We qualitatively analyzed comments from two open-ended survey questions reporting general experiences with vaccination and side effects. Comments were coded for attitudes towards COVID-19 vaccination, vaccine access, rheumatologic medication management around vaccination, and vaccine side effects. Themes were identified for the process and context of COVID-19 vaccine decisions, patient motivations for receiving or avoiding vaccination, and consistency of peri-vaccine medication management with current ACR guidelines. RESULTS We analyzed 710 comments from 537 respondents. Commenting respondents had a mean age of 64 years, were 87% female, 94% white, and 93% received/intended to receive ≥ 1 dose of a COVID-19 vaccine. Desire for protection and a return to normal routines motivated some commenters to get vaccinated, while concerns about vaccine side effects motivated others to delay or avoid vaccination. Several commenters reported disease flares following vaccination. Some commenters did not consult their providers about vaccination and failed to withhold immunomodulatory medications during vaccination, while others withheld medications more conservatively than recommended by current ACR guidelines, either on their own or directed by their provider. CONCLUSIONS While most commenters were vaccine-accepting, challenges to COVID-19 vaccine uptake in the RMD population may include fears of side effects, including worsened RMD symptoms, and perceptions that vaccination is unnecessary. Addressing these concerns and beliefs may be critical for promoting vaccination in this population.
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Affiliation(s)
- Yomei P Shaw
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Sara Hustek
- University of Michigan Division of Rheumatology, Ann Arbor, MI, USA
| | - Nina Nguyen
- University of Michigan Division of Rheumatology, Ann Arbor, MI, USA
| | | | - Kristin Wipfler
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA
| | - Beth I Wallace
- University of Michigan Division of Rheumatology, Ann Arbor, MI, USA
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Kaleb Michaud
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, KS, USA.
- University of Nebraska Medical Center, Omaha, NE, USA.
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Więsik-Szewczyk E, Ziętkiewicz M, Będzichowska A, Napiórkowska-Baran K, Matyja-Bednarczyk A, Felis-Giemza A, Jahnz-Różyk K. Coronavirus disease 2019 vaccination uptake and hesitancy among Polish patients with inborn errors of immunity, autoinflammatory syndromes, and rheumatic diseases: A multicenter survey. Front Immunol 2022; 13:1010899. [PMID: 36275663 PMCID: PMC9582147 DOI: 10.3389/fimmu.2022.1010899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022] Open
Abstract
Data regarding the willingness of patients affected by inborn errors of immunity to accept vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. Therefore, this study assessed SARS-CoV-2 vaccination coverage and hesitancy in immunodeficient patients by surveying adults with primary immune deficiencies and autoinflammatory and rheumatic diseases on biologic therapy. The study was conducted from September 20, 2021, to January 22, 2022, when the primary coronavirus disease 2019 (COVID-19) vaccinations were available to all adults in Poland. We included 207 participants consecutively recruited from five referral centers (57% female; median age: 42.6 [range: 18–76, standard deviation ± 14.70] years). Overall, 55% (n = 114), 17% (n = 36), and 28% (n = 57) of the patients had primary immune deficiencies, autoinflammatory diseases, and rheumatic diseases, respectively. Among the entire cohort, 168 patients (81%) were vaccinated, and 82% were willing to receive a booster dose. Patients with autoinflammatory diseases had the highest vaccination rate (94.4%). A strong conviction that it was the correct decision (72%), fear of getting COVID-19 (38%), and expert opinions (34%) influenced the decision to vaccinate. Among the unvaccinated patients, 33.3% had primary or vocational education (p <0.001). Furthermore, only 33% believed they were at risk of a severe course of COVID-19 (p = 0.014), and 10% believed in vaccine efficacy (p <0.001). They also doubted the safety of the vaccine (p <0.001) and feared a post-vaccination flare of their disease (p <0.001). Half of the unvaccinated respondents declared that they would consider changing their decision. Vaccination coverage in immunodeficient patients was higher than in the general Polish population. However, the hesitant patients doubted the vaccine’s safety, feared a post-vaccination disease flare, and had primary or vocational education. Therefore, vaccination promotion activities should stress personal safety and the low risk of disease flares due to vaccination. Furthermore, all evidence must be communicated in patient-friendly terms.
