Yanfang et al.

Advances in Rheumatology (2023) 63:54 Advances in Rheumatology

https://doi.org/10.1186/s42358-023-00335-x

RESEARCH Open Access

COVID‑19 vaccination of patients

with chronic immune‑mediated inflammatory
disease
Wen Yanfang1* , Chen Jianfeng2, Liu Changlian1 and Wang Yan1

Abstract
Objective This study aimed to analyze the safety and efficacy of COVID-19 vaccines among patients with chronic
immune-mediated inflammatory disease (IMID) in China.
Methods Participants who were diagnosed with a chronic IMID were eligible for inclusion in this study. Age- and sex-
matched healthy vaccinated individuals were set as the control group. All participants received two doses of the inac-
tivated CoronaVac vaccine or three doses of the recombinant protein subunit vaccine ZF2001. Adverse events, IMID
activity after vaccination, and the rate of COVID-19 in the two groups were compared.
Results There were 158 patients in the IMID group, with an average age of 40 ± 14 years old, and 98 female subjects.
In the IMID group, 123 patients received the inactivated CoronaVac vaccine, and 35 patients received the recombi-
nant protein subunit vaccine ZF2001. There were 153 individuals in the control group, including 122 who received
the CoronaVac vaccine and 31 who received the recombinant protein subunit vaccine ZF2001. The frequency
of vaccine-related adverse events in the IMID group was less than that in the control group, all of which were mild
local effects, and no serious events occurred. Of note, no disease flares occurred in the IMID group. No participants
in either group subsequently got COVID-19, so the incidence rate was 0% in both groups.
Conclusion COVID-19 vaccination was found to be safe for IMID subjects, any adverse events were mild, and vac-
cination did not increase the risk of disease activity. Meanwhile, vaccination could effectively reduce the incidence
of COVID-19 in IMID patients. In the future, studies with a larger sample size and a longer duration are needed.
Keywords Immune-mediated inflammatory disease, COVID-19 vaccine, Safety, Efficacy

Background in 2019, COVID-19 swept the world. According to data

Coronavirus disease 2019 (COVID-19) is caused by released by the World Health Organization in a platform
severe acute respiratory syndrome coronavirus 2 (SARS- committed to the development of digital health technolo-
CoV-2) infection. Since COVID-19 is easily transmissible, gies, there have been more than 500 million confirmed
people can easily become infected. Following its outbreak cases worldwide, and more than 6 million people have
died of the disease. Worse still, the constant mutation
of the virus has brought greater challenges to the global
*Correspondence:
Wen Yanfang control of the pandemic. To date, vaccination remains
[email protected] the most important way to control the pandemic. Coro-
1
Department of Rheumatology, Changsha Hospital of Traditional Chinese
naVac and recombinant subunit vaccines are the most
Medicine, Changsha, China
2
Department of Intensive Care Unit, Changsha Hospital of Traditional commonly used vaccines in China. The efficacy of these
Chinese Medicine, Changsha, China vaccines for the prevention of symptomatic forms of
COVID-19 is greater than 70%, and the adverse events

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecom-
mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Yanfang et al. Advances in Rheumatology (2023) 63:54 Page 2 of 6

