Impact of COVID-19 vaccination in patients with auto-immune diseases – A nationwide survey from 842 autoimmune patients

Abstract

To combat the Coronavirus Disease 2019 (COVID-19) pandemic, the World Health Organization announced the emergency license for the usage of COVID-19 vaccinations. Various literature postulated a few cross-talks between autoimmune disease and COVID-19 vaccination. The molecular mimicry between autoimmune diseases as well as autoimmune antibodies and the antibodies against Severe Acute Respiratory Syndrome Coronavirus-2 S proteins triggers the development of a severe form of autoimmune disease. The causal association between autoimmune disease and COVID-19 vaccinations is still under debate. Hence, in this study, we aim to analyze the impact of COVID-19 vaccination on patients with autoimmune diseases. Patients were recruited from a nationwide survey throughout India from October 1, 2021, to December 30, 2021. All patients of autoimmune diseases enrolled in this study had received a diagnosis of COVID-19. A Google form was created in the English language with relevant items, including demographic variables, COVID-19 vaccination-related variables, and its impact on autoimmune disease. Association between the COVID-19 severity, vaccination status, and autoimmune disease status was analyzed. Eight hundred and forty-two patients with autoimmune disease participated in the study with 86% of vaccination rate. We noted comparable infection rates among vaccinated (37.5%, n = 272) and non-vaccinated (33.3%, n = 39) respondents with autoimmune disease (P = 0.38). Although 22.5% (n = 163) of patients with autoimmune disease demonstrated deterioration following vaccination, 75.3% (n = 546) of patients did not show any change in disease profile. We noted a significant increase in the computed tomography (CT) severity score of COVID-19 infection among non-vaccinated individuals (odds ratio = 1.1,95% confidence interval [0.29, 2.29], P < 0.001). Moreover, we also noted a significant increase in the need (P = 0.01) and length of hospitalization (P < 0.001) among COVID-19 non-vaccinated individuals. We also noted vaccination significantly prevented an acute flare-up of auto-immune disease when infected with COVID-19 (P < 0.001). Although vaccination did not affect the incidence of disease among patients with auto-immune disease, it did significantly decrease the CT severity score, hospitalization rate, and length of stay following COVID-19 infection. Moreover, vaccination also prevented acute flare-ups of autoimmune disease following COVID-19 infection.