Vaccine effectiveness against SARS-CoV-2 infection and severe outcomes among individuals with immune-mediated inflammatory diseases tested between March 1 and Nov 22, 2021, in Ontario, Canada: a population-based analysis

Jessica Widdifield^{1

2

3}, Jeffrey C Kwong^{2

4

5

6}, Simon Chen², Lihi Eder^{7

8}, Eric I Benchimol^{2

3

9

10

11}, Gilaad G Kaplan¹², Carol Hitchon¹³, J Antonio Aviña-Zubieta^{14

15}, Diane Lacaille^{14

15}, Hannah Chung², Sasha Bernatsky¹⁶

Affiliations

¹ Holland Bone & Joint Program, Sunnybrook Research Institute, Toronto ON, Canada.
² ICES, Toronto, Canada.
³ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁴ Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁶ Public Health Ontario, Toronto, Canada.
⁷ Division of Rheumatology, University of Toronto, Toronto, ON, Canada.
⁸ Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
⁹ Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
¹⁰ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
¹¹ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
¹² Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
¹³ Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹⁴ Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
¹⁵ Arthritis Research Canada, Vancouver, BC, Canada.
¹⁶ Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.

PMID: 35441151
PMCID: PMC9009845
DOI: 10.1016/S2665-9913(22)00096-0

Vaccine effectiveness against SARS-CoV-2 infection and severe outcomes among individuals with immune-mediated inflammatory diseases tested between March 1 and Nov 22, 2021, in Ontario, Canada: a population-based analysis

Jessica Widdifield et al. Lancet Rheumatol. 2022 Jun.

. 2022 Jun;4(6):e430-e440.

doi: 10.1016/S2665-9913(22)00096-0. Epub 2022 Apr 14.

Authors

Affiliations

¹ Holland Bone & Joint Program, Sunnybrook Research Institute, Toronto ON, Canada.
² ICES, Toronto, Canada.
³ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁴ Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁶ Public Health Ontario, Toronto, Canada.
⁷ Division of Rheumatology, University of Toronto, Toronto, ON, Canada.
⁸ Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
⁹ Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
¹⁰ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
¹¹ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
¹² Department of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
¹³ Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹⁴ Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
¹⁵ Arthritis Research Canada, Vancouver, BC, Canada.
¹⁶ Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.

PMID: 35441151
PMCID: PMC9009845
DOI: 10.1016/S2665-9913(22)00096-0

Abstract

Background: We estimated COVID-19 vaccine effectiveness against SARS-CoV-2 infection and severe COVID-19 outcomes among individuals with immune-mediated inflammatory diseases in Ontario, Canada.

Methods: In this population-based analysis, we used a test-negative design across four immune-mediated inflammatory disease population-based cohorts, comprising individuals with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and inflammatory bowel disease. We identified all SARS-CoV-2 tests done in these populations between March 1 and Nov 22, 2021 (a period in which there was rapid uptake of vaccines, and the alpha [B.1.1.7] and delta [B.1.617.2] SARS-CoV-2 variants were predominantly circulating in Canada) and separately assessed outcomes of SARS-CoV-2 infection and severe COVID-19 outcomes (hospitalisation due to COVID-19 and death due to COVID-19) for each disease group. We used multivariable logistic regression to estimate the effectiveness of one, two, and three doses of mRNA-based COVID-19 vaccine (BNT162b2 [Pfizer-BioNTech], or mRNA-1273 [Moderna]) among individuals at the time of SARS-CoV-2 testing.

