ABSTRACT
As the SARS-CoV-2 vaccinated population increases, there have been many reports of vaccine-induced cutaneous reactions but scarce information on vaccine-induced autoimmune bullous disease. Vaccinations have been associated with the unmasking or development of autoimmune bullous disease;however, there is little data on SARS-CoV-2, specifically. We report a rare case of new-onset pemphigoid in a 70-year-old male following the second dose of the mRNA-1273 vaccine. The patient’s disease has been refractory to treatment, thus the underlying pathophysiology in vaccine-induced pemphigoid is likely unique, and further investigation into this pathophysiology is warranted. © 2022 THE AUTHORS.
ABSTRACT
INTRODUCTION AND OBJECTIVE: During the COVID-19 pandemic, the use of both video visits (VV) and telephone visits (TV) surged. While insurance coverage for VVs has continued after the pandemic, coverage for TVs remains less certain. We sought to evaluate why patients select TVs over VVs in our academic Urology practice. METHODS: All patients who attempted to schedule telemedicine visits with our practice from 11/2020-5/2021 were first offered a VV. If the patient declined a VV and selected a TV, they were prompted to select a reason from a list. Patient and visit characteristics for both VV and TV cohorts were reviewed and these variables were compared between groups. RESULTS: 1937 patients (1180 male, 757 female) completed telemedicine visits (27% VVs, 73% TVs) between 11/2020 and 5/2021 in our practice. Patients who opted for TVs were more likely to be male (74.6% of males vs 69.9% of females, p=.02), older (84.2% of >65 years old vs 71.5% of 51-65 years old vs 58.2% of 18-50 years old, p=.03), Spanish-speaking (85.9% of Spanish-speakers vs 68.9% of English-speakers, p<.001), and returning for a follow-up visit (79.3% of follow-up patients vs 44.2% of new patients, p<.001). The population did not vary significantly by race/ethnicity or socioeconomic status. Among 1409 TV patients, 1300 (92.3%) provided reasons for preferring TV over VV. The most commonly reported reasons were limited access to smart devices (39.4%) and lack of desire for a VV (47.7%). Less frequently reported responses included language barriers (2.1%), dissatisfaction with a prior telemedicine visit (2.1%), and data/network limitations (1%). CONCLUSIONS: Within our urban, racially diverse patient population, the majority of patients preferred TVs over VVs. Limited access to video-capable smart devices was a prevalent reason. Further analysis should be conducted into understanding the reasons why certain groups of patients are significantly more likely to opt for TVs than others, including males, older patients, Spanish-speakers, and follow-up patients. Additionally, in order to improve access to care in underserved areas, congressional efforts to continue adequate reimbursement for TVs should be encouraged and further research into barriers to patients' acceptance of VVs is needed. (Table Presented).
ABSTRACT
Introduction: Anti-CD20 treated MS patients may have higher risk of severe SARS-CoV-2. Early reports indicate they mount attenuated antibody responses to SARS-CoV-2 vaccines, raising significant concerns about their protection, and the merit of aCD20 infusion delay to enable more robust vaccine responses. Little is known about cellular responses (particularly spike-antigen-specific T-cell responses) to these vaccines in B cell-depleted state. Aims: To characterize the magnitude and kinetics of both antibody-and cell-based responses to SARS-CoV-2 mRNA vaccines in aCD20 treated MS patients, compared to healthy controls (HC). Methods: Both humoral IgG responses to Spike (S) protein and its receptor-binding-domain (RBD), as well as Spike-reactive B cells (flow cytometry) and S-protein-specific CD4+ and CD8+ T-cell responses (activation-induced marker/AIM assays), were serially assessed in 21 MS patients on aCD20 therapy and 10 HC, pre-and post-SARS-CoV-2 mRNA vaccination (pre-vaccine-T1;10 days post primary-T2, pre-booster-T3;10-day post-booster-T4 and 30 days post-booster-T5). Results: Antibodies to both S-protein and RBD were induced in 100% of HC by T4 and, with some lag (by T5), in 89% and 50% of MS patients, respectively. Mean Spike-IgG concentrations for HC and MS patients at T5 were 165.3± 201.9 units/mL (u/ml) and 22.3± 58.2 u/mL respectively (p=0.0004);and 97± 136 u/ mL(HC) and 10.2± 29 u/mL (MS) (p<0.0001) for RBD-IgG. All 6 patients vaccinated longer than 20 weeks after the last aCD20 treatment exhibited partial B-cell reconstitution, and all had measurable spike-specific memory B-cells at T5. All MS patients and HC mounted CD4+ and CD8+ T-cell responses to vaccine. Expansion of activated (Ki67+CD38+) CD4+ T-cells was robust in HC and somewhat attenuated in MS patients (p= 0.03), while expansion of activated (Ki67+CD38+) CD8+ T cells was robust in both cohorts. In AIM assays, spike-antigen-specific responses of CD4+ T-cells of patients were similarly mildly attenuated compared to HC, while those of CD8+ T cells were similarly robust for both patients and HC. Conclusion: In spite of attenuated humoral SARS-CoV-2 mRNA vaccine responses, aCD20 treated patients mount robust CD8+ and mildly attenuated CD4+ T-cell responses. Longer time from last aCD20 infusion may enable more robust humoral and cell-based responses. It will be important to study how cell-based responses relate to protection, complications and risk of infecting others.