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Affiliation(s)
- Ewa Więsik-Szewczyk
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland
- *Correspondence: Ewa Więsik-Szewczyk,
| | - Marcin Ziętkiewicz
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, Gdansk, Poland
| | - Agata Będzichowska
- Department of Pediatrics, Pediatric Nephrology and Allergology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland
| | - Katarzyna Napiórkowska-Baran
- Department of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | | | - Anna Felis-Giemza
- Biologic Therapy Center, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Karina Jahnz-Różyk
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland
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19
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Fuller A, Hancox J, Vedhara K, Card T, Mallen C, Van-Tam JSN, Abhishek A. Barriers and facilitators to vaccination uptake against COVID-19, influenza, and pneumococcal pneumonia in immunosuppressed adults with immune-mediated inflammatory diseases: A qualitative interview study during the COVID-19 pandemic. PLoS One 2022; 17:e0267769. [PMID: 36084032 PMCID: PMC9462800 DOI: 10.1371/journal.pone.0267769] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/12/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
To explore barriers and facilitators to COVID-19, influenza, and pneumococcal vaccine uptake in immunosuppressed adults with immune-mediated inflammatory diseases (IMIDs).
Methods
Recruiting through national patient charities and a local hospital, participants were invited to take part in an in-depth, one-to-one, semi-structured interview with a trained qualitative researcher between November 2021 and January 2022. Data were analysed thematically in NVivo, cross-validated by a second coder and mapped to the SAGE vaccine hesitancy matrix.
Results
Twenty participants (75% female, 20% non-white) were recruited. Barriers and facilitators spanned contextual, individual/group and vaccine/vaccination-specific factors. Key facilitators to all vaccines were higher perceived infection risk and belief that vaccination is beneficial. Key barriers to all vaccines were belief that vaccination could trigger IMID flare, and active IMID. Key facilitators specific to COVID-19 vaccines included media focus, high incidence, mass-vaccination programme with visible impact, social responsibility, and healthcare professionals’ (HCP) confirmation of the new vaccines’ suitability for their IMID. Novel vaccine technology was a concern, not a barrier. Key facilitators of influenza/pneumococcal vaccines were awareness of eligibility, direct invitation, and, clear recommendation from trusted HCP. Key barriers of influenza/pneumococcal vaccines were unaware of eligibility, no direct invitation or recommendation from HCP, low perceived infection risk, and no perceived benefit from vaccination.
Conclusions
Numerous barriers and facilitators to vaccination, varying by vaccine-type, exist for immunosuppressed-IMID patients. Addressing vaccine benefits and safety for IMID-patients in clinical practice, direct invitation, and public-health messaging highlighting immunosuppression as key vaccination-eligibility criteria may optimise uptake, although further research should assess this.
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Affiliation(s)
- Amy Fuller
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
| | - Jennie Hancox
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kavita Vedhara
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Tim Card
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Jonathan S. Nguyen Van-Tam
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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20
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DiIorio M, Kennedy K, Liew JW, Putman MS, Sirotich E, Sattui SE, Foster G, Harrison C, Larché MJ, Levine M, Moni TT, Thabane L, Bhana S, Costello W, Grainger R, Machado PM, Robinson PC, Sufka P, Wallace ZS, Yazdany J, Gore-Massy M, Howard RA, Kodhek MA, Lalonde N, Tomasella LA, Wallace J, Akpabio A, Alpízar-Rodríguez D, Beesley RP, Berenbaum F, Bulina I, Chock EY, Conway R, Duarte-García A, Duff E, Gheita TA, Graef ER, Hsieh E, El Kibbi L, Liew DF, Lo C, Nudel M, Singh AD, Singh JA, Singh N, Ugarte-Gil MF, Hausmann JS, Simard JF, Sparks JA. Prolonged COVID-19 symptom duration in people with systemic autoimmune rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. RMD Open 2022; 