S950 Symptomology Following SARS-CoV-2 mRNA Vaccination Among Patients With Inflammatory Bowel Disease Relative to Healthcare Workers

Abstract

Introduction: A common reason for SARS-CoV-2 vaccine hesitancy among patients with inflammatory bowel disease (IBD) is fear of post-vaccination adverse events (PMID 33549869). Post-vaccination symptoms within an IBD cohort were less frequent among those on biologic and immunosuppressive therapies (PMID 34047304). However, post-vaccination symptomology in IBD relative to a non-IBD population is unknown. Methods: We compared post-vaccination symptoms between healthcare workers (HCW) without IBD at an academic medical center and adult IBD patients both at the same center and across the United States. Recipients of BNT162b2 (Pfizer) or mRNA-1273 (Moderna) vaccines received automated electronic surveys one week after each dose to assess frequency, severity and duration of local and systemic post-vaccine symptoms. Significant symptoms were defined as moderate severity (at least some interference with daily activities) or greater, or duration lasting >2 days. We compared proportions using Chi-square; multivariable logistic regression was used to adjust for confounding variables. Results: Overall, 2324 subjects including 1391 with IBD (65% Crohn’s disease, 35% ulcerative colitis) and 933 HCW were included (Table 1). Overall, symptom frequency was lower in IBD compared to HCW after each dose (D1: 37% vs. 54%, P < 0.0001; D2: 55.5% vs 73.2%, P < 0.0001). After each dose, IBD subjects reported fewer injection site symptoms, fever or chills, fatigue or malaise, headache, dizziness, or lightheadedness, and muscle, bone, joint or nerve symptoms compared to HCW (P < 0.001 for each), but experienced more gastrointestinal (GI) symptoms after D1 (2.9% vs 6.0%, P = 0.001) but not after D2 (12.1% vs 12.7%, P = 0.75). Most symptoms were non-severe and lasted < 2 days. There were no differences in the proportion of those experiencing significant AE after either dose between IBD and HCW (Figure 1). On multivariable analysis, age >50 years and IBD were independently associated with fewer symptoms after both D1 (age OR 0.60 (95% CI 0.50 – 0.73), P < 0.001; IBD OR 0.45 (0.37 – 0.55, P < 0.001) and D2 (age OR 0.52 (95% CI 0.42 – 0.63), P < 0.001; IBD OR 0.44 (0.35 – 0.55, P < 0.001). Conclusion: IBD patients had overall fewer local and systemic symptoms after each dose, except for more frequent GI symptoms after D1 only. People with IBD can be reassured that post-vaccination symptoms are significantly reduced compared to HCW. Further study of post-vaccination GI symptoms in IBD is warranted.Figure 1.: Proportion of subjects experiencing varying degrees of local and systemic symptom severity after each SARS-CoV-2 mRNA vaccine dose (IBD, purple dots; healthcare workers, black dots)Table 1.: Proportion of symptoms experienced in IBD patients compared to healthcare workers after each dose of mRNA vaccination