are mild, with pain at the injection site being observed in The participants were required to tell the investigators if
phase III clinical data [1]. Patients with immune-medi- symptoms occurred.
ated inflammatory disease (IMID) are at a high risk for The disease activity scores on days 30 and 90 after vac-
COVID-19 due to immune dysregulation and chronic cination were recorded (SLEDAI, ASDAS, DAS28 scores,
use of immunosuppressive drugs. At present, those with etc.). Antirheumatic treatment continued during the
a IMID have been widely vaccinated with SARS-CoV-2 vaccination period. The patients who received a venous
vaccines in China, but studies on the safety and efficacy injection of cyclophosphamide or rituximab resumed
of vaccination in IMID patients are lacking. Therefore, we taking the drug at least four weeks after vaccination. The
performed a controlled trial that involved IMID patients patients taking other drugs did not change the timing of
and healthy adults (control group) who received two their drug administration.
doses of CoronaVac or three doses of the recombinant SPSS 26 software was used for data analysis. The t-test
protein subunit vaccine ZF2001 to evaluate the efficacy and chi-squared test were used for statistical analysis.
and safety of these vaccines in Chinese IMID patients. The difference was considered statistically significant
when P < 0.05.
Methods
This was a prospective cohort study. According to the Results
Guidelines for COVID-19 Vaccination Techniques (Ver- A total of 160 patients were included in both groups.
sion 1) published in China [2] and the recommendations Two patients withdrew from the IMID group and seven
of the American College of Rheumatology for patients participants withdrew from the control group because of
with rheumatic and musculoskeletal diseases on COVID- their concerns about adverse events of the vaccine.
19 vaccines, patients with IMIDs in remission who met The average age of the patients in the IMID group
the following criteria were included in this study: age of was 40 ± 14 years old, and 98 individuals were female
18–60 years old; no history of vaccine allergy; a diag- (Table 1). There were 77 individuals with SLE, 38 with
nosed IMID, including systemic lupus erythematosus RA, 33 with AS, 9 with pSS, and 1 with erythema nodo-
(SLE), primary Sjögren’s syndrome (pSS), rheumatoid sum. Among them, 80 patients received glucocorticoids
arthritis (RA), ankylosing spondylitis (AS), vasculitis, at a dose of 2.5–15 mg per day; 38 received human tumor
mixed connective tissue disease; stable disease for more necrosis factor alpha inhibitors; 39 received methotrex-
than 3 months, with a disease activity score (e.g., SLE- ate at a dose of 5–15 mg per week; 16 received mycophe-
DAI, DAS28, ASDAS, and ESSDAI) indicating stable nolate mofetil; 7 received cyclosporine A; 69 received
disease; and with no uncomfortable symptoms or active hydroxychloroquine; 5 received tocilizumab; and 16
infections. After conducting vaccination education, vac- received sulfasalazine (Table 2). With respect to vac-
cination was carried out if the participants consented. cination, 123 participants were inoculated with the
Age- and sex-matched healthy vaccinated individuals inactivated CoronaVac vaccine (Vero cells, Sinovac Life
were set as the control group. Coronavac was inocu- Sciences Co., Ltd.), and 35 participants received the
lated in two doses on day 0 and day 56, respectively. The recombinant protein subunit vaccine ZF2001.
recombinant protein subunit vaccine ZF2001(Anhui There were 153 individuals in the healthy control
Zhifei Longcom) was inoculated in three doses on day group, including 96 females and 57 males, with an aver-
0, day 42, and day 84, respectively. These regimens were age age of 41.3 ± 16. 1 years old. A total of 122 partici-
approved by the Chinese government. pants were inoculated with the inactivated CoronaVac
The primary objective of this study was to evaluate the vaccine, and 31 participants received the recombinant
safety and efficacy of these two vaccines at reducing the protein subunit vaccine ZF2001.
risk of COVID-19. None of the subjects in our study had The incidence of adverse events in the IMID group
COVID-19 before vaccination. We evaluated the vaccine with Coronavac was less than that in the normal con-
efficacy by comparing the incidence of COVID-19 in the trol group (19.5% vs. 50.8%, P < 0.05), most of the adverse
IMID group and the control group. events were mild local reactions, and no serious events
The participants were followed up for 90–180 days
after vaccination. The first follow-up was conducted at Table 1 General characteristics of patients in the two groups
seven days after vaccination, and all of the symptoms
Demographics IMID group Control group P
were recorded, including injection site reactions (pain, (n = 158) (n = 153)
redness, and swelling) and systemic reactions. The par-
ticipants were instructed on how to recognize signs and Age (years) 40 ± 14 41.3 ± 16.1 0.902
symptoms of COVID-19 and underwent SARS-CoV-2 Female, n (%) 98 (62%) 96 (62.7%) 0.355
nucleic acid detection tests if they had such symptoms. IMID, immune-mediated inflammatory disease
Yanfang et al. Advances in Rheumatology (2023) 63:54 Page 3 of 6

occurred (Table 3). There was no significant difference in her other tests were normal (with a SLEDAI score of
adverse events between the IMID patients receiving the only 4) and the fact that she had recurrent proteinuria
CoronaVac vaccine vs. the recombinant protein subu- for 2 years before vaccination (urine protein never more
nit vaccine ZF2001 (19.5% vs. 14.3%, P > 0.05). No dis- than 1 g/24 h), we thought that her kidney disease was
ease flares occurred in the IMID group after vaccination not in complete remission and we did not think that it
(Table 4). Of note, there was one SLE patient with new- was a flare of new-onset proteinuria after vaccination.
onset proteinuria according to the routine urine exami- In addition, the time interval between proteinuria and
nation on the day after vaccination. However, because vaccination was too short to support the emergence of