8:e002587. [PMID: 36104117 PMCID: PMC9475962 DOI: 10.1136/rmdopen-2022-002587] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/26/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE We investigated prolonged COVID-19 symptom duration, defined as lasting 28 days or longer, among people with systemic autoimmune rheumatic diseases (SARDs). METHODS We analysed data from the COVID-19 Global Rheumatology Alliance Vaccine Survey (2 April 2021-15 October 2021) to identify people with SARDs reporting test-confirmed COVID-19. Participants reported COVID-19 severity and symptom duration, sociodemographics and clinical characteristics. We reported the proportion experiencing prolonged symptom duration and investigated associations with baseline characteristics using logistic regression. RESULTS We identified 441 respondents with SARDs and COVID-19 (mean age 48.2 years, 83.7% female, 39.5% rheumatoid arthritis). The median COVID-19 symptom duration was 15 days (IQR 7, 25). Overall, 107 (24.2%) respondents had prolonged symptom duration (≥28 days); 42/429 (9.8%) reported symptoms lasting ≥90 days. Factors associated with higher odds of prolonged symptom duration included: hospitalisation for COVID-19 vs not hospitalised and mild acute symptoms (age-adjusted OR (aOR) 6.49, 95% CI 3.03 to 14.1), comorbidity count (aOR 1.11 per comorbidity, 95% CI 1.02 to 1.21) and osteoarthritis (aOR 2.11, 95% CI 1.01 to 4.27). COVID-19 onset in 2021 vs June 2020 or earlier was associated with lower odds of prolonged symptom duration (aOR 0.42, 95% CI 0.21 to 0.81). CONCLUSION Most people with SARDs had complete symptom resolution by day 15 after COVID-19 onset. However, about 1 in 4 experienced COVID-19 symptom duration 28 days or longer; 1 in 10 experienced symptoms 90 days or longer. Future studies are needed to investigate the possible relationships between immunomodulating medications, SARD type/flare, vaccine doses and novel viral variants with prolonged COVID-19 symptoms and other postacute sequelae of COVID-19 among people with SARDs.
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Affiliation(s)
- Michael DiIorio
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin Kennedy
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jean W Liew
- Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael S Putman
- Division of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Emily Sirotich
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sebastian E Sattui
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gary Foster
- Department of Health Research Methods, Evidence and Impact (HEI); Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Maggie J Larché
- Divisions of Clinical Immunology and Allergy/Rheumatology, McMaster University Department of Medicine, Hamilton, Ontario, Canada
| | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Tarin T Moni
- Department of Biochemistry & Biomedical Sciences, McMaster University Faculty of Science, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Suleman Bhana
- Rheumatology, Crystal Run Healthcare, Middletown, New York, USA
| | - Wendy Costello
- N/A, Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, University College London, London, UK
- Rheumatology, University College London Centre for Rheumatology, London, UK
| | - Philip C Robinson
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Metro North Hospital & Health Service, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
| | - Paul Sufka
- Rheumatology, HealthPartners, St Paul, Minnesota, USA
| | - Zachary S Wallace
- Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jinoos Yazdany
- Medicine/Rheumatology, University of California, San Francisco, California, USA
| | | | | | | | - Nadine Lalonde
- Patient Board, Covid-19 Global Rheumatology Alliance, London, Ontario, Canada
| | | | - John Wallace
- Rheumatology, Autoinflammatory UK, Edinburgh, UK
| | - Akpabio Akpabio
- Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | | | - Richard P Beesley
- Juvenile Arthritis Research, European Network for Childhood Arthritis (ENCA), Tonbridge, UK
| | | | - Inita Bulina
- Rheumatology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Eugenia Yupei Chock
- Section of Rheumatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Richard Conway
- Department of Rheumatology, Saint James's Hospital, Dublin, Ireland
| | | | - Eimear Duff
- Rheumatology, Saint James's Hospital, Dublin, Ireland
| | - Tamer A Gheita
- Rheumatology and Clinical Immunology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Elizabeth R Graef
- Rheumatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Evelyn Hsieh
- Division of Rheumatology, Yale School of Medicine, New Haven, Connecticut, USA
- Rheumatology, VA Connecticut Healthcare System-West Haven Campus, West Haven, Connecticut, USA
| | - Lina El Kibbi
- Internal Medicine Department, Division of Rheumatology, Specialized Medical Center Hospital, Riyadh, Saudi Arabia
| | - David Fl Liew
- Rheumatology, Austin Health, Heidelberg West, Victoria, Australia
- Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia
| | - Chieh Lo
- Rheumatology, I-Shou University College of Medicine, Yanchau Sheng, Taiwan
| | - Michal Nudel
- N/A, The Israeli Association for RMDs patients "Mifrakim Tz'eirim", Haifa, Israel
| | - Aman Dev Singh
- Department of Community Medicine, Government Medical College Amritsar, Amritsar, Punjab, India
- Rajindra Hospital Patiala, Patiala, Punjab, India
| | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Namrata Singh
- Medicine, Division of Rheumatology, University of Washington, Seattle, Washington, USA
| | - Manuel F Ugarte-Gil
- School of Medicine, Universidad Cientifica del Sur, Lima, Peru
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Jonathan S Hausmann
- Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Julia F Simard
- Epidemiology and Population Health and Department of Medicine, Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Department of Medicine, Clinical Epidemiology Unit, Sweden
| | - Jeffrey A Sparks
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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21
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Beckley M, Olson AK, Portman MA. Tolerability of COVID-19 Infection and Messenger RNA Vaccination Among Patients With a History of Kawasaki Disease. JAMA Netw Open 2022; 5:e2226236. [PMID: 35960521 PMCID: PMC9375169 DOI: 10.1001/jamanetworkopen.2022.26236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Kawasaki disease (KD) symptoms significantly overlap with multisystem inflammatory syndrome in children due to COVID-19. Patients with KD may be at risk for adverse outcomes from exposure to SARS-CoV-2 infection or vaccination. OBJECTIVE To describe the outcomes of patients with KD to SARS-CoV-2 infection or vaccination. DESIGN, SETTING, AND PARTICIPANTS This case series evaluated 2 cohorts using an existing KD database and reviewed individual electronic medical records for the period spanning January 1, 2020, through January 31, 2022, via electronic medical records that include Washington state immunization records. Vaccine cohort inclusion criteria consisted of being 21 years or younger at immunization and receiving 1 or more BNT162b2 (Pfizer-BioNTech) or messenger RNA (mRNA)-1273 (Moderna) vaccine doses. The COVID-19 cohort included patients 21 years or younger with positive polymerase chain reaction or nuclear capsid IgG findings for SARS-CoV-2. Participants included 826 patients from a preexisting KD database. One hundred fifty-three patients received at least 1 BNT162b2 or mRNA-1273 vaccine dose and were included in the mRNA vaccine cohort. Thirty-seven patients had positive test results for SARS-CoV-2 and were included in the COVID-19 cohort. EXPOSURES SARS-CoV-2 vaccination and/or infection. MAIN OUTCOMES AND MEASURES Adverse events after mRNA vaccination and/or COVID-19, including clinician visits, emergency department encounters, or hospitalizations. RESULTS Among the 153 patients included in the mRNA vaccination cohort (mean [SD] age, 13.0 [4.3] years; 94 male [61.4%]), the BNT162b2 vaccine was provided for 143 (93.5%), and the remaining 10 (6.5%) received mRNA-1273 or a combination of both. Among patients in the vaccine cohort, 129 (84.3%) were fully vaccinated or received a third-dose booster. No clinically severe adverse events occurred, and there were no reports of vaccine-related hospitalizations or outpatient visits. The COVID-19 cohort included 37 patients (mean [SD] age, 11.0 [5.5] years; 22 male [59.5%]). No patients required hospitalization due to COVID-19. The most common symptoms included low-grade fever, fatigue, cough, and myalgia with resolution within a few days. Two patients, aged 9 and 19 years, had extended cough and fatigue for 3 to 4 weeks. One patient developed COVID-19 within 6 weeks of receiving intravenous immunoglobulin for KD. CONCLUSIONS AND RELEVANCE These findings suggest that the mRNA vaccines may be safe and COVID-19 may not be severe for patients with a history of KD.
