Characteristics associated with the residual risk of severe COVID-19 after a complete vaccination schedule: A cohort study of 28 million people in France

Semenzato, Laura; Botton, Jérémie; Drouin, Jérôme; Baricault, Bérangère; Bertrand, Marion; Jabagi, Marie-Joëlle; Cuenot, François; Vu, Stéphane Le; Dray‐Spira, Rosemary; Weill, Alain; Zureik, Mahmoud

doi:10.1016/j.lanepe.2022.100441

Cited by 20 publications

(25 citation statements)

References 30 publications

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“…However, the sensitivity analysis of the vaccination periods did not reveal any significant differences from the main results. In addition, Semenzato et al 2,3 reported an increased risk of severe COVID-19 in SOTRs during the first wave in 2020 and a residual risk in the period after vaccination. Belatacept, a hospital-based immunosuppressant, was not included in our analyses because its reimbursement data are not provided in the SNDS.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

COVID-19 Hospitalization in Solid Organ Transplant Recipients on Immunosuppressive Therapy

Kolla,

Weill,

Zaidan

et al. 2023

JAMA Netw Open

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ImportanceSolid organ transplant recipients are at high risk of severe infection with SARS-CoV-2 compared with the general population. However, factors associated with COVID-19–related severity in this population are still insufficiently explored in the literature.ObjectiveTo examine which health conditions and immunosuppressive drugs for preventing graft rejection are associated with the risk of COVID-19–related hospitalization in solid organ transplant recipients.Design, Setting, and ParticipantsUsing the French National Health Data System, this cohort study assessed patients of any age who received transplants between their date of birth and entry into the cohort on February 15, 2020. The cohort was followed up between February 15, 2020, and July 31, 2022.ExposuresImmunosuppressive drugs, including steroids, and health conditions (age, sex, and comorbidities).Main Outcomes and MeasuresThe main outcome was hospitalization for COVID-19, defined by main diagnostic International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes. Factors associated with the outcome were identified with a nonconditional logistic regression. Confounding by indication was controlled using a multivariable model with adjustment for individual confounders. Each transplanted organ was examined separately.ResultsOverall, 60 456 participants (median [IQR] age, 59 [47-67] years; 63.7% male) were included in the study, of whom 41 463 (68.6%) had kidney transplants, 14 464 (23.9%) had liver transplants, 5327 (8.8%) had heart transplants, and 2823 (4.6%) had lung transplants. Among them, 12.7% of kidney transplant recipients, 6.4% of liver transplant recipients, 12.9% of heart transplant recipients, and 18.0% of lung transplant recipients were hospitalized for COVID-19. In kidney transplant recipients, steroids (adjusted odds ratio [AOR], 1.60; 95% CI, 1.49-1.73) and mycophenolic acid (AOR, 1.37; 95% CI, 1.25-1.51) were associated with a high risk of hospitalization. In liver transplant recipients, tacrolimus (AOR, 0.77; 95% CI, 0.61-0.98) was associated with a decreased risk, and steroids (AOR, 1.60; 95% CI, 1.38-1.86) and mycophenolic acid (AOR, 1.61; 95% CI, 1.37-1.90) were associated with an increased risk of hospitalizations. In heart transplant recipients, cyclosporine (AOR, 0.67; 95% CI, 0.47-0.94) was associated with a decreased risk, and steroids (AOR, 1.42; 95% CI, 1.11-1.82), mycophenolic acid (AOR, 1.29; 95% CI, 1.02-1.64), sirolimus (AOR, 2.71; 95% CI, 1.20-6.09), and everolimus (AOR, 1.24; 95% CI, 1.01-1.51) were associated with an increased risk of hospitalization. Only steroids (AOR, 1.72; 95% CI, 1.19-2.48) were associated with a high risk of COVID-19 hospitalization in lung transplant recipients.Conclusions and RelevanceThis study suggests that mycophenolic acid, sirolimus, and steroids are associated with an increased risk of COVID-19–related hospitalization in solid organ transplant recipients. These results should be considered by clinicians treating transplant recipients and may help inform epidemic-related decisions for this population in the future.