Findings: Between March 1 and Nov 22, 2021, we identified 2127 (5·9%) test-positive cases among 36 145 individuals (26 476 [73·2%] were female and 9669 [26·8%] were male) with rheumatoid arthritis tested, 476 (6·1%) test-positive cases among 7863 individuals (4130 [52·5%] were female and 3733 [47·5%] were male) with ankylosing spondylitis tested, 3089 (6·5%) test-positive cases among 47 199 individuals (26 062 [55·2%] were female and 21 137 [44·8%] were male) with psoriasis tested, and 1702 (5·4%) test-positive cases among 31 311 individuals (17 716 [56·6%] were female and 13 595 [43·4%] were male) with inflammatory bowel disease tested. Adjusted vaccine effectiveness of two doses against infection was 83% (95% CI 80-86) in those with rheumatoid arthritis, 89% (83-93) among those with ankylosing spondylitis, 84% (81-86) among those with psoriasis, and 79% (74-82) among those with inflammatory bowel disease. After two vaccine doses, effectiveness against infection generally peaked 31-60 days after vaccination and waned gradually with each additional month. Vaccine effectiveness against severe outcomes after two doses was 92% (95% CI 88-95) in those with rheumatoid arthritis, 97% (83-99) among those with ankylosing spondylitis, 92% (86-95) among those with psoriasis, and 94% (88-97) among those with inflammatory bowel disease. Vaccine effectiveness after a third dose against infection was similar to or higher than after the second dose (ranging from 76% [47-89] to 96% [72-99]), although due to a paucity of events, estimates could not be calculated for some subgroups for severe outcomes.

Interpretation: Two vaccine doses were found to be highly effective against both SARS-CoV-2 infection and severe COVID-19 outcomes in patients with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and inflammatory bowel disease during the study period. Research is needed to determine the durability of effectiveness of three doses over time, particularly against emerging variants.

Funding: Public Health Agency of Canada.

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Conflict of interest statement

GGK has received honoraria for speaking or consultancy from AbbVie, Janssen, Pfizer, and Takeda; has received research support from Janssen, AbbVie, GlaxoSmithKline, Merck, Ferring, and Shire; has been a consultant for Gilead; and shares ownership of two patents (Treatment of inflammatory disorders, autoimmune disease, and PBC, UTI Limited Partnership, assignee. patent WO2019046959A1. PCT/CA2018/051098. Sept 7, 2018). EIB has acted as a legal consultant for Hoffman La-Roche and Peabody & Arnold, and consultant for McKesson Canada for matters unrelated to a medication used to treat inflammatory bowel disease or COVID-19 (ie, unrelated to the submitted work). LE reports grants from AbbVie, Novartis, UCB, Pfizer, and Eli Lilly. All other authors declare no competing interests.

Figures

**Figure**
Unadjusted (A) and adjusted* (B) vaccine effectiveness against SARS-CoV-2 infection by time since second dose for those tested for SARS-CoV-2 between March 1 and Nov 22, 2021 Datapoints are vaccine effectiveness, with whiskers showing 95% CIs. *Adjusted for age, sex, region, biweekly period of test, number of previous SARS-CoV-2 tests, past SARS-CoV-2 infection, presence of any comorbidity, previous receipt of influenza vaccine, and area-level sociodemographic variables.

See this image and copyright information in PMC

References

1. Nasreen S, Chung H, He S, et al. Effectiveness of COVID-19 vaccines against symptomatic SARS-CoV-2 infection and severe outcomes with variants of concern in Ontario. Nat Microbiol. 2022;7:379–385. - PubMed
1. Chung H, He S, Nasreen S, et al. Effectiveness of BNT162b2 and mRNA-1273 COVID-19 vaccines against symptomatic SARS-CoV-2 infection and severe COVID-19 outcomes in Ontario, Canada: test negative design study. BMJ. 2021;374 - PMC - PubMed
1. Buchan SA, Chung H, Brown KA, et al. Effectiveness of COVID-19 vaccines against omicron or delta symptomatic infection and severe outcomes. medRxiv. 2022 doi: 10.1101/2021.12.30.21268565. published online on Jan 28. (preprint). - DOI - PMC - PubMed
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Vaccine effectiveness against SARS-CoV-2 infection and severe outcomes among individuals with immune-mediated inflammatory diseases tested between March 1 and Nov 22, 2021, in Ontario, Canada: a population-based analysis

Affiliations

Vaccine effectiveness against SARS-CoV-2 infection and severe outcomes among individuals with immune-mediated inflammatory diseases tested between March 1 and Nov 22, 2021, in Ontario, Canada: a population-based analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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