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Affiliation(s)
| | - Aaron K. Olson
- Seattle Children’s Research Institute, Seattle, Washington
- Division of Cardiology, Department of Pediatrics, University of Washington, Seattle
| | - Michael A. Portman
- Seattle Children’s Research Institute, Seattle, Washington
- Division of Cardiology, Department of Pediatrics, University of Washington, Seattle
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22
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Paik JJ, Sparks JA, Kim AHJ. Immunogenicity, breakthrough infection, and underlying disease flare after SARS-CoV-2 vaccination among individuals with systemic autoimmune rheumatic diseases. Curr Opin Pharmacol 2022; 65:102243. [PMID: 35636384 PMCID: PMC9058024 DOI: 10.1016/j.coph.2022.102243] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/20/2022] [Indexed: 12/18/2022]
Abstract
Many patients with systemic autoimmune rheumatic diseases (SARDs) require immunosuppression to reduce disease activity, but this also has important possible detrimental impacts on immune responses following vaccination. The phase III clinical trials for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines did not include those who are immunosuppressed. Fortunately, we now have a clearer idea of how immune responses following SARS-CoV-2 vaccination has for the immunosuppressed, with much of the data being within a year of its introduction. Here, we summarize what is known in this rapidly evolving field about the impact immunosuppression has on humoral immunogenicity including waning immunity and additional doses, breakthrough infection rates and severity, disease flare rates, along with additional considerations and remaining unanswered questions.
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Affiliation(s)
- Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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23
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Thorakkattil SA, Abdulsalim S, Karattuthodi MS, Unnikrishnan MK, Rashid M, Thunga G. COVID-19 Vaccine Hesitancy: The Perils of Peddling Science by Social Media and the Lay Press. Vaccines (Basel) 2022; 10:vaccines10071059. [PMID: 35891223 PMCID: PMC9316152 DOI: 10.3390/vaccines10071059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Vaccines are the best tools to end the pandemic, and their public acceptance is crucial in achieving herd immunity. Despite global efforts to increase access to vaccination, the World Health Organization explicitly lists vaccination hesitancy (VH) as a significant threat. Despite robust safety reports from regulatory authorities and public health advisories, a substantial proportion of the community remains obsessed with the hazards of vaccination. This calls for identifying and eliminating possible causative elements, among which this study investigates the inappropriate dissemination of medical literature concerning COVID-19 and adverse events following immunization (AEFI), its influence on promoting VH, and proposals for overcoming this problem in the future. Methods: We searched PubMed, Embase, and Scopus databases, using the keywords “adverse events following immunization (AEFI)”, “COVID-19”, “vaccines” and “hesitancy” and related medical and subjective headings (MeSH) up to 31 March 2022, and extracted studies relevant to the COVID-19 AEFI and associated VH. Finally, 47 articles were chosen to generate a narrative synthesis. Results: The databases depicted a steep rise in publications on COVID-19 AEFI and COVID-19 VH from January 2021 onwards. The articles depicted multiple events of mild AEFIs without fatal events in recipients. While documenting AEFIs is praiseworthy, publishing such reports without prior expert surveillance can exaggerate public apprehension and inappropriately fuel VH. VH is a deep-rooted phenomenon, but it is difficult to zero in on the exact reason for it. Spreading rumors/misinformation on COVID-19 vaccines might be an important provocation for VH, which includes indiscriminately reporting AEFI on a massive scale. While a number of reported AEFIs fall within the acceptable limits in the course of extensive COVID-19 vaccinations, it is important to critically evaluate and moderate the reporting and dissemination of AEFI in order to allay panic. Conclusions: Vaccination programs are necessary to end any pandemic, and VH may be attributed to multiple reasons. VH may be assuaged by initiating educational programs on the importance of vaccination, raising public awareness and monitoring the inappropriate dissemination of misleading information. Government-initiated strategies can potentially restrict random AEFI reports from lay epidemiologists and healthcare practitioners.
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Affiliation(s)
- Shabeer Ali Thorakkattil
- Pharmacy Services Department, Johns Hopkins Aramco Healthcare (JHAH), Dhahran 34465, Saudi Arabia;
| | - Suhaj Abdulsalim
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia
- Correspondence: ; Tel.: +966-550-892-550
| | - Mohammed Salim Karattuthodi
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal 576104, India; (M.S.K.); (M.R.); (G.T.)
| | | | - Muhammed Rashid
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal 576104, India; (M.S.K.); (M.R.); (G.T.)
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal 576104, India; (M.S.K.); (M.R.); (G.T.)
