The natural history of COVID-19 in vaccinated inflammatory bowel disease patients.

AIM: Assess the characteristics of break through COVID-19 in Inflammatory Bowel Disease (IBD) patients, despite complete vaccination. METHODS: Patients who reported a COVID-19 at least 3 weeks after complete vaccination were asked to answer an on-line anonymous questionnaire which included patient and disease characteristics, vaccination history, and the evolution of COVID-19. RESULTS: Among 3240 IBD patients who reported complete vaccination between 1st May 2021 and 30thJune 2022, 402 (12.4%) were infected by SARS Cov-2 [223 male, 216 Crohn's disease (CD), 186 Ulcerative Colitis (UC), mean (SD) age 42.3 (14.9) years, mean (SD) IBD duration 10.1 (9.7) years]. Three hundred and sixty-nine patients (91.8%) were infected once and 33 (8.2%) twice. The mean (SD) time between last vaccination and infection was 4.1 (1.6) months. Overall, 351 (87.3%) patients reported mild constitutional and/or respiratory symptoms, 34 (8.4%) were asymptomatic and only 17 patients (4.2%) required hospitalization. Of hospitalized patients, 2 UC patients died of COVID-19 pneumonia. The remaining hospitalized patients did not need high flow oxygen supply or ICU admission. CONCLUSIONS: A minority of completely vaccinated IBD patients developed COVID-19 which evolved with mild symptoms and a favorable outcome. These results reinforce the importance of vaccination especially in vulnerable populations.

The Natural History of Covid-19 in Vaccinated Inflammatory Bowel Disease Patients

Introduction: Patients with Inflammatory Bowel Disease (IBD), especially those on immunosuppressives (IMS), should be vaccinated against SARSCoV- 2 to prevent hospitalization, mechanical ventilation, and death. However, IMS may adversely affect response to vaccination, raising concerns as to how vulnerable these patients are to break through COVID-19 infections. Thus, we aimed to assess the proportion of IBD patients who despite complete vaccination developed COVID-19, as well as the course of COVID-19 disease. Aims & Methods: This study was an initiative of the Hellenic IBD Study Group (EOMIFNE) and involved 12 IBD referral Centers. Patients attending these Centers who reported a COVID-19 infection at least 3 weeks after vaccination completion were asked to complete an on-line anonymous questionnaire which included patient demographics and IBD clinical and therapeutic data, a detailed vaccination history, and the course and outcome of COVID-19, especially the need for hospitalization, oxygen supply, and admission to ICU. In patients with a grave outcome information was sought by family members. Result(s): On estimate, 3240 patients reported full vaccination (vaccination scheme either with combined Vaxzevria- Comirnaty or onlyComirnaty vaccine) in the 12 centers. Between 1stMay 2021 and 20thApril 2022,351 (10.8%) fully vaccinated IBD patients reported COVID-19 infection [187 male, 212 CD, 139 UC, mean (SD) age 42.3 (14.9) years, mean (SD) IBD duration mean (SD), 10.1 (9.7) years]. Among them, 322 (91.7%) were infected once and 29 (8.3%) patients twice. Seventy-three patients were receiving 5-ASAs, 15 corticosteroids, 46 azathioprine/methotrexate, 117 anti-TNFs as monotherapy and 21 in combination with azathioprine/methotrexate, and 2 with corticosteroids, 43 vedolizumab, 25 ustekinumab, 5 tofacitinib and 1 rizakinzumab at the time of COVID-19 diagnosis. Three patients did not receive any treatment. IBD was in remission in 279/351 patients (79.5%). Comorbidities were reported by 112 patients (thyroid disease 66;diabetes mellitus 13;hypertension 12;coronary heart disease 11;prior cancer 4;psoriasis 2;spondyoartropathy 2;dyslipidemia 1;and PSC 1 patient). The mean (SD) time between last vaccination dose and infection was 4.1 (1.6) months. Overall, 308 (87.7%) patients reported mild constitutional and respiratory symptoms, 29 (8.6%) were asymptomatic and only 14 patients (3.9%) required hospitalization. Of those hospitalized, 2 patients, both with UC, died because of COVID pneumonia (one aged 67, on infliximab, with diabetes and the second one aged 80, on 5-ASA, with a history of laryngeal cancer);however, the remaining 12 patients did not need high flow oxygen supply or ICU admission, and none reported symptoms of long COVID. IBD medications were stopped in 145 patients (41.3%) during the COVID-19 infection. Conclusion(s): A minority of fully vaccinated IBD vaccinated patients developed COVID-19 which was relatively mild and uneventful. These results reinforce the importance of vaccination especially in vulnerable populations.

Virtual clinics the future of thrombosis and anticoagulant consultations? A patient preference survey

Content: The COVID-19 pandemic onset in March 2020 resulted in the rapid implementation of virtual clinics throughout the NHS to minimise infection transmission in hospitals. This transformation may become permanent after the pandemic, in line with the NHS Long Term Plan (2019). This envisaged the increasing use of virtual/remote (telephone and video) Attend Anywhere consultations to improve convenience for patients, enhance clinic capacity, and more productive use of consultant time. Despite these potential benefits, there is limited research into the safety, acceptability and suitability of virtual/remote clinics for patients in different clinical services. We evaluated patient preferences and feasibility for the future use of virtual/remote consultations by conducting a telephone survey of patients remotely attending' thrombosis and anticoagulation clinics at a single London NHS Trust during the COVID-19 pandemic. At the end of each telephone consultation, patients were asked two questions: (1) In the current climate of the COVID-19 pandemic, what would your preference be in terms of being seen in future clinics face to face, video or telephone?', (2) Do you have access to a smartphone or computer that you could use with video consultations in the future or can you get support from a family member/friend to do this?' Patient preferences were analysed by median age group, gender, and new/follow-up status. A total of 51 patients [23 females (45.1%) and 28 males (54.9%)] were surveyed. Median age was 65.5 years (range 23 100 years). There were 16 new and 35 follow-up patients with 42 patients attending consultant-led thrombosis clinics and 9 attending nurse/pharmacist-led anticoagulant clinics. 42 patients were seen because of venous thromboembolism (VTE), 6 because of atrial fibrillation (AF), and 3 for other conditions. 45 patients (88.2%) preferred a specific type of consultation and 6 patients (11.8%) showed no preference. 33 of 45 patients (64.7%) preferred virtual/remote consultation, whereas 12 patients (23.5%) preferred face-to-face contact. Out of the 33 patients who preferred a virtual/remote consultation, 17 (33.3%) preferred only telephone, 8 (15.7%) preferred only video, and 8 (15.7%) preferred either video or telephone. These proportions were similar in females and males, aged under and over 65, and new compared to follow-up patients. 37 patients (72.5%) had access to a smartphone or computer. Median age of patients who had access was 65.5 years (range 23-91 years), and in patients who did not have access was 76.0 years (range 29-100 years). The majority of patients preferred virtual/remote consultations for the future. Telephone consultations appeared more popular than video consultations, despite most patients having access to a smartphone or computer. The findings may be influenced by the methodology of the survey being conducted at the end of a phone consultation and during the COVID-19 pandemic. Remote/virtual thrombosis clinics seem likely to continue for many patients after the COVID pandemic. Further research is needed to identify the factors that determine individual patient preferences and the clinical implications and safety of different types of consultation.