Infectious Disease

Immune dysfunction associated with ‘significant risk’ for breakthrough COVID-19 infection

January 19, 2022

3 min read

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Disclosure:
Sun makes no relevant financial disclosures. The relevant financial information of all other authors can be found in the study.

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Although vaccines reduce the overall risk of COVID-19 regardless of immune status, the data show that patients with immune dysfunction are at “significant risk” for breakthrough infection compared to those without.

Specifically, the researchers found that patients with rheumatoid arthritis, HIV infection, or organ transplants had a higher rate of breakthrough infections despite being fully vaccinated against COVID-19.

RH0122Sun_Graphic_01

Although vaccines reduce overall risk of COVID-19 regardless of immune status, patients with immune dysfunction have a “significant risk” of breakthrough infection compared to patients without immunodeficiency, according to data from Sun J, et al. JAMA Intern Med. 2021;doi:10.1001/jamainternmed.2021.7024.

“People with immune dysfunction have been largely excluded from clinical trials of SARS-CoV-2 vaccines, creating a large evidence gap.” Jing Sun, MD, MPH, PhD, from the Johns Hopkins Bloomberg School of Public Health in Baltimore, opposite Healio. “Our observational study using a nationally representative electronic medical record database provided real-world evidence of risk and incidence rates for breakthrough infections and the effectiveness of vaccines in these vulnerable populations.”

To analyze the incidence rate and incidence rate ratio for post-vaccination breakthrough COVID-19 infection in individuals with or without immune dysfunction, Sun and colleagues conducted a retrospective cohort study using data from the National COVID Cohort Collaborative (N3C). According to the researchers, N3C is a partnership overseen by the NIH National Center for Advancing Translational Sciences, which has developed a centralized registry based on electronic medical records including COVID-19 clinical data provided by academic medical centers across the United States .

Sun_Jing_2022

Ying sun

The researchers enrolled a total of 664,722 people who received at least one dose of a COVID-19 vaccine between December 10, 2020 and September 16, 2021 with 4,436,139 person-months of follow-up. Of these people, 633,365 – or 95.3% – completed all recommended doses. A total of 35,512 people in the total sample – or 5.3% – had an immune dysfunction. For this study, immune dysfunction was defined as HIV infection, multiple sclerosis, RA, solid organ transplantation, or bone marrow transplantation.

Breakthrough infection was defined as COVID-19 contraction on or after day 14 of vaccination. The risk of infection after full or partial vaccination was assessed for patients with and without immune dysfunction using Poisson regression models. The regression models were controlled for the study period—before or after the emergence of the delta variant in late June 2021—as well as for complete vaccination status, pre-vaccination infection, demographics, geographic location, and comorbidities.

According to the researchers, who published their findings in JAMA Internal Medicine, the overall incidence rate for breakthrough COVID-19 infections was 5 per 1,000 person-months in fully vaccinated individuals, but was higher after the delta variant became the dominant strain. The incidence rate before June 20, 2021 was 2.2 per 1,000 person-months (95% CI, 2.2-2.2) compared to 7.3 (95% CI, 7.3-7.4) after that date .

Full vaccination was associated with a 28% reduced risk of breakthrough infection compared to partial vaccination (adjusted IRR = 0.72; 95% CI, 0.68-0.76). Patients with breakthrough infection after full vaccination were more likely to be elderly and female. Patients with HIV infection (adjusted IRR = 1.33; 95% CI, 1.18-1.49), RA (adjusted IRR = 1.2; 95% CI, 1.09-1.32) and solid organ transplantation (adjusted IRR = 2.16; 95% CI, 1.96-2.38) showed a higher rate of breakthrough infections compared to those without immune dysfunction.

“As expected, individuals with immune dysfunction have a higher incidence rate and risk of breakthrough infection after their COVID-19 vaccination compared to those without immune dysfunction,” Sun said. “Although individuals with immune dysfunction are at higher risk for breakthrough infection, we found that disease severity is lower in breakthrough infection cases compared to pre-vaccination COVID-19 cases, regardless of the patient’s immune status.”

“These results suggest that individuals with immune dysfunction are still at significant risk of COVID-19 infection even after they have been fully vaccinated,” she added. “Therefore, in clinical practice, the continued use of non-pharmaceutical measures – e.g. B. Wearing masks, social distancing, avoiding travel and crowds – and alternative vaccination strategies – e.g. additional doses or immunogenicity testing – are recommended.”

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COVID-19 and Rheumatology

COVID-19 and Rheumatology

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