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COVID-19 Vaccines in the Context of Patients with Autoimmune Inflammatory Diseases

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A special issue of Vaccines (ISSN 2076-393X). This special issue belongs to the section "COVID-19 Vaccines and Vaccination".

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 33231

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Dr. Karen Schreiber

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Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark Institute for Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
Interests: autoimmune inflammatory rheumatic diseases (AIRDs); women’s health in patients with AIRDs; inflammation and hyperinflammation; COVID-19 vaccines

Prof. Dr. Oliver Hendricks

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Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark Institute for Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
Interests: autoimmune inflammatory rheumatic diseases; COVID-19 vaccines; inflammation and hyperinflammation

Prof. Dr. Mathias W. Pletz

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Guest Editor

Institute for Infectious Diseases and Infection Control, Jena University Hospital / Friedrich-Schiller-University, Am Klinikum 1, 07747 Jena, Germany
Interests: pneumonia; sepsis; vaccines; antibiotic resistance
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Special Issue Information

Dear Colleagues,

The COVID-19 pandemic, at this stage, has almost resulted in 4 million deaths globally.

A growing body evidence is emerging on the epidemiology and pathophysiology of COVID-19. There has been a considerable amount of concern amongst physicians and scientists about patients with underlying autoimmune inflammatory diseases in relation to whether this particular patient group is more susceptible to becoming infected with COVID-19; whether they have more severe COVID-19-related disease morbidity and mortality; whether the currently available vaccinations against COVID-19 are efficient.

This Special Issue will focus on COVID-19 vaccines in the context of patients with autoimmune inflammatory diseases in a broad context.

Dr. Karen Schreiber
Prof. Dr. Oliver Hendricks
Prof. Dr. Mathias Pletz
Guest Editors

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Keywords

COVID-19 vaccines
autoimmune diseases
immunosuppression

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Published Papers (10 papers)

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Research

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9 pages, 254 KiB

Open AccessArticle

Effects of Different Biological Therapies on S1/S2 Antibody Response to SARS-CoV-2 Vaccination in a Cohort of Patients with Inflammatory Bowel Disease

by Nunzia Labarile, Fabio Castellana, Annamaria Sila, Pasqua Letizia Pesole, Sergio Coletta, Margherita Curlo, Rodolfo Sardone, Gianluigi Giannelli and Mauro Mastronardi

Vaccines 2022, 10(7), 1077; https://doi.org/10.3390/vaccines10071077 - 4 Jul 2022

Cited by 1 | Viewed by 1565

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected the entire planet. The objectives of our study were to compare responses to the vaccine (Pfizer-Biontech COMIRNATY) in a population of patients with intestinal bowel syndrome undergoing different biological therapies or conventional therapy. The study recruited 390 patients who received the first vaccination dose during the dedicated vaccination campaign for inflammatory bowel disease (IBD) patients. The inclusion criteria were a diagnosis of CD or UC and complete vaccination with the Pfizer–BioNTech COVID-19 (Comirnaty) vaccine. The exclusion criteria were other significant diseases or important therapies under way or contraindications to vaccination according to the European drug surveillance recommendations. Linear rank models were run to assess the association between the different therapies and S1/S2 antibodies at three different times. The models showed that in patients with IBD receiving Vedolizumab a significant increase in mean IgG levels was observed, independently of other therapies and confounding factors (β: 57.45, 95% CI 19.62 to 19.00). This study confirmed the complete antibody response to vaccination against COVID-19 in patients with IBD undergoing biological therapy—particularly Vedolizumab treatment—but also a reduced immune response due to concomitant steroid therapy. Full article

(This article belongs to the Special Issue COVID-19 Vaccines in the Context of Patients with Autoimmune Inflammatory Diseases)

13 pages, 271 KiB

Open AccessArticle

Experiences during the COVID-19 Pandemic among People with Inflammatory Arthritis: “Reopening of Society Is Harder than Lock-Down”—A Qualitative Interview Study

by Lene Dahl Lund, Mette Margrethe Løwe, Oliver Hendricks, Karen Schreiber, Bente Glintborg, Randi Petersen, Christiane Plischke, Willy Fick and Jette Primdahl

Vaccines 2022, 10(7), 982; https://doi.org/10.3390/vaccines10070982 - 21 Jun 2022