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24
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Cooksey R, Underwood J, Brophy S, Atkinson M, Kennedy J, Choy E. Shielding reduced incidence of COVID-19 in patients with inflammatory arthritis but vulnerability is associated with increased mortality. Rheumatology (Oxford) 2022; 61:SI120-SI128. [PMID: 35567479 PMCID: PMC9248059 DOI: 10.1093/rheumatology/keac283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Investigate whether individuals with inflammatory arthritis (IA), their treatments and shielding status affect the risk of adverse outcomes from COVID-19 for the entire population of Wales, UK. METHODS Retrospective, population-based cohort study using linked, anonymized electronic health data from SAIL Databank, including primary/secondary care, rheumatology, Office for National Statistics Mortality and COVID-19 laboratory data. Individuals aged 18 years and over testing positive for COVID-19 between March 2020 and May 2021 with READ Codes present for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis formed the study cases. RESULTS A total of 1966 people with IA and 166 602 without tested positive for COVID-19. The incidence rate was 3.5% (1966/56 914) in IA, vs 6% in the general population (166 602/2 760 442), (difference: 2.5%, 95% CI: 2.4%, 2.7%, P ≤0.001). In an adjusted Cox proportional hazard model, IA was not associated with higher mortality (HR: 0.56, 95% CI: 0.18, 1.64, P=0.286). Significant risk factors included shielding (HR: 1.52, 95% CI: 1.40, 1.64, P ≤0.001), hospitalization for previous infections (HR: 1.20, 95% CI: 1.12, 1.28, P ≤0.001), hospitalizations one year pre-pandemic (HR: 1.34, 95% CI: 1.25, 1.44, P ≤0.001) and glucocorticoid use (HR: 1.17, 95% CI: 1.09, 1.25, P ≤0.001). CONCLUSIONS Individuals with IA had a lower incidence of COVID-19, probably due to shielding. IA was not associated with increased mortality following COVID-19 infection; being vulnerable (shielded), comorbidities and other factors were associated with increased risk. These key risk factors can identify individuals with IA at greater risk from COVID-19 and advised to shield during high community prevalence.
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Affiliation(s)
- Roxanne Cooksey
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff
- National Centre for Population Health and Wellbeing Research
| | - Jonathan Underwood
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff
- School of Medicine, Heath Park Campus, Cardiff
| | - Sinead Brophy
- School of Medicine, Heath Park Campus, Cardiff
- Health Data Research UK, Data Science Building, Swansea University Medical School, Swansea, UK
| | - Mark Atkinson
- School of Medicine, Heath Park Campus, Cardiff
- Health Data Research UK, Data Science Building, Swansea University Medical School, Swansea, UK
| | - Jonathan Kennedy
- School of Medicine, Heath Park Campus, Cardiff
- Health Data Research UK, Data Science Building, Swansea University Medical School, Swansea, UK
| | - Ernest Choy
- CREATE Centre, Section of Rheumatology, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff
- National Centre for Population Health and Wellbeing Research
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25
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Sparks JA, Singh N, Wallace ZS. Effectiveness of COVID-19 vaccination in immune-mediated inflammatory diseases. THE LANCET. RHEUMATOLOGY 2022; 4:e380-e382. [PMID: 35441152 PMCID: PMC9009834 DOI: 10.1016/s2665-9913(22)00109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Namrata Singh
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | - Zachary S Wallace
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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26
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Abutiban F, Saleh K, Hayat S, Tarakmah H, Al-Herz A, Ghanem A. COVID-19 outcomes among rheumatic disease patients in Kuwait: Data from the COVID-19 Global Rheumatology Alliance (C19-GRA) physician registry. Int J Rheum Dis 2022; 25:743-754. [PMID: 35543332 PMCID: PMC9347605 DOI: 10.1111/1756-185x.14332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/10/2022] [Accepted: 04/24/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE We aimed to assess the characteristics of inflammatory rheumatic disease (IRD) patients in Kuwait diagnosed with COVID-19 and the factors linked with hospitalization, complications, and mortality. METHODS Data of IRD patients from Kuwait diagnosed with COVID-19 between March 2020 and March 2021, submitted to the COVID-19 