AUTHOR=Kharouf Fadi , Eviatar Tali , Braun Maya , Pokroy-Shapira Elisheva , Brodavka Michal , Zloof Yair , Agmon-Levin Nancy , Toledano Kochava , Oren Shirly , Lidar Merav , Zisman Devy , Tavor Yonit , Amit-Vazina Mirit , Sabbah Firas , Breuer Gabriel S. , Dagan Amir , Beshara-Garzuzi Rima , Markovits Doron , Elias Muna , Feld Joy , Tayer-Shifman Oshrat , Gazitt Tal , Reitblatt Tatiana , Rubin Limor , Haddad Amir , Giryes Sami , Paran Daphna , Peleg Hagit , Molad Yair , Elkayam Ori , Mevorach Dror , Balbir-Gurman Alexandra , Braun-Moscovici Yolanda TITLE=A deep look into the storm: Israeli multi-center experience of coronavirus disease 2019 (COVID-19) in patients with autoimmune inflammatory rheumatic diseases before and after vaccinations JOURNAL=Frontiers in Immunology VOLUME=14 YEAR=2023 URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2023.1064839 DOI=10.3389/fimmu.2023.1064839 ISSN=1664-3224 ABSTRACT=Objective

We aimed to characterize the course of COVID-19 in autoimmune inflammatory rheumatic disease (AIIRD) patients in Israel, taking into consideration several remarkable aspects, including the outcomes of the different outbreaks, the effect of vaccination campaigns, and AIIRD activity post-recovery.

Methods

We established a national registry of AIIRD patients diagnosed with COVID-19, including demographic data, AIIRD diagnosis, duration and systemic involvement, comorbidities, date of COVID-19 diagnosis, clinical course, and dates of vaccinations. COVID-19 was diagnosed by a positive SARS-CoV-2 polymerase chain reaction.

Results

Israel experienced 4 outbreaks of COVID-19 until 30.11.2021. The first three outbreaks (1.3.2020 – 30.4.2021) comprised 298 AIIRD patients. 64.9% had a mild disease and 24.2% had a severe course; 161 (53.3%) patients were hospitalized, 27 (8.9%) died. The 4th outbreak (delta variant), starting 6 months after the beginning of the vaccination campaign comprised 110 patients. Despite similar demographic and clinical characteristics, a smaller proportion of AIIRD patients had negative outcomes as compared to the first 3 outbreaks, with regards to severity (16 patients,14.5%), hospitalization (29 patients, 26.4%) and death (7 patients, 6.4%). COVID-19 did not seem to influence the AIIRD activity 1-3 months post-recovery.

Conclusions

COVID-19 is more severe and has an increased mortality in active AIIRD patients with systemic involvement, older age and comorbidities. Vaccination with 3 doses of the mRNA vaccine against SARS-CoV-2 protected from severe COVID-19, hospitalization and death during the 4th outbreak. The pattern of spread of COVID-19 in AIIRD patients was similar to the general population.