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Association of Self-Reported COVID-19 Vaccination Status with COVID-19 Infection Among Adult Long-Term Hematopoietic Cell Transplantation Survivors
Liang, E. C., Onstad, L. E., Carpenter, P., Pergam, S. A., Flowers, M. E., Lee, S. J., Liu, C.
Transplantation and cellular therapy. 2023
Abstract
BACKGROUND Hematopoietic cell transplantation (HCT) recipients experience significant morbidity and mortality from coronavirus disease 19 (COVID-19) infection. Data are limited regarding long-term HCT survivors' uptake of and experiences with COVID-19 vaccination and infection. OBJECTIVE To characterize COVID-19 vaccination uptake, use of other prevention measures, and COVID-19 infection outcomes in adult HCT recipients at our institution. STUDY DESIGN From July 1, 2021 to June 30, 2022, long-term adult HCT survivors were surveyed regarding overall health, chronic graft-versus-host (cGVHD) status, and experiences with COVID-19 vaccinations, prevention measures, and infections. Patient-reported COVID-19 vaccination status, vaccine-related adverse effects, use of non-pharmaceutical prevention measures, and infection. Comparisons by response and vaccination status were performed using Chi-square test and Fisher's exact test for categorical variables and Kruskal-Wallis test for continuous variables. RESULTS Of 4758 adult HCT survivors who underwent HCT from 1971-2021 and consented to receive annual surveys, 1719 (36%) completed the COVID-19 module. 1598/1705 (94%) reported receiving ≥1 dose of COVID-19 vaccine. Severe vaccine-related adverse effects were infrequent (5%). Among respondents receiving mRNA vaccine, completion of doses according to the Centers for Disease Control (CDC) vaccine recommendations at time of survey return was: 2 doses (675/759 [89%]); 3 (610/778 [78%]); 4 doses (26/55 [47%]). 250 (15%) respondents reported COVID-19 infection; 25 (10%) required hospitalization. Vaccinated respondents reported significantly higher uptake of household vaccination (1284/1404 [91%] vs. 18/88 [20%], p < 0.001) and use of non-pharmaceutical interventions (p < 0.001). Among those vaccinated prior to infection, vaccinated respondents were significantly less likely to have contracted COVID-19 (85/1480 [6%] vs. 130/190 [68%], p < 0.001) as were their household members (149/1451 [10%] vs. 85/185 [46%], p < 0.001). Receipt of additional COVID-19 vaccine doses beyond the first dose was associated with a reduced risk of COVID-19 infection (OR = 0.63, 95% CI, 0.47-0.85, p = 0.002). CONCLUSIONS Vaccination was well-tolerated and associated with a lower risk of COVID-19 infection among HCT survivors and their household contacts. Vaccination and booster doses should be encouraged as part of a multi-faceted approach in this high-risk population.