Global Rheumatology Alliance physician-reported registry, were included in our analysis. Data on patients' age, gender, smoking, diagnosis, IRD activity, and other comorbidities were collected. Statistical Package for the Social Sciences (SPSS), version 25, was used for statistical analysis. RESULTS A total of 52 patients were included, with a mean age of 55 years (±14). The majority of patients were ≤65 years (77%), female (77%), non-smokers (80.8%), and diagnosed with rheumatoid arthritis (67.0%). Of the included patients, 19.2%, 9.6%, and 7.7% reported having methotrexate monotherapy, antimalarials monotherapy, and interleukin-6 inhibitors monotherapy immediately before COVID-19, respectively. Most of the included patients (92.3%) were either in remission or had minimal/low disease activity, while others (7.7%) had moderate disease activity. Forty-three patients (82.7%) were hospitalized, while 11 patients (25.6%) required ventilation (invasive or non-invasive). Ten of the ventilated patients (90.9%) received glucocorticoids as part of the local protocol to treat severe COVID symptoms, and 4 patients (7.69%) died. The duration till symptom-free ranged between 0 to 30 days, with a mean value of 10 days (±6.5). CONCLUSION The current study provides timely real-world evidence regarding characteristics and potential risk factors linked to poor COVID-19-related outcomes in the IRD population in Kuwait.
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Affiliation(s)
- Fatemah Abutiban
- Department of Medicine, Jaber Alahmed Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Khulood Saleh
- Department of Medicine, Farwaniyah Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Sawsan Hayat
- Department of Medicine, Mubarak Alkabeer Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Hoda Tarakmah
- Department of Medicine, Mubarak Alkabeer Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Adeeba Al-Herz
- Department of Medicine, AlAmiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Aqeel Ghanem
- Department of Medicine, Mubarak Alkabeer Hospital, Ministry of Health, Kuwait City, Kuwait
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27
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Rider LG, Parks CG, Wilkerson J, Schiffenbauer AI, Kwok RK, Noroozi Farhadi P, Nazir S, Ritter R, Sirotich E, Kennedy K, Larche MJ, Levine M, Sattui SE, Liew JW, Harrison CO, Moni TT, Miller AK, Putman M, Hausmann J, Simard JF, Sparks JA, Miller FW. Baseline Factors Associated with Self-reported Disease Flares Following COVID-19 Vaccination among Adults with Systemic Rheumatic Disease: Results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. Rheumatology (Oxford) 2022; 61:SI143-SI150. [PMID: 35460240 DOI: 10.1093/rheumatology/keac249] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/30/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine the frequency of, and risk factors for, disease flare following COVID-19 vaccination in patients with systemic rheumatic disease (SRD). METHODS An international study was conducted from April 2 to August 16, 2021, using an online survey of 5619 adults with SRD for adverse events following COVID-19 vaccination, including flares of disease requiring a change in treatment. We examined risk factors identified a priori based on published associations with SRD activity and SARS-CoV-2 severity, including demographics, SRD type, comorbidities, vaccine type, cessation of immunosuppressive medications around vaccination, and history of reactions to non-COVID-19 vaccines, using multivariable logistic regression. RESULTS Flares requiring a change in treatment following COVID-19 vaccination were reported by 4.9% of patients. Compared with rheumatoid arthritis, certain SRD, including systemic lupus erythematosus (OR 1.51, 95%CI 1.03, 2.20), psoriatic arthritis (OR 1.95, 95%CI 1.20, 3.18), and polymyalgia rheumatica (OR 1.94, 95%CI 1.08, 2.48) were associated with higher odds of flare, while idiopathic inflammatory myopathies were associated with lower odds for flare (OR 0.54, 95%CI 0.31-0.96). The Oxford-AstraZeneca vaccine was associated with higher odds of flare relative to the Pfizer-BioNTech vaccine (OR 1.44, 95%CI 1.07, 1.95), as were a prior reaction to a non-COVID-19 vaccine (OR 2.50, 95%CI 1.76, 3.54) and female sex (OR 2.71, 95%CI 1.55, 4.72). CONCLUSION SRD flares requiring changes in treatment following COVID-19 vaccination were uncommon in this large international study. Several potential risk factors, as well as differences by disease type, warrant further examination in prospective cohorts.
