Originally published by our sister publication Infectious Disease Special Edition
Marie Rosenthal, MS
Despite vaccination, people with an immunocompromising condition, particularly those with multiple sclerosis (MS), are disproportionately affected by COVID-19 compared with the general population. This was seen during the omicron era, according to information presented at the ESCMID (European Society of Clinical Microbiology and Infectious Diseases) 2024 Global Congress (formerly called ECCMID), held in Barcelona, Spain (oral abstract 0051).
Even after receiving at least three COVID-19 vaccinations, people with MS had an almost six times greater risk for COVID-19 hospitalization and nearly four times greater risk for COVID-19 deaths compared with the general population, according to Lance Turtle, BSc, PhD, MBBS, FRCP, DTMH, the chair and an honorary consultant physician in infectious diseases, and the deputy head of the Department of Clinical Infection, Microbiology and Immunology, at the University of Liverpool, in England.
“There is a fair amount of COVID-19 fatigue, I think amongst both the patients, the public and other clinicians,” Dr. Turtle said. “But I want to talk to you about one of many groups who I think are not getting COVID-19 fatigue. They’re still suffering disproportionately from this disease, and this is at least in part due to suboptimal vaccine responses.”
Smaller studies have suggested that people taking immunomodulating suppressive treatments are at increased risk for COVID-19. Dr. Turtle and his colleagues wanted to know whether people with MS were at risk and the degree of that risk. He presented data from the INFORM (INvestigation oF cOvid-19 Risk among iMmunocompromised populations) retrospective cohort study, which analyzed data of nearly 12 million people 12 years of age and older in England to assess COVID-19’s impact, risk and healthcare resource use among immunocompromised populations beginning in 2022 as omicron variants became dominant. The INFORM study is a data science study based on a random sample of 25% of the NHS digital data of the population of England.
Much of the data for INFORM research comes from the primary care GDPPR database, but that can’t be used to define patients as suffering with MS, because it did not include any MS diagnostic codes. So, the researchers turned to a different database, the hospital episode statistics (HES) database, which is a database of diagnostic coding on discharge from the hospital—what Dr. Turtle referred to was secondary care—and day case admission such as someone who received an infusion and then left the hospital the same day.
“The discharge coding defines people who’ve got multiple sclerosis, and their data are then linked back with the GDPPR database. And that enables the extraction of baseline demographic data, age, sex, comorbidity, etc., and COVID-19 testing and outcome details,” he explained.
They looked at people with a diagnosis of MS from January 2017 to Jan. 1, 2022, and identified more than 16,000 patients with MS in England. They also considered various factors, such as age, sex, comorbid conditions, COVID-19 testing, hospitalization and deaths for the calendar year 2022.
Most of the people defined as MS patients were older than the general population of England, and most were white. In addition, the patients had two or three additional comorbidities, Dr. Turtle explained. The MS population also received more vaccinations than the general population.
“About 80% of MS patients identified in this way were fully vaccinated with three or more doses of a COVID-19 vaccine compared with 50% of the general population at that point in 2022,” Dr. Turtle said.
They were only able to define a portion of the population with MS, he explained, about one in every two patients with MS.
They found absolute risk for MS patients of hospitalization of 13.7 per 1,000 patient-years and about 1.5 per 1,000 person-years risk for death annually form COVID-19. When they accounted for factors such as race, age, sex and comorbidities, the relative risk for a COVID-19 hospital admission was about 5.5-fold for patients with MS and a relative risk for death of about 3.5-fold compared with the general population. And vaccination while protective, did not completely reduce the risk, he told Infectious Disease Special Edition.
They compared these risks to other immunocompromised groups and found that people with MS had the third highest risk for hospital admission with COVID-19, which was equal to people with primary immune deficiency, but after people who received a recent stem cell or organ transplant.
Patients with MS who had a hospital encounter in the past five years “were disproportionately affected by COVID-19,” Dr. Turtle said, even if they were fully vaccinated.
“Most of the illness and death occurred in people who were fully vaccinated compared with the general population. There was about a 5.5-fold increased risk for hospitalization and about a 3.5-fold increased risk for death,” he said.
Although the research did not consider their immunotherapies, Dr. Turtle said the researchers suspect the increased risk of hospital admission and death had more “to do with the therapy, not the disease.”
INFORM data from January to June 2023 show that despite receiving at least four COVID-19 vaccinations, many immunocompromised individuals remain insufficiently protected against the virus and are at a disproportionately high risk for severe outcomes from COVID-19, including hospitalization and death, compared with the general population.
Among those having at least four COVID-19 vaccinations, the risk for COVID-19 hospitalization was particularly high in certain immunocompromised groups compared with the general population:
- 18 times higher for people who received stem cell transplants in the last two years;
- nine times higher for those with hematologic malignancies on active treatment in the last six months; and
- nearly seven times higher for organ transplant recipients in the last five years.
- Other patient populations with at least a two times greater risk for COVID-19 hospitalizations included patients with end-stage kidney disease.
The study also identified specific immunocompromised populations, including those with hematologic malignancies, organ/stem cell transplant recipients, those with end-stage kidney disease on dialysis and those taking certain immunosuppressive medicines who continue to have an increased risk for severe COVID-19 outcomes.
COVIDRIVE Study
In a separate analysis of the COVIDRIVE study, an ongoing noninterventional, multicountry, multicenter, hospital-based study, researchers found that immunocompromised people still accounted for about one-fourth of COVID-19 hospitalizations and deaths (poster 382). COVIDRIVE is run by id.DRIVE, a public–private partnership of vaccine companies and research groups who joined forces in 2021 to collect real-world data on the effectiveness of COVID-19 vaccines in Europe.
The new data presented at ESCMID are based on an analysis of 5,280 COVIDRIVE patients who were hospitalized with severe acute respiratory infections at contributing sites in Belgium, Italy and Spain from May 1, 2021, to May 31, 2023. Immunocompromised patients were defined by the presence of a chronic immunocompromising condition or having cancer.
New data from COVIDRIVE found:
- Among those testing positive for SARS-CoV-2 (and thus diagnosed with severe COVID-19), nearly 30% were immunocompromised (including due to immunodeficiency, organ transplant and/or cancer), despite comprising just up to 4% of the population.
- The prevalence of people with immunocompromising conditions who tested positive for SARS-CoV-2 was markedly higher than those who tested negative from February 2022 onward, and greater than 50% in July 2023.
- Most patients hospitalized for severe acute respiratory infection had multiple chronic conditions (20.1% had four or more), with those testing positive observed to have a slightly higher prevalence of chronic kidney disease than those who tested negative.
