COVID-19 vaccinations and infections among individuals with systemic sclerosis: a Scleroderma Patient-centered Intervention Network (SPIN) Cohort study

Abstract

Background/Purpose: We previously surveyed adults with systemic sclerosis (SSc) regarding COVID-19 vaccination in April-May 2021. The objective of the present study was to update through June-July 2022 and assess self-reported (1) COVID-19 vaccination rates, including boosters; (2) vaccine-related adverse events; (3) peri-vaccination immunosuppressive medication management; (4) vaccine hesitancy; and (5) prevalence and severity of COVID-19 infections. Methods: In April-May 2021 and June-July 2022, SPIN Cohort participants completed surveys on COVID-19 vaccination and infection. Primary vaccine series was defined according to the standard for each COVID-19 vaccine; additional vaccine administrations were considered booster doses. Fully vaccinated was defined as having completed a primary vaccine series and at least one booster dose. Results: 544 participants completed the 2021 survey only, 101 the 2022 survey only, and 388 both surveys. Among 489 participants with 2022 data, 437 (89%) had received both primary and booster vaccines. Among all 1,033 participants, 960 (93%) received at least one dose. At least one adverse reaction was reported by 34% (330 of 960 participants) following first, 48% (314 of 657 participants) following second, and 34% (147 of 437 participants) following booster vaccine doses (primarily sore arm and fatigue); no severe adverse reactions were reported. SSc symptom worsening was reported in 6% (53 of 960) after the first, 6% after the second (39 of 657), and 4% (17 of 437) after the booster dose. Of participants taking methotrexate or mycophenolate (including Cellcept or Myfortic), 34 of 266 (13%) reported that they temporarily stopped or decreased their medication at the first dose, 32 of 215 (15%) at the second dose, and 28 of 148 (19%) for booster vaccination. Of 52 individuals not fully vaccinated with primary and booster doses in 2022, 29 (56%) reported worry about vaccine related SSc flares. 172 of 489 (35%) 2022 participants reported a history of at least one COVID-19 infection; 114 (66%) occurred after receiving at least a primary vaccine series. Among initial COVID-19 infections, 9 (5%) were asymptomatic, 66 (38%) involved mild symptoms, 82 (48%) moderate symptoms, and 15 (9%) required hospitalization. Conclusion: Most people with SSc in the study were fully vaccinated, and most continued their methotrexate or mycophenolate post-primary and booster vaccinations. Over half of vaccine-hesitant participants were concerned regarding risk of SSc flare; however, few vaccinated participants reported this. These data may be useful for counselling people with SSc regarding COVID-19 vaccine safety and outcomes.