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

Abstract

Background As of November 2020, SARS-CoV-2 has resulted in 55 million infections worldwide and over 1.3 million deaths from COVID-19. Outcomes following SARS-CoV-2 infection in individuals with primary immunodeficiency or symptomatic secondary immunodeficiency remain uncertain. Objectives To document the outcomes of individuals with primary or symptomatic secondary immunodeficiency following COVID-19 in the United Kingdom. Methods At the start of the COVID-19 pandemic, the United Kingdom Primary Immunodeficiency Network (UK PIN) 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 100 patients had been enrolled by 1st July 2020, 60 with primary immunodeficiency (PID), 7 with other inborn errors of immunity including autoinflammatory diseases and C1 inhibitor deficiency and 33 with symptomatic secondary immunodeficiency (SID). In individuals with PID, 53.3% (n=32/60) were hospitalized, the infection fatality rate (IFR) was 20.0% (n=12/60), the case fatality rate (CFR) was 31.6% (n=12/38) and the inpatient mortality 37.5% (n=12/32). Individuals with SID had worse outcomes than those with PID. 75.8% (n=25/33) were hospitalized, the IFR was 33.3% (n=11/33), the CFR was 39.2% (n=11/28), and inpatient mortality 44.0% (n=11/25). 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.

Outcome of SARS-CoV-2 Infection in 121 Patients With Inborn Errors of Immunity: A Cross-sectional Study

“…Predominantly antibody de ciencies represented the most common IEI among our patients (43.8%) as described in other series [14,16], but in lower proportion, particularly in comparison to Shields' group (76.7%). In our series, the second most frequent IEI was complement de ciencies (20.7%), absent from Meyts' group and in lower numbers in Shields' group (6.7%), due to different structured groups of specialists registering HAE patients.…”

“…In our group of 121 IEI patients with SARS-CoV-2 infection, females were more frequent (55.4%), unlike Meyts' et al study [14], however similar to the 60 IEI patients from Shields et al [16] report. Our group of patients was younger than the other series of patients.…”

“…Young patients had severe cases in our series. In addition, we did not identify protection against severe COVID-19 among patients with antibody de ciencies, as was shown by Meyts' [14], Ho's [12] and Shields' [16], and contrary to what was reported at the beginning of the pandemic [17,46]. Five (83.3%) deceased patients were ≤ 59 yo and three (50%) of them had antibody de ciencies.…”

“…The restricted knowledge about the immunopathology of SARS-CoV-2 infection for IEI patients raised the question about the clinical impact of COVID-19 and the risk involved for these patients [27]. As already mentioned, several case reports were previously published [7][8][9][10][11][12][13]15], as well as two larger series: 94 IEI patients in Meyts et al study, from ESID [14], and 60 IEI patients and 33 secondary immunode cient patients from Shields et al study [16], in the UK.…”

“…Case reports and case series have been published about the clinical outcome of patients with IEI [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”