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COVID-19 in patients with primary and secondary immunodeficiency: The United Kingdom experience

Shields, Adrian M., Burns, Siobhan O., Savic, Sinisa, Richter, Alex G., Anantharachagan, Ariharan, Arumugakani, Gururaj, Baker, Kenneth, Bahal, Sameer, Bermingham, William, Bhole, Malini, Boules, Evon, Bright, Philip, Burns, Siobhan, Cleave, Betsy, Dempster, John, Devlin, Lisa, Dhalla, Fatima, Drewe, Elizabeth, Duncan, Christopher, Dziadzio, Magdalena, Elkhalifa, Shuayb, Gennery, Andrew, Goddard, Sarah, Grigoriadou, Sofia, Hayman, Grant, Herwadkar, Archana, Huissoon, Aarnoud, Jain, Rashmi, Jolles, Stephen, Johnston, Sarah, Leeman, Lucy, Mahabir, Shanti, MacLochlainn, Dylan, McDermott, Elizabeth, Misbah, Siraj, Morsi, Hadeil, Murng, Sai, Noorani, Sadia, O?Brien, Rachael, Patel, Smita, Price, Arthur, Richter, Alex, Savic, Sinisa, Seneviratne, Suranjith, Shields, Adrian, Shrimpton, Anna, Stroud, Catherine, Vaitla, Prashantha and Verma, Nisha 2021. COVID-19 in patients with primary and secondary immunodeficiency: The United Kingdom experience. Journal of Allergy and Clinical Immunology 147 (3) , pp. 870-875. 10.1016/j.jaci.2020.12.620

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Background As of November 2020, severe acute respiratory syndrome coronavirus 2 has resulted in 55 million infections worldwide and more than 1.3 million deaths from coronavirus disease 2019 (COVID-19). Outcomes following severe acute respiratory syndrome coronavirus 2 infection in individuals with primary immunodeficiency (PID) or symptomatic secondary immunodeficiency (SID) remain uncertain. Objectives We sought to document the outcomes of individuals with PID or symptomatic SID following COVID-19 in the United Kingdom. Methods At the start of the COVID-19 pandemic, the United Kingdom Primary Immunodeficiency Network established a registry of cases to collate the nationwide outcomes of COVID-19 in individuals with PID or symptomatic SID and determine risk factors associated with morbidity and mortality from COVID-19 in these patient groups. Results A total of 100 patients had been enrolled by July 1, 2020, 60 with PID, 7 with other inborn errors of immunity including autoinflammatory diseases and C1 inhibitor deficiency, and 33 with symptomatic SID. In individuals with PID, 53.3% (32 of 60) were hospitalized, the infection-fatality ratio was 20.0% (12 of 60), the case-fatality ratio was 31.6% (12 of 38), and the inpatient mortality was 37.5% (12 of 32). Individuals with SID had worse outcomes than those with PID; 75.8% (25 of 33) were hospitalized, the infection-fatality ratio was 33.3% (11 of 33), the case-fatality ratio was 39.2% (11 of 28), and inpatient mortality was 44.0% (11 of 25). Conclusions In comparison to the general population, adult patients with PID and symptomatic SID display greater morbidity and mortality from COVID-19. This increased risk must be reflected in public health guidelines to adequately protect vulnerable patients from exposure to the virus.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Elsevier
ISSN: 0091-6749
Date of Acceptance: 2 December 2020
Last Modified: 08 Mar 2021 10:06

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