SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: results from the COVID-19 Global Rheumatology Alliance provider registry

OBJECTIVE: While COVID-19 vaccination prevents severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analysed the clinical characteristics of patients with rheumatic disease who developed breakthrough COVID-19 after vaccination against SARS-CoV-2. METHODS: We included people partially or fully vaccinated against SARS-CoV-2 who developed COVID-19 between 5 January and 30 September 2021 and were reported to the Global Rheumatology Alliance registry. Breakthrough infections were defined as occurring ≥14 days after completion of the vaccination series, specifically 14 days after the second dose in a two-dose series or 14 days after a single-dose vaccine. We analysed patients' demographic and clinical characteristics and COVID-19 symptoms and outcomes. RESULTS: SARS-CoV-2 infection was reported in 197 partially or fully vaccinated people with rheumatic disease (mean age 54 years, 77% female, 56% white). The majority (n=140/197, 71%) received messenger RNA vaccines. Among the fully vaccinated (n=87), infection occurred a mean of 112 (±60) days after the second vaccine dose. Among those fully vaccinated and hospitalised (n=22, age range 36-83 years), nine had used B cell-depleting therapy (BCDT), with six as monotherapy, at the time of vaccination. Three were on mycophenolate. The majority (n=14/22, 64%) were not taking systemic glucocorticoids. Eight patients had pre-existing lung disease and five patients died. CONCLUSION: More than half of fully vaccinated individuals with breakthrough infections requiring hospitalisation were on BCDT or mycophenolate. Further risk mitigation strategies are likely needed to protect this selected high-risk population.

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UNC Libraries
Published
2025-04-16
DOI
https://doi.org/10.17615/kx7z-4p28
Primary Topic
SARS-CoV-2 and COVID-19 Research
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article
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article

SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: results from the COVID-19 Global Rheumatology Alliance provider registry

Loreto Carmona, Jonathan S. Hausmann, G. K. Yardimci, Inita Buliņa et al.
UNC Libraries
SARS-CoV-2 and COVID-19 Research
article

SARS-CoV-2 breakthrough infections among vaccinated individuals with rheumatic disease: results from the COVID-19 Global Rheumatology Alliance provider registry

Loreto Carmona, Jonathan S. Hausmann, G. K. Yardimci, Inita Buliņa, Philip C. Robinson, Jūlija Zepa, Zachary S. Wallace, Ellison Smith, Frances Stafford, Emily Kowalski, Saskia Lawson‐Tovey, Jeffrey A. Sparks, Anja Strangfeld, Greta Reyes-Cordero, Jinoos Yazdany, Naomi J. Patel, Abdurrahman Tufan, Leanna Wise, Genevieve Katigbak, Kimme L Hyrich, Fatemah Abutiban, Milena Gianfrancesco, Emily Sirotich, Suleman Bhana, Rebecca Grainger, Christine Graver, Zara Izadi, David Liew, Lauren Kaufman, Elsa F Mateus, Dfiza Dey, Pedro Machado, Martin Schäfer, Carly Harrison, Evelyn O. Salido, Marco Ulises Martínez‐Martínez, Laure Gossec, Paul Sufka, Samar Al Emadi, Monique Gore‐Massy, David Snow, Stephanie Rush, Claire Cook, Clairissa Ja, Lindsay Jacobsohn
article en

Abstract

OBJECTIVE: While COVID-19 vaccination prevents severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analysed the clinical characteristics of patients with rheumatic disease who developed breakthrough COVID-19 after vaccination against SARS-CoV-2. METHODS: We included people partially or fully vaccinated against SARS-CoV-2 who developed COVID-19 between 5 January and 30 September 2021 and were reported to the Global Rheumatology Alliance registry. Breakthrough infections were defined as occurring ≥14 days after completion of the vaccination series, specifically 14 days after the second dose in a two-dose series or 14 days after a single-dose vaccine. We analysed patients' demographic and clinical characteristics and COVID-19 symptoms and outcomes. RESULTS: SARS-CoV-2 infection was reported in 197 partially or fully vaccinated people with rheumatic disease (mean age 54 years, 77% female, 56% white). The majority (n=140/197, 71%) received messenger RNA vaccines. Among the fully vaccinated (n=87), infection occurred a mean of 112 (±60) days after the second vaccine dose. Among those fully vaccinated and hospitalised (n=22, age range 36-83 years), nine had used B cell-depleting therapy (BCDT), with six as monotherapy, at the time of vaccination. Three were on mycophenolate. The majority (n=14/22, 64%) were not taking systemic glucocorticoids. Eight patients had pre-existing lung disease and five patients died. CONCLUSION: More than half of fully vaccinated individuals with breakthrough infections requiring hospitalisation were on BCDT or mycophenolate. Further risk mitigation strategies are likely needed to protect this selected high-risk population.

UNC Libraries
University of North Carolina at Chapel Hill (US)
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SARS-CoV-2 and COVID-19 Research
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