The danger of poor outcomes during acute COVID-19 infection is well established for individuals with systemic autoimmune rheumatic disorders (SARDs), but the consequences of other long-term COVID-19 sequelae are less clear. Post-acute sequelae of COVID-19, or PASC, are symptoms that continue or develop after an acute infection and are frequently referred to as "Long COVID." A recent study looked into the relationship between COVID-19 vaccination and risk of PASC in patients with SARDs because individuals with SARDs are frequently at increased risk for severe, acute COVID-19 infection and may have impaired immune responses.
A prospective, long-term study was carried out by Mass General Brigham (MGB) researchers, who invited patients to take part. According to the US CDC definition, the primary outcome was PASC ("long COVID"), which is any persistent symptom at least 28 days after COVID-19 infection. A secondary outcome was persistent symptom at least 90 days after COVID-19 infection (per the WHO definition). Being fully immunized at the commencement of COVID-19 was the exposure of interest, as opposed to a partially immunized or unvaccinated condition. The difference in symptom-free duration between people with breakthrough infection and those without breakthrough infection was evaluated using restricted mean survival time. Being unvaccinated or only partially immunized at the time of COVID-19 diagnosis was considered to be a non-breakthrough COVID-19 infection.The probabilities of PASC at 28 and 90 days were calculated using multivariable logistic regression, once more comparing those with breakthrough infection to those without breakthrough infection.
Between March 2020 and July 2022, patients over the age of 18 who had been diagnosed with an immune-mediated disease and tested positive for COVID-19 by PCR or antigen nasopharyngeal swab were sought out. In the study, 280 patients were assessed; their average age was 53 years, and 82% of them were white. Of these, 41% had received all recommended vaccinations, 28% had received some, and 11% had not. Inflammatory arthritis was the most prevalent rheumatic autoimmune disease (59%) and was followed by connective tissue disease (24%) and vasculitis (9%). Researchers inquired about the onset and length of COVID-19 symptoms, any therapies administered, hospitalization, vaccination status, and the time it took for symptoms to go away.Fever, sore throat, cough, nasal congestion, dyspnea, chest pain, rash, myalgia, exhaustion, headache, nausea/vomiting, diarrhea, anosmia, dysgeusia, and joint pain were among the symptoms of COVID-19 that were evaluated.
After controlling for comorbidities and the use of four immune-suppressing medicines, fully immunized patients were 90% less likely to experience long COVID 3 months after infection (aOR 0.010) and 50% less likely to experience long COVID symptoms at 28 days (aOR 0.49). (anti-CD20 monoclonal antibodies, methotrexate, mycophenolate or glucocorticoids). Those who were fully immunized (breakthrough infections) had significantly lower symptom duration and, on average, 21 more days without symptoms in follow-up compared to those who were not immunized (p = 0.04). In addition, the vaccinated group scored less painfully and fatiguedly than the unprotected group.One intriguing finding was that whether a breakthrough infection occurred or not, the severity of PASC as determined by patient-reported metrics for exhaustion, pain, disability, and health-related quality of life was comparable.
The examination at a single academic healthcare institution and the cohort's lack of diversity in terms of race and ethnicity are two of the study's weaknesses. Additionally, breakthrough infections were more frequently seen later in the pandemic when the Delta and Omicron variants were prevalent. As a result, the authors hypothesize that some findings may not be related to vaccine impact but rather to variations in the SARS-CoV-2 variant. Observational studies imply that in the general population, those who receive the vaccine before being infected have a lower likelihood of developing long-lasting COVID symptoms, and that the vaccine can help most people with long-lasting COVID symptoms.This study provides an intriguing viewpoint on the role of vaccination in reducing the rate of long COVID (PASC) symptoms in patients with rheumatic disease following acute COVID-19 infection. This perspective can be used in patient counseling regarding the vaccines for those who are still unvaccinated.