Viewed by 1856

Abstract

People with inflammatory arthritis (IA) treated with immunosuppressive disease-modifying anti-rheumatic drugs (DMARDs) were initially considered to have an increased risk of severe illness from the SARS-CoV-2 virus compared to the general population. The aim of this study was to explore how people with IA experienced restrictions during the pandemic and the possible impact of vaccination on their protection against COVID-19 and their everyday lives. Nineteen people with IA were interviewed in May–August 2021; shortly thereafter they were enrolled in the Danish national COVID-19 vaccination programme. Concurrently, society gradually reopened after a national complete lockdown. The analysis was inspired by inductive qualitative content analysis. Participants expressed a lack of targeted information on the specific risk associated with IA if they contracted COVID-19. They had to define their own level of daily-life restrictions to protect themselves and their families. They were impacted by inconsistent announcements by the authorities, and some expressed concerns regarding the potential influence of DMARDs on vaccine effectiveness. A societal spirit of being “in this together” emerged through the lockdown, and some were concerned that the reduced level of restrictions in the reopened society would put them at higher risk of a COVID-19 infection and force them to continue self-isolating. Full article

(This article belongs to the Special Issue COVID-19 Vaccines in the Context of Patients with Autoimmune Inflammatory Diseases)

6 pages, 751 KiB

Open AccessCommunication

COVID-19 Vaccination Coverage in Patients with Rheumatic Diseases in a German Outpatient Clinic: An Observational Study

by Marco Krasselt, Christoph Baerwald and Olga Seifert

Vaccines 2022, 10(2), 253; https://doi.org/10.3390/vaccines10020253 - 7 Feb 2022

Cited by 8 | Viewed by 1856

Abstract

Background: In the second year of the COVID-19 pandemic, highly effective and safe vaccines became available. Since patients with rheumatic diseases show increased susceptibility to infections and typical medications raise the risk of severe COVID-19, high vaccination coverage is of significant importance to these patients. Methods: Consecutive patients with different rheumatic diseases were asked for their vaccination status regarding COVID-19, influenza and Streptococcus pneumoniae during their routine consultations. Any reported vaccination was validated with their personal vaccination card and/or by reviewing the CovPass smartphone app. Reasons for not having a COVID-19 vaccination were documented. Results: A total of 201 patients (mean age 62.3 ± 14.1 years) were included, the majority of them (44.3%) with rheumatoid arthritis, followed by spondyloarthritis (27.4%) and connective tissue diseases (21.4%). Vaccination coverage for SARS-CoV-2 was 80.1%; 85.6% got at least the first vaccination shot. Both valid influenza and pneumococcus coverage were associated with a higher probability of SARS-CoV-2 vaccination (odds ratio (OR) 6.243, 95% confidence interval (CI) 2.637–14.783, p < 0.0001 and OR 6.372, 95% CI 2.105–19.282, p = 0.0003, respectively). The main reason for a missing SARS-CoV-2 vaccination (70%) was being sceptical about the vaccine itself (i.e., the subjective impression that the vaccine was not properly tested and fear of unwanted side effects). Conclusions: Vaccination coverage against SARS-CoV-2 is high in patients with rheumatic diseases. Nevertheless, there are unmet needs regarding vaccination education to further increase vaccination rates. Full article

(This article belongs to the Special Issue COVID-19 Vaccines in the Context of Patients with Autoimmune Inflammatory Diseases)

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7 pages, 824 KiB

Open AccessCommunication

Reduced Humoral Response of SARS-CoV-2 Antibodies following Vaccination in Patients with Inflammatory Rheumatic Diseases—An Interim Report from a Danish Prospective Cohort Study

by Karen Schreiber, Christine Graversgaard, Randi Petersen, Henning Jakobsen, Anders Bo Bojesen, Niels Steen Krogh, Bente Glintborg, Merete Lund Hetland and Oliver Hendricks

