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16-09-2021 | COVID-19 | News

Low rates of breakthrough SARS-CoV-2 infection after vaccination in people with RMDs

Author: Claire Barnard


medwireNews: Preliminary findings from two studies point to low overall rates of breakthrough COVID-19 following vaccination in people with rheumatic and musculoskeletal diseases (RMDs).

In the first study, Pedro Machado (University College London, UK) and team used EULAR’s COVID-19 and COVAX registries to evaluate the characteristics of 38 people with RMDs who developed COVID-19 at least 14 days after partial (n=28) or full (n=10) vaccination.

These individuals with breakthrough infections represented less than 1% of the 9118 patients with SARS-CoV-2 infection in the COVID-19 registry, and less than 1% of the 4393 vaccinated individuals from the COVAX registry, say the researchers.

They report that the majority (74%) of people with breakthrough infections fully recovered, whereas 8% had ongoing sequelae at the time of reporting and 8% died.

Machado and team caution that the study was insufficiently powered to evaluate associations between patient-specific factors and infection rates, or to calculate vaccine failure rates. Nevertheless, they say that “the low numbers of SARS-CoV-2 infection post-vaccination in both registries are encouraging.”

The second study was conducted in the USA, and involved a cohort of 340 patients with RMDs from the Mass General Brigham healthcare system who developed COVID-19 after the initial FDA authorization for vaccine use. Of these, 4.7% had breakthrough infections, defined as a positive SARS-CoV-2 test at least 14 days after the final vaccine dose.

Zachary Wallace (Massachusetts General Hospital, Boston) and team report that 93% of the 16 breakthrough infections were symptomatic; six patients required hospitalization, during which four were given supplemental oxygen and one mechanical ventilation.

The researchers note that DMARDs used prior to hospitalization included rituximab in four patients and mycophenolate mofetil or mycophenolic acid in two. Two patients died, both of whom had interstitial lung disease and had received rituximab treatment.

These findings show that “a small portion of COVID-19 cases among patients with [RMDs] in a large US healthcare system occurred among fully vaccinated patients,” write Wallace and team.

They conclude: “In light of our findings, additional studies are urgently needed to estimate the risk of breakthrough infections among patients with [RMDs] and to evaluate the efficacy of booster vaccines and other strategies for DMARD users with poor immunological response to COVID-19 vaccination.”

Both studies are published as letters to the Annals of the Rheumatic Diseases.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

16 September 2021: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Ann Rheum Dis 2021; doi:10.1136/annrheumdis-2021-221217
Ann Rheum Dis 2021; doi:10.1136/annrheumdis-2021-221326