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.

Perceptions and attitudes of blood donors in Greece towards vaccination against COVID-19

Background: The speed of development of COVID-19 vaccines, and the need to balance their effectiveness versus possible complications, raised doubts over vaccine acceptance in the first period of the national vaccination campaign aiming at herd immunity against SARSCoV- 2. In the field of transfusion medicine, timely vaccination of the blood donor population represents a powerful measure in the general strategy to sustain blood collection and optimize the blood supply. Aims: To explore perceptions and attitudes of blood donors towards SARS-CoV-2 vaccination, in comparison to the general population. Methods: Donors in 20 blood collection services throughout Greece in May-October 2021 answered voluntarily and confidentially a structured questionnaire, covering: donor demographics;date and type of blood donation;frequency of donation;history of COVID-19;SARSCoV- 2 vaccination including type and doses;reasons for getting vaccinated or not;satisfaction with the vaccination procedure;side effects;feelings after vaccination;certainty about return to normality;and recommending vaccination to others. Hesitancy and beliefs leading to not getting vaccinated, worries over future side effects, and not recommending vaccination to others were also investigated. Results: Completed questionnaires were received from 3361 blood donors (61% response rate) aged 18-65 years during blood sessions at mobile sites and within hospitals. Respondents were mainly males (72%). A very high proportion (92%) of responders had completed high school of higher education and the majority resided in large cities. Almost half were regular donors. A small proportion (5.4%) had undergone a mild COVID19 infection and 17.3% mentioned COVID-19 in a relative. 52% had already been vaccinated. The proportion vaccinated increased steadily throughout the study. Vaccine acceptance was highest in males 45-54 years old and in females 18-24 and 50-59 years old. All four EMA approved vaccines (Pfizer, Moderna, Astra Zeneca and Johnson) were used. Mild complications were reported by 21% of vaccinated donors after the first dose and 19% after the second. Thirty-five donors reported fever and local pain at the vaccination site after both doses. The vast majority (79%) of vaccinated donors were very satisfied with the vaccination procedure and only 10 complained. After vaccination, 20% of donors felt safe and protected against COVID-19 and 55% intended to continue all recommended personal protective measures in their families and felt satisfaction for doing the right thing. Among unvaccinated respondents, 48% were awaiting their appointment, 19% were undecided, 16% were afraid of complications, a few said that they were waiting for more information about the beneficial effect of the vaccines, or that COVID-19 is not a severe disease, and 10% did not specify their reasons. In the general population of Greece surveyed in May 2021 in the Flash Eurobarometer study, COVID-19 vaccination acceptance was 59%. The proportion of those with negative perception and attitude towards vaccination was 12%. Key reasons for getting vaccinated or not were similar to those found in blood donors. Summary/Conclusions: The benefits of vaccination and the need to continue all personal protection measures were highly recognized by blood donors, whether already vaccinated or awaiting vaccination. The perceptions and attitudes towards vaccination against COVID-19, especially of regular donors, are compatible with their high social, altruistic and humanitarian behaviour.

The natural history of COVID-19 in patients with IBD: A nationwide study by the hellenic society for the study of IBD

Introduction: COVID-19 has evolved into a global health crisis, variably affecting the management of patients with chronic illnesses. Patients with inflammatory bowel disease (IBD) may represent a vulnerable population due to the frequent administration of immune-modifying treatments. Aims & Methods: We aimed to depict the natural history of COVID-19 infection in Greek patients with IBD at a nationwide level via the unbiased reporting of all cases that were registered during the first and second waves of the pandemic. Following a national call from the Hellenic Society for the study of IBD, we enrolled all IBD patients with established diagnoses of COVID-19. Clinical and epidemiological data, including COVID-19 modifying factors and IBDassociated therapies, were analyzed against adverse outcomes (hospitalization, ICU admission, and death). Results: We identified 160 IBD patients who were diagnosed with COVID- 19 during the study period (male:56.9%;mean age=41.6 [SD=14.8] years;CD:64.4%). Adverse outcomes were reported in 34 patients (21.3%), including 3 ICU admissions (1.9%) and 2 deaths (1.3%). As shown in the table prognostic factor for adverse events due to COVID-19 in IBD patients were sought. Through multivariate logistic regression age (OR=1.04, 95% CI=1-1.08) and dyspnoea at presentation (OR=8.72, 95% CI=2.14-35.57) were identified as negative prognostic factors while there was also a tendency for fever at presentation (OR=3.23, 95% CI=0.91-11.43). In contrast, treatment with biologics, in particular anti-TNF agents, exerted a protective effect against an unfavorable course COVID-19 (OR=0.33, 95% CI=0.13-0.84). Patients on subcutaneous biologics were more likely to halt treatment due to the infection as compared to those on intravenous medications. Conclusion: IBD patients who developed COVID-19 had a benign course with adverse outcomes being scarce. Treatment with biologics had a beneficial effect, supporting the continuation of therapy during the pandemic. (Table Presented).