Vaccines 2022, 10(1), 35; https://doi.org/10.3390/vaccines10010035 - 28 Dec 2021

Cited by 7 | Viewed by 2199

Abstract

Background/Purpose: In light of the current COVID-19 pandemic, whether patients with rheumatic musculoskeletal disease (RMD) treated with conventional (cs) or biologic (b) disease-modifying drugs (DMARDs) exhibit an adequate immune response to the currently available SARS-CoV-2 vaccinations remains a major concern. There is an urgent need for more SARS-CoV-2 vaccine efficacy data to inform healthcare providers on the potential need for a booster vaccine. We established the ‘Detection of SARS-CoV-2 antibodies in Danish Inflammatory Rheumatic Outpatients’ study (DECODIR) in March 2021 in order to assess and compare the immunoglobulin G (IgG response) of the SARS-CoV-2 BNT162b2 vaccine (Pfizer, Groton, CT, USA/BioNTech, Mainz, Germany) and mRNA-1273 vaccine (Moderna, Cambridge, MA, USA) administered as part of the national vaccine roll out in patients with RMDs, irrespective of treatment. Patients’ SARS-CoV-2 IgG level was used as proxy to determine vaccination response. Methods: The study is a longitudinal prospective cohort study in which the SARS-CoV-2 antibody response was measured and compared at baseline and at six weeks following vaccination. The study population consisted of patients with rheumatoid arthritis (RA), spondyloarthropathies (SpA), or psoriatic arthritis (PsA) receiving their outpatient treatment at the Danish Hospital for Rheumatic Diseases, Sonderborg. Bloods, patient reported outcome measurements (PROMS), clinical data, and treatment information (cs/bDMARD) were collected at baseline/6 weeks and documented in the Danish DANBIO registry. Commercially available antibody tests (ThermoFisher, Waltham, MA, USA) were used, and SARS-CoV-2 IgG levels were reported in EliA U/mL. Sufficient IgG response was defined as ≥10 EliA U/mL (manufacturers cut-off). Associations between antibody response, age, gender, disease (RA/PsA/SpA), no treatment or cs/bDMARD treatment, and disease activity were tested using proportional odds regression and bootstrapped tests of medians. Results were reported using mean, median (IqR), and bootstrapped 95% confidence interval (CI) of the median. Results: A total of 243 patients were included. We observed a significant increase in IgG levels (median of <0.7 EliA U/mL at baseline versus 34.5 EliA U/mL at 6 weeks). Seventy-two patients (32%) had an insufficient IgG response. The median IgG level in patients treated with cs/bDMARD combination therapy was significantly lower compared to patients without any DMARD treatment (12 EliA U/mL vs. 92 EilA U/mL (p < 0.01)). Conclusion: Patients treated with a combination of cs/bDMARD are at significantly higher risk of an inadequate response to SARS-CoV-2 vaccines as measured by IgG level compared to patients without DMARD treatment. IgG SARS-CoV-2 are only part of the immune response, and further data are urgently needed. At present, our results may inform healthcare providers and policy makers on the decision for the need of a booster vaccine in this particular patient group. Full article

(This article belongs to the Special Issue COVID-19 Vaccines in the Context of Patients with Autoimmune Inflammatory Diseases)

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11 pages, 943 KiB

Open AccessArticle

Serological Response to BNT162b2 and ChAdOx1 nCoV-19 Vaccines in Patients with Inflammatory Bowel Disease on Biologic Therapies

by Mohammad Shehab, Fatema Alrashed, Ahmad Alfadhli, Khazna Alotaibi, Abdullah Alsahli, Hussain Mohammad, Preethi Cherian, Irina Al-Khairi, Thangavel Alphonse Thanaraj, Arshad Channanath, Hamad Ali, Mohamed Abu-Farha, Jehad Abubaker and Fahd Al-Mulla

Vaccines 2021, 9(12), 1471; https://doi.org/10.3390/vaccines9121471 - 13 Dec 2021

Cited by 19 | Viewed by 3601

Abstract

Introduction: The immunogenicity of SARS-CoV-2 vaccines in patients with inflammatory bowel disease (IBD) on biologic therapies is not well studied. The goal of this study was to measure the serological response to BNT162b2 and ChAdOx1 nCoV-19 vaccines in patients with IBD receiving different biologic therapies. Methods: We performed a multi-center prospective study between 1 August 2021 and 15 September 2021. We measured the seropositivity of SARS-CoV-2 antibodies (SARS-CoV-2 IgG) and neutralizing antibody concentrations in patients with IBD receiving biologic therapies 4–10 weeks after their second dose or 3–6 weeks after their first dose of BNT162b2 or ChAdOx1 nCoV-19 vaccines. Results: A total of 126 patients were enrolled (mean age, 31 years; 60% male; 71% Crohn’s disease, 29% ulcerative colitis). Of these, 92 patients were vaccinated with the BNT162b2 vaccine (73%) and 34 patients with the ChAdOx1 nCoV-19 vaccine (27%). In patients being treated with infliximab and adalimumab, the proportion of patients who achieved positive anti-SARS-CoV-2 IgG antibody levels after receiving two doses of the vaccine were 44 out of 59 patients (74.5%) and 13 out of 16 patients (81.2%), respectively. In contrast, of those receiving ustekinumab and vedolizumab, the proportion of patients who achieved positive anti-SARS-CoV-2 IgG antibody levels after receiving two doses of the vaccine were 100% and 92.8%, respectively. In patients receiving infliximab and adalimumab, the proportion of patients who had positive anti-SARS-CoV-2 neutralizing antibody levels after two-dose vaccination was 40 out of 59 patients (67.7%) and 14 out 16 patients (87.5%), respectively. On the other hand, the proportion of patients who had positive anti-SARS-CoV-2 neutralizing antibody levels were 12 out of 13 patients (92.3%) and 13 out of 14 patients (92.8%) in patients receiving ustekinumab and vedolizumab, respectively. Conclusions: The majority of patients with IBD who were on infliximab, adalimumab, and vedolizumab seroconverted after two doses of SARS-CoV-2 vaccination. All patients on ustekinumab seroconverted after two doses of SARS-CoV-2 vaccine. The BNT162b2 and ChAdOx1 nCoV-19 SARS-CoV-2 vaccines are both likely to be effective after two doses in patients with IBD on biologics. Larger follow-up studies are needed to evaluate if decay of antibodies occurs over time. Full article

