Risk of SARS-CoV-2 infection and adverse outcomes among vaccinated patients with tuberculosis

Renin Chang; Sheng-Yin Chen; Tina Yi-Jin Hsieh; Hui-Yuan Chen; Shiow-Ing Wang; Yao-Min Hung; James Cheng-Chung Wei

doi:10.1016/j.puhe.2024.09.028

Risk of SARS-CoV-2 infection and adverse outcomes among vaccinated patients with tuberculosis

Public Health. 2025 Jan 10:239:80-86. doi: 10.1016/j.puhe.2024.09.028. Online ahead of print.

Authors

Renin Chang¹, Sheng-Yin Chen², Tina Yi-Jin Hsieh³, Hui-Yuan Chen⁴, Shiow-Ing Wang⁵, Yao-Min Hung⁶, James Cheng-Chung Wei⁷

Affiliations

¹ Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Recreation and Sports Management, Tajen University, Pintung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan. Electronic address: [email protected].
² Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA. USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: [email protected].
³ Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA; Department of Bioinformatics, Harvard Medical School, Boston, MA, USA. Electronic address: [email protected].
⁴ Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. Electronic address: [email protected].
⁵ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan. Electronic address: [email protected].
⁶ Department of Internal Medicine, Taitung Hospital, Ministry of Health and Welfare, Taitung, Taiwan; Master Program in Biomedicine, College of Science and Engineering, National Taitung University, Taitung, Taiwan; College of Health and Nursing, Meiho University, Pingtung, Taiwan. Electronic address: [email protected].
⁷ Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, China; Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan; Institute of Medicine/Department of Nursing, Chung Shan Medical University, Taichung, Taiwan. Electronic address: [email protected].

PMID: 39798219
DOI: 10.1016/j.puhe.2024.09.028

Abstract

Objectives: Limited data are available to assess breakthrough SARS-CoV-2 infections, medical utilization, and mortality in patients with tuberculosis (TB). The aim of this study was to examine the risk of COVID-19 and severe outcomes in patients with TB between January 2020 and March 2022.

Study design: US electronic medical records were used to identify TB and non-TB patients who completed the primary series of vaccination and had no prior COVID-19.

Methods: Breakthrough infections and severe adverse outcomes, defined by the Centers for Disease Control and Prevention as hospitalization, need for mechanical ventilation and/or intensive care unit admission, or in-hospital mortality, following a positive SARS-CoV-2 polymerase chain reaction (PCR) test. Follow-up began 14 days after the primary vaccination series was completed and continued for 365 days.

Results: The study included 15,541 TB and 15,541 non-TB patients. The risk of breakthrough infection was significantly higher in the TB group than in the non-TB group after controlling for age, sex, ethnicity, socioeconomic status, and lifestyles (adjusted HR, 1.444; 95 % CI, 1.321-1.579). Similar trends were observed in pre-specified subgroup analyses stratified by age, sex, and status of TB. Patients in the TB group had higher risks of emergency room visit and critical care admission [adjusted HRs, 1.244 (95 % CI, 1.175-1.316) and 1.404 (95 % CI, 1.182-1.668)].

Conclusions: Our study revealed a higher risk of COVID-19 breakthrough infections and adverse outcomes among patients with TB. Thus, besides priority COVID-19 vaccination, healthcare providers should continue vigilance for patients with TB.

Keywords: Breakthrough infection; COVID-19; Cohort study; Tuberculosis; Vaccination.