Omicron variant infection in inflammatory rheumatological conditions - outcomes from a COVID-19 naive population in Aotearoa New Zealand

Jonathon Brooks; Anna Montgomery; Nicola Dalbeth; Mark Sapsford; Rachel Ngan Kee; Amy Cooper; Vicki Quincey; Suleman Bhana; Monique Gore-Massy; Jonathan Hausmann; Jean Liew; Pedro M Machado; Paul Sufka; Emily Sirotich; Philip Robinson; Zachary Wallace; Jinoos Yazdany; Rebecca Grainger

doi:10.1016/j.lanwpc.2023.100843

Omicron variant infection in inflammatory rheumatological conditions - outcomes from a COVID-19 naive population in Aotearoa New Zealand

Lancet Reg Health West Pac. 2023 Jul 18:38:100843. doi: 10.1016/j.lanwpc.2023.100843. eCollection 2023 Sep.

Authors

Jonathon Brooks¹, Anna Montgomery², Nicola Dalbeth^{3

4}, Mark Sapsford¹, Rachel Ngan Kee⁵, Amy Cooper⁵, Vicki Quincey⁶, Suleman Bhana⁷, Monique Gore-Massy⁸, Jonathan Hausmann^{9

10}, Jean Liew¹¹, Pedro M Machado^{12

13

14}, Paul Sufka¹⁵, Emily Sirotich¹⁶, Philip Robinson^{17

18}, Zachary Wallace¹⁹, Jinoos Yazdany², Rebecca Grainger^{5

20}

Affiliations

¹ Te Whatu Ora Health New Zealand Counties Manukau, Auckland, New Zealand.
² Division of Rheumatology, University of California, San Francisco, CA, USA.
³ Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
⁴ Te Whatu Ora Health New Zealand Te Toka Tumai Auckland, New Zealand.
⁵ Department of Medicine, University of Otago Wellington, New Zealand.
⁶ Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand.
⁷ Pfizer, Inc., New York, NY, USA.
⁸ Lupus Foundation of America, USA.
⁹ Program in Rheumatology, Division of Immunology, Boston Children's Hospital, Boston, MA, USA.
¹⁰ Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA.
¹¹ Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
¹² Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.
¹³ National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
¹⁴ Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
¹⁵ Healthpartners, St. Paul, MN, USA.
¹⁶ Yale School of Medicine, New Haven, CT, USA.
¹⁷ University of Queensland School of Clinical Medicine, Herston, Queensland, Australia.
¹⁸ Department of Rheumatology, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland, Australia.
¹⁹ Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, USA.
²⁰ Te Whatu Ora Health New Zealand Capital Coast and Hutt, Wellington, New Zealand.

Abstract

Background: Due to geographic isolation and border controls Aotearoa New Zealand (AoNZ) attained high levels of population coronavirus disease-19 (COVID-19) vaccination before widespread transmission of COVID-19. We describe outcomes of SARS-CoV-2 infection (Omicron variant) in people with inflammatory rheumatic diseases in this unique setting.

Methods: This observational study included people with inflammatory rheumatic disease and SARS-CoV-2 infection in AoNZ between 1 February and 30 April 2022. Data were collected via the Global Rheumatology Alliance Registry including demographic and rheumatic disease characteristics, and COVID-19 vaccination status and outcomes. Multivariable logistic regression was used to explore associations of demographic and clinical factors with COVID-19 hospitalisation and death.

Findings: Of the 1599 cases included, 96% were from three hospitals that systematically identified people with inflammatory rheumatic disease and COVID-19. At time of COVID-19, 1513 cases (94.6%) had received at least two COVID-19 vaccinations. Hospitalisation occurred for 104 (6.5%) cases and 10 (0.6%) patients died. Lower frequency of hospitalisation was seen in cases who had received at least two vaccinations (5.9%), compared to the unvaccinated (20.6%) or those with a single vaccine dose (10.7%). In multivariable adjusted models, people with gout or connective tissue diseases (CTD) had increased risk of the combined outcome of hospitalisation/death, compared to people with inflammatory arthritis. Glucocorticoid and rituximab use were associated with increased rates of hospitalisation/death. All patients who died had three or more co-morbidities or were over 60 years old.

Interpretation: In this cohort with inflammatory rheumatic diseases and high vaccination rates, severe outcomes from SARS-CoV-2 Omicron variant were relatively infrequent. The outcome of Omicron variant infection among vaccinated but SARS-CoV-2 infection-naive people with inflammatory rheumatic disease without other known risk factors were favourable.

Funding: Financial support from the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) included management of COVID-19 Global Rheumatology Alliance funds.

Keywords: COVID-19; Outcomes; Rheumatic disease; SARS-CoV-2.