(This article belongs to the Special Issue COVID-19 Vaccines in the Context of Patients with Autoimmune Inflammatory Diseases)

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Review

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23 pages, 1326 KiB

Open AccessReview

COVID-19 Vaccines and Autoimmune Hematologic Disorders

by María Eva Mingot-Castellano, Nora Butta, Mariana Canaro, María del Carmen Gómez del Castillo Solano, Blanca Sánchez-González, Reyes Jiménez-Bárcenas, Cristina Pascual-Izquierdo, Gonzalo Caballero-Navarro, Laura Entrena Ureña, Tomás José González-López and on behalf of the GEPTI

Vaccines 2022, 10(6), 961; https://doi.org/10.3390/vaccines10060961 - 16 Jun 2022

Cited by 24 | Viewed by 7451

Abstract

Worldwide vaccination against SARS-CoV-2 has allowed the detection of hematologic autoimmune complications. Adverse events (AEs) of this nature had been previously observed in association with other vaccines. The underlying mechanisms are not totally understood, although mimicry between viral and self-antigens plays a relevant role. It is important to remark that, although the incidence of these AEs is extremely low, their evolution may lead to life-threatening scenarios if treatment is not readily initiated. Hematologic autoimmune AEs have been associated with both mRNA and adenoviral vector-based SARS-CoV-2 vaccines. The main reported entities are secondary immune thrombocytopenia, immune thrombotic thrombocytopenic purpura, autoimmune hemolytic anemia, Evans syndrome, and a newly described disorder, so-called vaccine-induced immune thrombotic thrombocytopenia (VITT). The hallmark of VITT is the presence of anti-platelet factor 4 autoantibodies able to trigger platelet activation. Patients with VITT present with thrombocytopenia and may develop thrombosis in unusual locations such as cerebral beds. The management of hematologic autoimmune AEs does not differ significantly from that of these disorders in a non-vaccine context, thus addressing autoantibody production and bleeding/thromboembolic risk. This means that clinicians must be aware of their distinctive signs in order to diagnose them and initiate treatment as soon as possible. Full article

(This article belongs to the Special Issue COVID-19 Vaccines in the Context of Patients with Autoimmune Inflammatory Diseases)

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Other

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8 pages, 827 KiB

Open AccessProtocol

Evaluation of the Real-World Effectiveness of Vaccines against COVID-19 at a Local Level: Protocol for a Test-Negative Case–Control Study

by Cátia Brazete, Marta Pinto, Lígia Sá, Ana Aguiar, Filipe Alves and Raquel Duarte

Vaccines 2022, 10(5), 822; https://doi.org/10.3390/vaccines10050822 - 23 May 2022

Cited by 3 | Viewed by 2575

Abstract

Vaccines against COVID-19 approved for use in the EU/EEA have been shown to be highly effective against wild-type SARS-CoV-2. However, their effectiveness against new variants may be reduced. This study aims to evaluate the effectiveness of vaccines against COVID-19 in the prevention of symptomatic and severe disease, during pre- and post-omicron phases. Individuals who sought treatment at the emergency department of a Portuguese hospital with COVID-19-like disease and were tested for SARS-CoV-2 are the subjects of the study. Patients who received a positive result are considered cases, while those with negative results are the controls. The test-negative case–control method is one of the study designs recommended by WHO to estimate the effectiveness of vaccines against COVID-19. The main advantage of this design is that it controls for the healthcare seeking bias, commonly present in traditional cohort and case–control designs. This study may have broad implications for understanding the real-world performance of the COVID-19 vaccines at the local level, which may play a key role in promoting adherence to vaccination. Moreover, this study may contribute to inform decisions regarding booster doses and variant-specific vaccine formulations leading to the control of this and future pandemics. Full article

