Problems associated with new coronavirus infection vaccination in patients with rheumatic diseases

BACKGROUND: Decreasing new coronavirus infection-associated morbidity and mortality among patients with rheumatic diseases is one of the main goals of current rheumatology. Vaccination may be one of the ways to limit the incidence of new coronavirus infection in patients with rheumatic diseases.

AIM: To evaluate the results of vaccination in the patients with rheumatic diseases against the new coronavirus infection according to the data from real clinical practice and a review of the literature.

MATERIALS AND METHODS: 68 out of 556 literary medical sources and data from the St. Petersburg register of patients with rheumatic diseases as of September 1, 2021 (n = 16,263) have been analyzed. The data from the register have been compared with the population data on morbidity and mortality from a new coronavirus infection (data of the Ministry of Health of the Russian Federation).

RESULTS: Despite the matched incidence rates of new coronavirus infection associated mortality and morbidity in rheumatological patients and population (morbidity 26.2 and 34.1% mortality 3.47 and 2.8%, respectively), the patients with rheumatic diseases demonstrate three times lower frequency of vaccination against new coronavirus infection (13.2% of patients versus 31.8% in the population, respectively). Vaccination is prescribed by rheumatologists in 8.2%; 75% of patients are self-vaccinated. Data analysis from 2,134 rheumatological patients vaccinated in 2021 have shown a decrease in the incidence of the new coronavirus infection to 0.25% compared to the incidence of unvaccinated patients (25.6%) in the absence of deaths among the vaccinated. There were no serious adverse reactions to vaccination among the vaccinated rheumatological patients; in 12% of the cases, pyrogenic post-vaccination reactions, arthralgias and myalgias have been noted. A prolonged pyrogenic reaction, myalgia, arthralgia, hypercreatinophosphataemia have been revealed in 11 patients, who recovered within 6 months. Exacerbations of the underlying rheumatic disease after vaccination has been revealed in 12% of the cases, all the exacerbations have been resolved with the use of standard tactics recommended by the Association of Russian Rheumatologists.

The question of the timing and the necessity of revaccination, as well as the long-term efficacy and safety of vaccination, has not yet been resolved. Determining the level of antibodies to coronavirus infection can be a useful option in the formation of an individual vaccination plan for rheumatological patients in the present conditions.

CONCLUSIONS: The register data show the efficacy and safety of vaccination against COVID-19 in rheumatological patients in the short term, including in relation to exacerbation of rheumatic disease, and justify the need to comply with epidemiological safety measures after vaccination.