COVID-19 severity, breakthrough infections and vaccine safety in young individuals with autoimmune diseases: insights from the COVAD study
Authors: Alunno Alessia , Carubbi Francesco , Tan Ai Lyn , Sen Parikshit , Cavagna Lorenzo , Joshi Mrudula , Day Jessica , Saha Sreoshy , Gutiérrez Carlos Enrique Toro , Caballero-Uribe Carlo Vinicio , Distler Oliver , Chinoy Hector , Aggarwal Rohit , Agarwal Vikas , Gupta Latika ,   COVAD Study Group, Nikiphorou Elena , Nune Arvind , Lilleker James B. , Pauling John D. , Wincup Chris , Gasparyan Armen Yuri , Agarwal Vishwesh , Kadam Esha , Barman Bhupen , Singh Yogesh Preet , Ranjan Rajiv , Jain Avinash , Pandya Sapan C. , Pilania Rakesh Kumar , Sharma Aman , Manoj M Manesh , Gupta Vikas , Kavadichanda Chengappa G. , Patro Pradeepta Sekhar , Ajmani Sajal , Phatak Sanat , Goswami Rudra Prosad , Chowdhury Abhra Chandra , Mathew Ashish Jacob , Shenoy Padnamabha , Asranna Ajay , Bommakanti Keerthi Talari , Shukla Anuj , Pande Arunkumar R. , Gaur Prithvi Sanjeevkumar , Mamadapur Mahabaleshwar , Ghodke Akanksha , Chandwar Kunal , Darooka Naitica , Yaadav Praggya , Salim Babur , Fazal Zoha Zahid , Javaid Mahnoor , Yildrim Resit , Makol Ashima , Chatterjee Tulika , Patel Aarat , Giannini Margherita , Maurier Francois , Campagne Julien , Meyer Alain , Del Papa Nicoletta , Sambataro Gianluca , Fabiola Atzeni , Govoni Marcello , Parisi Simone , Bocci Elena Bartoloni , Sebastiani Gian Domenico , Fusaro Enrico , Sebastiani Marco , Quartuccio Luca , Franceschini Franco , Sainaghi Pier Paolo , Orsolini Giovanni , De Angelis Rossella , Danielli Maria Giovanna , Venerito Vincenzo , Grignaschi Silvia , Giollo Alessandro , Andreoli Laura , Lini Daniele , Iannone Florenzo , Fornaro Marco , Traboco Lisa S. , Shaharir Syahrul Sazliyana , Tan Chou Luan , Wibowo Suryo Anggoro Kusumo , Ramos Abraham Edgar Gracia- , Saavedra Miguel A. , Tehozol Erick Adrian Zamora , Serrano Jorge Rojas , La Torre Ignacio García-De , Colunga-Pedraza Iris J. , Merayo-Chalico Javier , Aranega Raquel , Loarce-Martos Jesús , Prieto-González Sergio , Shinjo Samuel Katsuyuki , Hoff Leonardo Santos , Kuwana Masataka , Yoshida Akira , Nakashima Ran , Sato Shinji , Kimura Naoki , Kaneko Yuko , Gono Takahisa , Parodis Ioannis , Milchert Marcin , Knitza Johannes , Tomaras Stylianos , Proft Fabian Nikolai , Holzer Marie-Therese , Schreiber Karen , Gromova Margarita Aleksandrovna , Aharonov Or , Nagy-Vincze Melinda , Griger Zoltán , Ziade Nelly , Hmamouchi Ihsane , bouchti Pr Imane El , Baba Zineb , Dey Dzifa , Ima-Edomwonyi Uyi , Dedeke Ibukunoluwa , Airenakho Emorinken , Madu Nwankwo Henry , Yerima Abubakar , Olaosebikan Hakeem , Okwara Celestine Chibuzo , Becky A , Koussougbo Ouma Devi , Palalane Elisa , Langguth Daman , Limaye Vidya , Needham Merrilee , Srivastav Nilesh , Hudson Marie , Landon-Cardinal Océane , Velikova Tsvetelina , Shumnalieva Russka , Zuleta Wilmer Gerardo Rojas , Arbeláez Álvaro , Cajas Javier , Silva José António Pereira , Fonseca João Eurico , Zimba Olena , So Ho , Ugarte-Gil Manuel Francisco , Chinchay Lyn , Bernaola José Proaño , Pimentel Victorio , Hasan A. T. M. Tanveer , Vaidya Binit , Gheita Tamer A. , Fathi Hanan Mohamed , Mohammed Reem Hamdy A. , Chen Yi-Ming , Harifi Ghita , Kibbi Lina El , Halabi Hussein , Goo Phonpen Akawatcharangura , Katchamart Wanruchada , Fuentes-Silva Yurilís , Cabriza Karoll , Losanto Jonathan , Colaman Nelly , Cachafeiro-Vilar Antonio , Bautista Generoso Guerra , Ho Enrique Julio Giraldo , Nunez Lilith Stange , Vergara M Cristian , Báez Jossiell Then , Alonzo Hugo , Pastelin Carlos Benito Santiago , Salinas Rodrigo García , Obiols Alejandro Quiñónez , Chávez Nilmo , Ordóñez Andrea Bran , Llerena Gil Alberto Reyes , Sierra-Zorita Radames , Arrieta Dina , Hidalgo Eduardo Romero , Saenz Ricardo , Escalante M Idania , Calapaqui Wendy , Quezada Ivonne , Arredond Gabriela 
Published: July 2024

Notwithstanding the wealth of literature on COVID-19, studies focusing on young adults with autoimmune diseases (AD) are lacking. To determine early (within 7 days) and late (after 7 days) anti-SARS-CoV-2 vaccine-related adverse events (AEs), post-vaccine disease flares, COVID-19 severity and breakthrough infections (B-INFs) in young people with rheumatic diseases (RMDs) and non-rheumatic autoimmune diseases (nr-ADs) compared to healthy controls (HC). Data were captured through the international COVID-19 vaccination in autoimmune diseases (COVAD) 1 and 2 questionnaires. Of 20,685 complete responses, we identified 6010 from patients aged 18–35 years (1692 RMD, 400 nrADs, 3918 HC) who received up to 4 vaccine doses. BNT162b2 was the most frequently administered vaccine and prior to vaccination, 7% of people with nrAD were taking immunosuppressants (IS) versus 80% in RMDs. Early mild AEs were more frequent in RMDs (93%) and nr-ADs (92%) compared to HC (85%). The frequency of late mild AEs was < 20% in all groups. Severe AEs were rare. SARS-CoV-2 infection rates were similar across all groups, however, RMD patients reported a single episode of infection more frequently than nrADs and HC, while nrADs reported multiple infections more frequently than RMD. Self-reported disease flares were reported by 10% or RMD and 7% of nrAD patients. Our study reinforces the safety of anti-SARS-CoV-2 vaccine also in young people with ADs, but it also highlights that among young individuals the number and clinical picture of SARS-CoV-2 infections is affected more by the type of AD rather than by coexisting IS therapy.