RMD Open (Apr 2023)
Characteristics and outcomes of SARS-CoV-2 breakthrough infections among double-vaccinated and triple-vaccinated patients with inflammatory rheumatic diseases
- ,
- Tobias Alexander,
- Hendrik Schulze-Koops,
- Ulf Müller-Ladner,
- Rebecca Fischer-Betz,
- Martin Aringer,
- Rieke Alten,
- Petra Saar,
- Tim Schmeiser,
- Marina Backhaus,
- Stephanie Finzel,
- Cornelia Glaser,
- Hildrun Haibel,
- Hanns-Martin Lorenz,
- Gamal Chehab,
- Christof Specker,
- Reinhard E Voll,
- Anja Strangfeld,
- Norbert Blank,
- Matthias Braun,
- Alexander Pfeil,
- Rebecca Hasseli,
- Andreas Krause,
- Anne Constanze Regierer,
- Peer Aries,
- Ioana Andreica,
- Jacqueline Detert,
- Elvira Decker,
- Urs Hartmann,
- Joerg Henes,
- Kirsten de Groot,
- JOACHIM GEORGI,
- Hans Bastian,
- Christoph Fiehn,
- Martin Feuchtenberger,
- Martin Fleck,
- Christian Blum,
- Mathias Grunke,
- Martin Bohl-Bühler,
- Georg Gauler,
- Bimba Franziska Hoyer,
- Guido Hoese,
- Janine Günther,
- Matthias Braunisch,
- Jutta G. Richter,
- Sabine Reckert,
- Anett Gräßler,
- Andreas Kapelle,
- Silke Osiek,
- Anna Knothe,
- Jan Brandt-Jürgens,
- Anja Maltzahn,
- Fredrik Albach,
- Annette Alberding,
- Susanne Aman,
- Christopher Amberger,
- Michaela Amberger,
- Bianka Andermann,
- Nils Anders,
- Jan Andresen,
- Nikolaos Andriopoulos,
- Elizabeth Arauj,
- Uta Arndt,
- Sarah Avemarg,
- Christoph Baerwald,
- Erich Bärlin,
- Nora Bartholomä,
- Michael Bäuerle,
- Jutta Bauhammer,
- Christine Baumann,
- Klaus Becker,
- Heidemarie Becker,
- Michaela Bellm,
- Sylvia Berger,
- Andrea Berghofen,
- Gerhard Birkner,
- Daniel Blendea,
- Hans Bloching,
- Sebastian Blötz,
- Stephanie Boeddeker,
- Susanne Bogner,
- Lara Bohnen,
- Ilka Bösenberg,
- Nicole Böttcher,
- Diana Braun,
- Jan Philipp Bremer,
- Matthias Broll,
- Andreas Bruckner,
- Veronika Brumberger,
- Martin Brzank,
- Sahra Büllesfeld,
- Sandra Burger,
- Michaela Christenn,
- Anne Claußnitzer,
- Frank Demtröder,
- Rainer Dörfler,
- Elke Drexler,
- Valeria Dudics,
- Edmund Edelmann,
- Roman Eder,
- Christina Eisterhues,
- Joachim Michael Engel,
- Brigitte Erbslöh-Möller,
- Miriam Feine,
- Samantha Ferdinan,
- Claudia Franke,
- Stefanie Freudenberg,
- Christian Fräbel,
- Petra Fuchs,
- Regina Gaissmaier,
- Ino Gao,
- Oliver Gardt,
- Katrin Geißler,
- Karolina Gente,
- Jasmin Gilly,
- Yannik Gkanatsas,
- Agnes Gniezinski- Schwister,
- Rahel Gold,
- Norman Görl,
- Ralf Görlitz,
- Karl-Heinz Göttl,
- Beate Göttle,
- Ricardo Grieshaber Bouyer,
- Gisela Grothues,
- Florian Günther,
- Mirjam Haag,
- Linda Haas,
- Anna Haas-Wöhrle,
- Denitsa Hadjiski,
- Till Hallmann-Böhm,
- Peter Härle,
- Charlotte Hasenkamp,
- Maura-Maria Hauf,
- Matthias Hauser
Affiliations
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital-Radiumhospitalet, Oslo, Norway
- Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
- Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians-University, Munich, Germany
- Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Giessen, Germany
- Rebecca Fischer-Betz
- Martin Aringer
- 2 Internal Medicine III, Medical Faculty, Technical University of Dresden, Dresden, Germany
- Rieke Alten
- Petra Saar
- Rheumatology, Private Practice Endokrinologikum, Frankfurt, Germany
- Tim Schmeiser
- Rheumatology, Private Practice Rheumatologie im Veedel Cologne, Cologne, Germany
- Marina Backhaus
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Academic Hospital of the Charité Berlin, Berlin, Germany
- Stephanie Finzel
- Cornelia Glaser
- Hildrun Haibel
- Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- Gamal Chehab
- Christof Specker
- 6 Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte—KEM, Essen, Germany
- Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Medical Center – University of Freiburg, Faculty of Medicine, Freiburg, Germany
- Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
- Norbert Blank
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- Matthias Braun
- Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
- Rebecca Hasseli
- Department of Internal Medicine D, Section of Rheumatology and Clinical Immunology, University Hospital Munster, Munster, Germany
- Andreas Krause
- 2 Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin—Wannsee Branch, Berlin, Germany
- Anne Constanze Regierer
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
- Peer Aries
- Ioana Andreica
- Jacqueline Detert
- Elvira Decker
- Urs Hartmann
- Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases (INDIRA) and Department of Internal Medicine II (Oncology, Haematology, Rheumatology and Clinical Immunology), University Hospital Tuebingen, Tuebingen, Germany
- Kirsten de Groot
- JOACHIM GEORGI