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Section: Strengths and Limitationsmentioning

confidence: 99%

COVID-19 Hospitalization in Solid Organ Transplant Recipients on Immunosuppressive Therapy

Kolla,

Weill,

Zaidan

et al. 2023

JAMA Netw Open

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“…With the growing interest of the scientific medical community in real-world data from large administrative healthcare databases, the SNDS is increasingly used for pharmacoepidemiologic studies, 16,17 including studies on COVID-19. 8,11,18,19 The study took advantage of the G9 mapping, a useful tool provided within the SNDS which allows an automatic selection of individuals labelled with a given chronic disease in a given year. 20 Several pathologies have been considered in the G9 mapping including persons with end stage terminal kidney disease (ESKD) and we used it for selecting the persons included in the study.…”

Section: Methodsmentioning

confidence: 99%

Direct and indirect impact of the COVID-19 pandemic on the survival of kidney transplant recipients: a national observational study in France

Leye

Delory

Karoui

et al. 2023

Preprint

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Background During the pandemic period, healthcare systems were substantially reorganized for managing COVID-19 cases. The corresponding changes on the standard care of persons with chronic diseases and the potential consequences on their outcomes remain insufficiently documented. This observational study investigates the direct and indirect impact of the pandemic period on the survival of kidney transplant recipients (KTR), in particular in those not hospitalized for COVID-19. Methods We conducted a cohort study using the French national health data system which contains all healthcare consumptions in France. Incident persons with end stage kidney disease between January 1, 2015 and December 31, 2020 who received a kidney transplant were included and followed-up from their transplantation date to December 31, 2021. The survival of KTR during the pre-pandemic and pandemic periods was investigated using Cox models with time-dependent covariates, including vaccination and hospitalization events. Findings There were 10,637 KTR included in the study, with 324 and 430 deaths observed during the pre-pandemic (15,115 person-years of follow-up) and pandemic periods (14,657 person-years of follow-up), including 127 deaths observed among the 659 persons with a COVID-19-related hospitalization. In multivariable analyses, the risk of death during the pandemic period was similar to that observed during the pre-pandemic period (hazard ratio (HR) [95% confidence interval]: 0.92 [0.77-1.11]), while COVID-19-related hospitalization was associated with an increased risk of death (HR: 10.62 [8.46-13.33]). In addition, pre-emptive kidney transplantation was associated with a lower risk of death (HR: 0.71 [0.56-0.89]), as well as a third vaccine dose (HR: 0.42 [0.30-0.57]), while age, diabetes and cardiovascular diseases were associated with higher risks of death. Interpretation Considering persons living with a kidney transplant with no severe COVID-19-related hospitalization, the pandemic period was not associated with a higher risk of death.

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“…The study was based on data of the National Health Data System (SNDS) which covers more than 99% of the French population (67 million inhabitants). 2,3 Data on hospital admission were obtained from the French hospital discharge database (PMSI) and linked at the individual level with the nationwide databases for Covid-19 vaccination (VAC-SI) and testing (SI-DEP).…”

Section: Supplementary Informationmentioning

confidence: 99%

“…These binary variables reflected a prior history (within 5 years unless otherwise mentioned) of the following conditions: sarcoidosis, opioid use disorder, coronary artery disease and myocardial infarction, heart failure, antihypertensive drug use, arrhythmia, diabetes, autoimmune disease, respiratory disease, active cancer, and antibiotic use (within a month). 2…”

Section: Supplementary Informationmentioning

confidence: 99%

Risk of Myocarditis after Covid-19 mRNA Vaccination: Impact of Booster Dose and Dosing Interval

Vu¹,

Bertrand²,

Jabagi³

et al. 2022

Preprint

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Covid-19 mRNA vaccines have been shown to be associated with a short-term increased risk of myocarditis, with the highest risk observed after the second dose compared to the first. The extent of the risk associated with more distant booster doses is less clear. Here, we aimed to assess the relation between dosing interval and the risk of myocarditis, for both the two-dose primary series and the third dose (first booster). Extending our previous matched case-control study, we included 4 890 cases of myocarditis aged 12 or more and 48 900 controls up to January 31, 2022. We found that the risk of myocarditis remained elevated after the booster dose and that longer intervals between each consecutive dose (including booster doses) may decrease the occurrence of vaccine-associated myocarditis.

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Characteristics associated with the residual risk of severe COVID-19 after a complete vaccination schedule: A cohort study of 28 million people in France

Cited by 20 publications

References 30 publications

COVID-19 Hospitalization in Solid Organ Transplant Recipients on Immunosuppressive Therapy

COVID-19 Hospitalization in Solid Organ Transplant Recipients on Immunosuppressive Therapy

Direct and indirect impact of the COVID-19 pandemic on the survival of kidney transplant recipients: a national observational study in France

Risk of Myocarditis after Covid-19 mRNA Vaccination: Impact of Booster Dose and Dosing Interval

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