SARS-COV-2 VACCINATION HESITANCY AND RISK OF DISEASE FLARE ARE BOTH LOW AMONG AN AUTOIMMUNE HEPATITIS PATIENT COHORT

ABSTRACT

Introduction: Exacerbation of pre-existing autoimmune disease and de novo vaccine-related autoimmunity after SARS-CoV-2 vaccine has been reported. These observations could lead to vaccine hesitancy among autoimmune hepatitis (AIH) patients. We aimed to assess hesitancy as well as prevalence of flare and disease onset after vaccination in an online AIH cohort. Methods: Electronic invitation to complete a vaccine-specific questionnaire was posted weekly to the Autoimmune Hepatitis Association (www.aihep.org) social media communities (membership 4700) over 3-weeks. Individuals 18 years or older with AIH diagnosis made by a physician were eligible. Vaccine hesitancy was defined as not receiving SARS-CoV-2 vaccine. AIH flare was defined as abnormal liver tests, when previously normal for 1 year, requiring escalation of immunosuppression within 2 months of SARS-CoV-2 vaccine. Continuous variables were summarized as means and standard deviations and pvalues were obtained using the Student's T-test. P-values for discrete variables were obtained from the Chi-Square test. The study was approved by local institutional review board. Results: A total of 643 individuals, 91.9% female, 91.8% white, mean age of 54 years and disease duration of 7 years, completed the questionnaire. A majority (599, 93.2%) had received at least 1 dose of vaccine including Pfizer-BioNTech (50.2%), Moderna (35.2%), AstraZeneca (11.1%), and Johnson & Johnson (3.5%). Hesitant patients were less likely female (79.5% vs 92.8%), younger (48 vs 55 years) and had higher prevalence of COVID- 19 infection (27.3% vs 10.2%) compared to vaccinated (p < 0.005 for all). Among those eligible, 95.3% received a second dose and 53.7% a third dose. Five patients did not receive a second vaccine dose because of prior adverse reactions or liver test elevations. A third dose was not administered to 263 patients because it was too early (57%), patient choice (21%), adverse side effects (9%), initial vaccine was Johnson & Johnson (7%), or abnormal liver tests (6%). Among those with normal liver tests prior to vaccination, 5% (15/288) reported increased tests after first or second dose. Liver test elevations were more likely in non-white (67% vs 95%, p = 0.001) and Hispanic/Latino patients (27% vs 4%, p = 0.001) compared to those without elevations. Only 2 patients had disease flare after first dose, whereas no AIH flares were reported after second. New diagnosis of AIH was reported 2 months beyond vaccination in 7% of vaccinated patients (42/599) 16 after first dose and 26 after second dose. Conclusion: SARS-CoV-2 vaccine hesitancy among AIH patients was minimal compared to the national average. Reports of liver test elevation and disease flare were rare after vaccination. New AIH diagnosis near vaccine was reported, yet new diagnosis was also observed in vaccine hesitant patients. (Table Presented)