- Hans Bastian
- Christoph Fiehn
- Martin Feuchtenberger
- Martin Fleck
- Christian Blum
- Mathias Grunke
- Martin Bohl-Bühler
- Georg Gauler
- Bimba Franziska Hoyer
- Clinic for Internal Medicine I, Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany
- Guido Hoese
- Rheumatology, Private Practice, Stadthagen, Germany
- Janine Günther
- Matthias Braunisch
- Jutta G. Richter
- Clinic for Rheumatology, University Hospital Duesseldorf, Medical Faculty of Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
- Sabine Reckert
- Rheumatology, Private Practice, Potsdam, Germany
- Anett Gräßler
- Rheumatology, Private Practice, Pirna, Germany
- Andreas Kapelle
- Rheumatology, Private Practice, Hoyerswerda, Germany
- Silke Osiek
- Rheumatology, Private Practice Dialysezentrum, Schweinfurt, Germany
- Anna Knothe
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Giessen, Germany
- Jan Brandt-Jürgens
- Rheumatology, Private Practice, Berlin, Germany
- Anja Maltzahn
- Rheumatology, Private Practice, Göttingen, Germany
- Fredrik Albach
- Annette Alberding
- Susanne Aman
- Christopher Amberger
- Michaela Amberger
- Bianka Andermann
- Nils Anders
- Jan Andresen
- Nikolaos Andriopoulos
- Elizabeth Arauj
- Uta Arndt
- Sarah Avemarg
- Christoph Baerwald
- Erich Bärlin
- Nora Bartholomä
- Michael Bäuerle
- Jutta Bauhammer
- Christine Baumann
- Klaus Becker
- Heidemarie Becker
- Michaela Bellm
- Sylvia Berger
- Andrea Berghofen
- Gerhard Birkner
- Daniel Blendea
- Hans Bloching
- Sebastian Blötz
- Stephanie Boeddeker
- Susanne Bogner
- Lara Bohnen
- Ilka Bösenberg
- Nicole Böttcher
- Diana Braun
- Jan Philipp Bremer
- Matthias Broll
- Andreas Bruckner
- Veronika Brumberger
- Martin Brzank
- Sahra Büllesfeld
- Sandra Burger
- Michaela Christenn
- Anne Claußnitzer
- Frank Demtröder
- Rainer Dörfler
- Elke Drexler
- Valeria Dudics
- Edmund Edelmann
- Roman Eder
- Christina Eisterhues
- Joachim Michael Engel
- Brigitte Erbslöh-Möller
- Miriam Feine
- Samantha Ferdinan
- Claudia Franke
- Stefanie Freudenberg
- Christian Fräbel
- Petra Fuchs
- Regina Gaissmaier
- Ino Gao
- Oliver Gardt
- Katrin Geißler
- Karolina Gente
- Jasmin Gilly
- Yannik Gkanatsas
- Agnes Gniezinski- Schwister
- Rahel Gold
- Norman Görl
- Ralf Görlitz
- Karl-Heinz Göttl
- Beate Göttle
- Ricardo Grieshaber Bouyer
- Gisela Grothues
- Florian Günther
- Mirjam Haag
- Linda Haas
- Anna Haas-Wöhrle
- Denitsa Hadjiski
- Till Hallmann-Böhm
- Peter Härle
- Charlotte Hasenkamp
- Maura-Maria Hauf
- Matthias Hauser
- DOI
- https://doi.org/10.1136/rmdopen-2023-002998
- Journal volume & issue
-
Vol. 9,
no. 2
Abstract
Objective To analyse the clinical profile of SARS-CoV-2 breakthrough infections in at least double-vaccinated patients with inflammatory rheumatic diseases (IRDs).Methods Data from the physician-reported German COVID-19-IRD registry collected between February 2021 and July 2022 were analysed. SARS-CoV-2 cases were stratified according to patients’ vaccination status as being not vaccinated, double-vaccinated or triple-vaccinated prior to SARS-CoV-2 infection and descriptively compared. Independent associations between demographic and disease features and outcome of breakthrough infections were estimated by multivariable logistic regression.Results In total, 2314 cases were included in the analysis (unvaccinated n=923, double-vaccinated n=551, triple-vaccinated n=803, quadruple-vaccinated n=37). SARS-CoV-2 infections occurred after a median of 151 (range 14–347) days in patients being double-vaccinated, and after 88 (range 14–270) days in those with a third vaccination. Hospitalisation was required in 15% of unvaccinated, 8% of double-vaccinated and 3% of triple-vaccinated/quadruple-vaccinated patients (p<0.001). Mortality was 2% in unvaccinated, 1.8% in the double-vaccinated and 0.6% in triple-vaccinated patients. Compared with unvaccinated patients, double-vaccinated (OR 0.43, 95% CI 0.29 to 0.62) and triple-vaccinated (OR 0.13, 95% CI 0.08 to 0.21) patients showed a significant lower risk of COVID-19-related hospitalisation. Using multivariable analysis, the third vaccination was significantly associated with a lower risk for COVID-19-related death (OR 0.26; 95% CI 0.01 to 0.73).Conclusions Our cross-sectional data of COVID-19 infections in patients with IRD showed a significant reduction of hospitalisation due to infection in double-vaccinated or triple-vaccinated patients compared with those without vaccination and even a significant reduction of COVID-19-related deaths in triple-vaccinated patients. These data strongly support the beneficial effect of COVID-19 vaccination in patients with IRD.Trial registration number EuDRACT 2020-001958-21.
