The impact of the COVID-19 pandemic on autoimmune diagnostics in Europe: A lesson to be learned

Nagy, Eszter; Infantino, María; Bizzaro, Nicola; Andreeva, Hristina; Bontkes, Hetty J.; Bossuyt, Xavier; Fabien, Nicole; Fischer, Katarzyna; Heijnen, Ingmar; Herold, Manfred; Kozmar, Ana; Kuhi, Liisa; López‐Hoyos, Marcos; Pullerits, Rille; Sousa, Maria José Rego de; Tsirogianni, Alexandra; Damoiseaux, Jan

doi:10.1016/j.autrev.2021.102985

Cited by 7 publications

(3 citation statements)

References 36 publications

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“…Reasons may include a decrease in the demand and supply of health care services and patient-physician encounters. During the COVID-pandemic, such was shown by a reduced testing for autoimmune disease–related antibodies . Regarding other possible reasons for lower incidence during the epidemic, we are unaware of any changes in the diagnosis processes or guidelines during the study from 2019 to 2022.…”

Section: Discussionmentioning

confidence: 99%

Sudden Hearing Loss Following Vaccination Against COVID-19

Nieminen

Kivekäs

Artama

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceSpontaneous adverse reaction reports of sudden hearing loss have been observed, and a population-based cohort study conducted in Israel showed an increase in the incidence of sudden sensorineural hearing loss (SSNHL) following vaccination with messenger RNA COVID-19 vaccine BNT162b2 (Pfizer-BioNTech). However, in this setting, the possibility of confounding remained.ObjectiveTo assess a potential association between COVID-19 vaccinations and SSNHL.Design, Setting, and ParticipantsThis register-based country-wide retrospective cohort study of 5.5 million Finnish residents was conducted from January 1, 2019, to April 20, 2022, and included all individuals who were identified from the population information system who were alive or born during the study period except individuals who had SSNHL during 2015 to 2018 according to specialized care derived diagnosis codes for SSNHL (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code H91.2) as a primary or secondary diagnosis.ExposuresThe a priori primary risk period was 0 to 54 days following each COVID-19 vaccination. The risk periods for different vaccine doses did not overlap so that a later vaccine exposure ended the previous risk period. The secondary risk period was from 55 days following each COVID-19 vaccination until a subsequent COVID-19 vaccination. A secondary analysis included a risk time from 0 to 54 days following a positive polymerase chain reaction test result for SARS-CoV-2.Main Outcomes and MeasuresThe incidences of SSNHL following COVID-19 vaccination were compared with the incidences before the COVID-19 epidemic in Finland. The Poisson regression model included calendar time, age, sex, diabetes, cardiovascular disease, other chronic diseases, and the number of visits in primary health care.ResultsFor the 5.5 million Finnish residents included in the study, the comparison time comprised 6.5 million person-years, the primary risk time of 1.7 million person-years, and the secondary risk time of 2.1 million person-years. Before the COVID-19 epidemic in Finland, 18.7/100 000 people received a diagnosis of SSNHL annually. The study data suggested no increased risk for SSNHL following any COVID-19 vaccination. In particular, adjusted incidence rate ratios with 95% confidence intervals for the BNT162b2 vaccine’s 3 doses were 0.8 (95% CI, 0.6-1.0), 0.9 (95% CI, 0.6-1.2), and 1.0 (95% CI, 0.7-1.4), respectively. There was no association between SARS-CoV-2 infection and an increased incidence of SSNHL.Conclusions and RelevanceThe results of this cohort study show no evidence of an increased risk of SSNHL following COVID-19 vaccination. The study accounted for previous disease and other potential confounding factors. These results are based on diagnosis codes in specialized care but still need to be verified in settings that are capable of evaluating the degree of hearing loss.

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Section: Discussionmentioning

confidence: 99%

Sudden Hearing Loss Following Vaccination Against COVID-19

Nieminen

Kivekäs

Artama

et al. 2023

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

show abstract

“…During the COVID-pandemic such was shown by a reduced testing for autoimmune disease related antibodies. 26 Regarding other possible reasons for lower incidence during the epidemic, we are unaware of any changes in the diagnosis processes or guidelines during the study, from 2019 to 2022.…”

Section: Discussionmentioning

confidence: 99%

Sudden hearing loss following vaccination against COVID-19

Nieminen

Kivekäs

Artama

et al. 2022

Preprint

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Importance Spontaneous adverse reaction reports of sudden hearing loss have been observed and a population-based cohort study conducted in Israel showed an increase in the incidence of sudden sensorineural hearing loss (SSNHL) following vaccination with messenger RNA COVID-19 vaccine BNT162b2 (Pfizer-BioNTech). However, in this setting, possibility of confounding remained. Objective To assess a potential association between COVID-19 vaccinations and SSNHL. Design A register-based country-wide observational study with study period from January 1, 2019, until Apr 12, 2022. Setting Residents in Finland: 5.8 million. Participants All individuals identified from population information system alive or born during the study period except individuals having SSNHL during 2015 to 2018 according to specialized care derived diagnosis codes for SSNHL (ICD10-code H91.2) as a primary or secondary diagnosis. Exposures The a priori primary risk period was 0 to 54 days following each COVID-19 vaccine dose. The secondary risk time was 55 or more days after the vaccination. A later vaccine exposure overruled a previous one. A secondary analysis included a risk time of 0 to 54 days following a positive polymerase chain reaction (PCR) test for SARS-CoV-2. Main Outcome We compared incidences of SSNHL following COVID-19 vaccination to incidences before the COVID-19 epidemic in Finland. In our Poisson regression analysis, we adjusted for calendar time, age, sex, diabetes, cardiovascular disease, other chronic diseases, number of visits in primary health care. Results Comparison time constituted of 6.5 million person years, primary risk time of 1.7 million person years, and secondary risk time of 2.1 million person years. Before the epidemic yearly 18.7 / 100,000 people were diagnosed with SSNHL. Our data suggested no increased risk for SSNHL following any COVID-19 vaccination. In particular, adjusted incidence rate ratios, with 95 percent confidence intervals (95% CI) for the BNT162b2 vaccine's three doses were 0.8 (95% CI 0.6 to 1.0), 0.9 (95% CI 0.6 to 1.2), and 1.3 (95% CI 0.9 to 2.0). SARS-CoV-2 infection was not associated with an increased incidence of SSNHL either. Conclusions and relevance Our results show no evidence of increased SSNHL with the COVID-19 vaccinations. We accounted for previous disease and other potential confounding factors. Our results base on diagnosis codes in specialized care but still need to be verified with settings, that are capable to evaluate the degree of hearing loss.

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“…We read the article by Nagy E, et al, titled “The impact of the COVID-19 pandemic on autoimmune diagnostics in Europe: A lesson to be learned” with great interest [ 1 ]. We have observed a very similar impact of the pandemic on the usage of mobile application RheumaHelper for rheumatologists.…”

mentioning

confidence: 99%