ABSTRACT
Background Patients with celiac disease (CeD) reported increased COVID-19 vaccine hesitancy due to a fear of adverse events (AEs). However, the risk of AEs post-COVID-19 vaccination in patients with CeD is unknown. Purpose To assess whether the rate of common side effects (SEs) and AEs due to COVID vaccines are higher in patients with CeD compared to a non-CeD population. Method We conducted a collaborative international cross-sectional study in 16 countries between April 2022 and July 2022. An online survey was distributed to patients with CeD through patients' local societies, and to non-CeD from the general population in each country through social media posts, word-of-mouth, and through academic institutions. We collected data on participant demographics, medical conditions, CeD diagnosis, GFD adherence, history of COVID-19 vaccinations (type and doses) and self-reported SEs and AEs post-COVID-19 vaccine. SEs included pain/swelling at the site, fatigue, fever, chills, nausea and/or headaches. AEs included thrombosis, myocarditis, anaphylactic reaction, and hospitalization related to the vaccine. Logistic regression models were used to assess predictors such as CeD diagnosis, age, gender, vaccine type and comorbidities on the likelihood of reporting SEs and AEs post-vaccine. Result(s) : A total of 17,795 participants completed the survey, 13,638 with CeD (median age of 45[27]) and 4,157 non-CeD controls (median age of 43[20]). There were no significant differences in sex between CeD and controls. Overall, CeD patients had similar odds of SEs compared with non-CeD individuals (aOR=1.02;95% CI=0.92-1.14). SEs were slightly increased only in the second dose of the vaccine in the CeD population compared to non-CeD individuals (aOR= 1.35;95% CI=1.19-1.53). The most common reported SEs in CeD and controls were pain/swelling at the injection site (29% vs 23 %, p< 0.0001) and fatigue (29% vs 24%, p<0.0001). The odds of SEs were higher with Moderna Spikevax, AstraZeneca/Oxford and Johnson and Johnson vaccines than after the Pfizer vaccine (p< 0.0001). The overall rate of AEs post-vaccine was similar between patients with CeD and non-CeD individuals (aOR= 1.29;95% CI= 0.89-1.87). Overall, female gender, older age, GFD adherence, respiratory conditions, obesity and receiving immunosuppressive medications increased the odds of SEs, while only age and a history of allergies increased the odds of AEs. Conclusion(s) In this large international study, patients with CeD reported similar rates of SEs and AEs post-COVID vaccine compared to non-CeD individuals. This information is highly relevant as it addresses the main concern leading to COVID-19 vaccine hesitancy in CeD patients. Disclosure of Interest None Declared
ABSTRACT
Background: Celiac disease (CeD) has been associated with an increased risk of respiratory infections, however, we recently demonstrated that the odds of contracting COVID-19 in patients with CeD is similar to that of the general population. Due to this discrepancy, how patients with CeD perceive their risk may differ from their actual risk. Aims: The aim of this study was to investigate the risk perceptions for contracting COVID-19 in patients with CeD and to determine the factors that may influence their perceptions. Methods: We distributed a survey throughout 10 countries between March and June 2020 and collected data on demographics, diet, COVID-19 testing, and risk perceptions of COVID-19 in patients with CeD. Participants were recruited through various celiac associations, clinic visits, and social media. Risk perception was assessed by asking individuals whether they believe patients with CeD are at an increased risk of contracting COVID-19 compared to the general population. Logistic regression was used to determine the influencing factors associated with COVID-19 risk perception, such as age, sex, adherence to a gluten-free diet (GFD), and comorbidities such as cardiac/respiratory conditions and diabetes. Data was presented as adjusted odds ratios (aORs). Results: A total of 10,737 participants with CeD completed the survey. From them, 6,019 (56.1%) patients with CeD perceived they were at a higher risk or were unsure if they were at a higher risk of contracting COVID-19 compared to the non-CeD population. A greater proportion of patients with CeD had high levels of COVID-19 risk perceptions when compared to infections in general (56.1% vs 26.7%;p<0.0001). Consequently, 28.8% reported taking extra COVID-19 precautions as a result of their CeD. Members of celiac associations had lower rates of perceiving an increased risk of COVID-19 when compared to non-members (49.5% vs 57.4%, p<0.0001). Older age (aOR: 0.9;95% CI: 0.9 to 1, p<0.001), male sex (aOR: 0.85;95% CI: 0.76 to 0.94, p=0.001), and strict adherence to a GFD (aOR: 0.89;95% CI 0.82 to 0.97, p=0.007) were associated with a lower perception of COVID-19 risk. Meanwhile, the presence of comorbidities was associated with a higher perception of COVID-19 risk (aOR: 1.34;95% CI: 1.20 to 1.51, p<0.001). Conclusions: Overall, a large proportion of patients with CeD, particularly females, those with comorbidities, or those not adhering to a strict GFD, believed they were or were unsure if they were at a higher risk of contracting COVID-19 due to their condition. As high levels of risk perception may increase an individual's pandemic-related stress and contribute to negative mental health consequences, healthcare providers should maintain consistent communication with the celiac community and provide them with evidence-based recommendations.