(This article belongs to the Special Issue COVID-19 Vaccines in the Context of Patients with Autoimmune Inflammatory Diseases)

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5 pages, 500 KiB

Open AccessCase Report

Group Vaccination Five Days before a COVID-19 Outbreak in a Long-Term Care Facility

by Mathias W. Pletz, Sabine Trommer, Steffi Kolanos, Norman Rose, Veit Kinne, Riccardo Spott, Michael Baier and Isabel Lange

Vaccines 2021, 9(12), 1450; https://doi.org/10.3390/vaccines9121450 - 8 Dec 2021

Cited by 3 | Viewed by 2435

Abstract

Rapid vaccination may be of benefit in long-term care facilities (LTCF) that are affected by an ongoing COVID-19 outbreak. However, there are concerns regarding the safety and effectiveness of such an approach, particularly regarding the vaccination of pre-symptomatic patients. Here, we report the effectiveness of vaccination in a German LTCF hit by an outbreak that was detected 5 days after the first vaccine doses were administered. In detail, 66.7% of the unvaccinated patients experienced an unfavorable course; this proportion was much lower (33.3%) among the vaccinated patients. Even though this study is limited by a small number of patients, the observation and the comparison with related published data shows that vaccination (i) is safe and (ii) may still be of benefit when given shortly before an infection or even in pre-symptomatic LTCF-patients. Full article

(This article belongs to the Special Issue COVID-19 Vaccines in the Context of Patients with Autoimmune Inflammatory Diseases)

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6 pages, 11066 KiB

Open AccessCase Report

First Report of Two Cases of Löfgren’s Syndrome after SARS-CoV-2 Vaccination-Coincidence or Causality?

by Jan-Gerd Rademacher, Björn Tampe and Peter Korsten

Vaccines 2021, 9(11), 1313; https://doi.org/10.3390/vaccines9111313 - 11 Nov 2021

Cited by 20 | Viewed by 3982

Abstract

Sarcoidosis can present as an acute form or take a chronic course. One of the acute presentations is Löfgren’s syndrome (LS), consisting of the symptom triad of bilateral hilar lymphadenopathy, erythema nodosum, and ankle periarthritis. In addition, there are occasional reports of sarcoid-like reactions following drug exposures. Nevertheless, reports of sarcoidosis or LS after vaccination have not been published. Here, we report two cases of de novo LS in a temporal association with different vaccines against the new coronavirus SARS-CoV-2. One patient developed the first symptoms three days after the second vaccination (first vaccination ChadOx-1, Astra Zeneca; second vaccination CX-024414, Moderna); in the second patient, symptoms started 28 days after the first vaccination (ChadOx-1, Astra Zeneca). Both patients eventually required treatment with glucocorticoids. Both patients achieved clinical improvement with treatment. In conclusion, we report the first two cases of LS shortly after SARS-CoV-2 vaccination. Full article

(This article belongs to the Special Issue COVID-19 Vaccines in the Context of Patients with Autoimmune Inflammatory Diseases)

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8 pages, 2961 KiB

Open AccessCase Report

Kikuchi–Fujimoto Disease Post COVID-19 Vaccination: Case Report and Review of Literature

by Hui Min Tan, Susan Swee-Shan Hue, Aileen Wee and Kay Choong See

Vaccines 2021, 9(11), 1251; https://doi.org/10.3390/vaccines9111251 - 29 Oct 2021

Cited by 25 | Viewed by 4378

Abstract

With the rapid development of various coronavirus disease 2019 (COVID-19) vaccines in a bid to counter and contain the COVID-19 pandemic, unusual and uncommon side effects of COVID-19 vaccination have been increasingly reported in the literature. Ipsilateral lymphadenopathy is a fairly common side effect of vaccination of any kind, with its etiology most commonly related to reactive lymphadenopathy. However, Kikuchi–Fujimoto Disease (KFD) or necrotizing histiocytic lymphadenitis is rarely observed post-vaccination, with only one other case of KFD post COVID-19 vaccination reported to date. We report two more cases of KFD post COVID-19 vaccination in the Asian population, highlighting the clinical course and salient clinical, radiological and histologic findings. In addition, we provide a literature review of the existing cases of lymphadenopathy post COVID-19 vaccination with cytologic and/or histologic correlation. Full article

(This article belongs to the Special Issue COVID-19 Vaccines in the Context of Patients with Autoimmune Inflammatory Diseases)

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