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Affiliation(s)
- Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS, National Institutes of Health (NIH), Bethesda, MD, USA)
| | | | | | - Adam I Schiffenbauer
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS, National Institutes of Health (NIH), Bethesda, MD, USA)
| | - Richard K Kwok
- Office of the Director, NIEHS, NIH, Research Triangle Park, NC, USA
| | - Payam Noroozi Farhadi
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS, National Institutes of Health (NIH), Bethesda, MD, USA)
| | - Sarvar Nazir
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS, National Institutes of Health (NIH), Bethesda, MD, USA)
| | | | | | - Kevin Kennedy
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | | | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Sebastian E Sattui
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jean W Liew
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | | | - Tarin T Moni
- Department of Biochemistry and Biomedical Sciences, McMaster University Faculty of Science, Hamilton, ON, Canada
| | - Aubrey K Miller
- Office of the Director, NIEHS, NIH, Research Triangle Park, NC, USA
| | | | - Jonathan Hausmann
- Program in Rheumatology, Boston Children's Hospital, Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - Julia F Simard
- Department of Epidemiology and Population Health, and Immunology and Rheumatology (Department of Medicine), Stanford University School of Medicine, USA
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS, National Institutes of Health (NIH), Bethesda, MD, USA)
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Topless RK, Gaffo A, Stamp LK, Robinson PC, Dalbeth N, Merriman TR. Gout and the risk of COVID-19 diagnosis and death in the UK Biobank: a population-based study. THE LANCET. RHEUMATOLOGY 2022; 4:e274-e281. [PMID: 35128470 PMCID: PMC8798088 DOI: 10.1016/s2665-9913(21)00401-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is a paucity of data on outcomes for people with gout and COVID-19. We aimed to assess whether gout is a risk factor for diagnosis of COVID-19 and COVID-19-related death, and to test for sex- and drug-specific differences in risk. METHODS We used data from the UK Biobank, which included 15 871 people with gout. We used multivariable-adjusted logistic regression in the following analyses using a case-control study design: to test for an association between gout and COVID-19 diagnosis in the entire UK Biobank cohort (n=459 837); to test for an association between gout and COVID-19-related death in people who were known to have died or survived with COVID-19 (n=15 772); to test for an association between gout and COVID-19-related death in the entire UK Biobank cohort (n=459 837); and to assess risk of COVID-19-related death in a subset of patients from the UK Biobank cohort with prescription data, stratified by prescription of urate-lowering therapy and colchicine (n=341 398). Models 1 and 2 were adjusted for age group, sex, ethnicity, Townsend deprivation index, BMI, and smoking status. Model 2 was also adjusted for diagnosis of 16 other diseases that are established comorbidities of gout or established risk factors for COVID-19-related death. FINDINGS Gout was associated with diagnosis of COVID-19 (odds ratio [OR] 1·20, 95% CI 1·11-1·29) but not with risk of COVID-19-related death in the cohort of patients diagnosed with COVID-19 (1·20, 0·96-1·51). In the entire cohort, gout was associated with COVID-19-related death (1·29, 1·06-1·56); women with gout had an increased risk of COVID-19-related death (1·98, 1·34-2·94), whereas men with gout did not (1·16, 0·93-1·45). We found no significant differences in the risk of COVID-19-related death according to prescription of urate-lowering therapy or colchicine. When patients with gout were stratified by vaccination status, the risk of diagnosis with COVID-19 was significant in the non-vaccinated group (1·21, 1·11-1·30) but not the vaccinated group (1·09, 0·65-1·85). INTERPRETATION Gout is a risk factor for COVID-19-related death in the UK Biobank cohort, with an increased risk in women with gout, which was driven by risk factors independent of the metabolic comorbidities of gout. FUNDING Health Research Council of New Zealand.
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Affiliation(s)
- Ruth K Topless
- Biochemistry Department, University of Otago, Dunedin, New Zealand
| | - Angelo Gaffo
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham Veteran Affairs Medical Center, Birmingham, AL, USA
| | - Lisa K Stamp
- University of Otago Christchurch, Christchurch, New Zealand
| | | | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tony R Merriman
- Biochemistry Department, University of Otago, Dunedin, New Zealand
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
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