SARS-COV2-INFECTION after VACCINATION AGAINST COVID-19 in PATIENTS with RHEUMATIC DISORDERS in A REAL LIFE SETTING of A RHEUMATOLOGICAL OUTPATIENT CENTER

ABSTRACT

Background: Coronavirus SARS-CoV-2 and its associated disease COVID-19 have become a worldwide pandemic since its frst case in 12/2019. Since approvement of the frst vaccines against COVID-19 in Europe in 12/2020 a large vaccination campaign was started. Our patients with infammatory diseases (ID) were graded as higher risk, thus an early vaccination was possible. Many of our patients used the possibility and got vaccinated. Until now, there is few knowledge about the efficacy and safety of vaccination in patients with rheumatic disorders. There are some reports of less vaccination response in patients with ID (1). First reports of those patients with rheumatological disorder and infection with SARS-CoV2 are available (1,2). Nevertheless, there is few knowledge about SARS-CoV2-infection in patients with ID after vaccination against COVID-19, yet. Objectives: The aim of our study was to evaluate, how many patients got infected with SARS-CoV2 after vaccination against COVID-19 and the course of the disease. Methods: All consecutive patients of the routine follow up visits from 07/2021 to 01/2022 in our rheumatological outpatient center were questioned for SARS-CoV2-infection. In case of infection, they were questioned for vaccination status and the course of the disease. Results: N=1206 patients could be evaluated. N=1183/1206 (98.1%) vaccinations were documented. N=12/1183 (1%) patients got infected with SARS-CoV2 after at least 2 doses of vaccination against COVID-19. N=1/12 (8.3%) patient got infected after 3 doses of vaccination. N=3/12 (25%) received 2 doses Vaxzev-ira (AstraZeneca), n=2/12 (16,7) patients 1st dose Vaxzevira, 2nd dose Comir-naty (Biontech), n=7/58.3%) patients two doses Comirnaty. In n=8/12 (66.7%) patients antibody levels were available. N=7/8 (87,5%) patients developed high antibody levels after 2 vaccinations. N=1/8 (21,5%) patient developed any antibodies against SARS-CoV2 after 2 doses of Comirnaty, measured ≥4 months after 2nd vaccination dose. This patient was treated with Abatacept. This patient came down with COVID-19 5 months after complete vaccination and died after long-standing highly intensive care. All other patients developed a mild to moderate course of COVID-19, without need of hospitalizing. Conclusion: There is a very high number of patients (98,1%), who got vaccinated in a real life setting of our rheumatological outpatient center. We have seen only a low number of SARS-CoV2-infections (1%). Most patients developed high antibody levels after vaccination and fortunately had a mild to moderate course of COVID-19 in case of SARS-CoV2-infection, independently from the different vaccination agents. Nevertheless, 1 patient came down with COVID-19 5 months after complete vaccination and died after long-standing highly intensive care. This patient did not develop any antibodies after vaccination. In conclusion, vaccination seems to be effective in patients with rheumatological disorders. However, we must be aware of the small group of patients without antibody development, since they are at risk to have a fatal course. Yet, antibody testing is not recommended in routine clinical care by official recommendations, largely because it is still unknown which level of antibodies predicts protection (3). The booster campaign and 3rd vaccinations will change the current state again, but a revaluation and further studies will be necessary.