Table 2 Treatments used for patients with IMIDs

IMID diagnosis, n Immunosuppressive treatments, n (%)
GC MTX TNFi CsA Lef HCQ JAKi MMF SSZ

All IMIDs, n = 158 80 (50.6) 39 (24.7) 38 (24. 1) 7 (4.4) 24 (15.2) 69 (43.7) 5 (3.2) 16 (16.5) 16 (10. 1)
RA, n = 38 4 (10.5) 30 (78.9) 15 (39.5) 0 24 (63.2) 2 (5.3) 5(13.2) 0 2 (5.3)
AS, n = 33 0 5 (15.2) 23(69.7) 0 0 0 0 0 14 (42.4)
SLE, n = 77 70(90.9) 3 (3.9) 0 5 (6.5) 0 60 (77.9) 0 14 (18.2) 0
pSS, n = 9 5 (55.6) 0 0 2 (22.2) 0 7 (77.8) 0 2 (22.2) 0
Others, n = 1 1 (100) 1(100) 0 0 0 0 0 0 0
IMID Immune-mediated inflammatory disease, GC Glucocorticoid, MTX Methotrexate, TNFi Tumor necrosis factor alpha inhibitor, CsA Cyclosporine A, Lef Leflunomide,
HCQ Hydroxychloroquine, JAKi Janus kinase inhibitor, MMF Mycophenolate mofetil, SSZ Sulfasalazine, RA Rheumatoid arthritis, AS Ankylosing spondylitis, SLE Systemic
lupus erythematosus, pSS Primary Sjögren’s syndrome

Table 3 Adverse events following vaccination in patients with IMIDs and healthy controls
CoronaVac vaccine P ZF2001 vaccine P

IMID group Control group IMID group Control group

(n = 123) (n = 122) (n = 35) (n = 31)

Adverse events, n (%) 24 (19.5) 62 (50.8) 0.000 5 (14.3) 6 (19.4) 0.581

Local reactions, n (%) 22 (17.9) 53 (43.4) 0.000 4 (11.4) 5 (16.1) 0.579
Pain 18 (14.6) 45 (36.9) 0.000 4 (11.4) 9 (29) 0.073
Swelling 5 (4. 1) 7 (5.7) 0.544 2 (5.7) 3 (9.7) 0.544
Erythema 5 (4.1) 6 (4.9) 0.747 0 1 (3.2) 0.284
Induration 3 (2.4) 4 (3.3) 0.693 1 (2.9) 0 0.343
Systemic reactions, n (%) 2 (1.6) 9 (7.4) 0.030 1 (2.9) 1 (3.2) 0.931
Myalgia 1 (0.8) 2 (1.6) 0.557 0 1 (3.2) 0.284
Fatigue 2 (1.6) 5 (4.1) 0.245 1 (3.2) 1 (3.2) 0.931
Fever 0 1 (0.8) 0.314 0 0
Headache 1 (0.8) 4 (3.3) 0.172 0 0
Shivering 0 0 0 0
IMID Immune-mediated inflammatory disease

Table 4 Disease activity score before and after vaccination

IMID diagnosis Before 30 days after P value Before 90 days after P value
vaccination vaccination vaccination vaccination

RA DAS28 1.915 1.905 0.895 1.915 1.885 0.696

AS ASDAS 1.03 1.09 0.352 1.03 1.05 0.776
SLE SLEDAI 0.33 0.53 0.533 0.33 0.13 0.287
IMID Immune-mediated inflammatory disease
Yanfang et al. Advances in Rheumatology (2023) 63:54 Page 4 of 6

vaccine-induced proteinuria. Importantly, no partici- a relatively large sample size [16, 17]. Although two
pants had had COVID-19 during the study, so the inci- patients died several weeks after vaccination in a mul-
dence rate was 0% in both groups. ticenter study of mRNA vaccination of patients with
autoimmune rheumatic diseases, the deaths were both
Discussion irrelevant to the vaccines themselves [16].
Patients with IMIDs take long-term immunosuppres- However, mRNA vaccination seems to result in an
sive drugs, such as glucocorticoids, biological agents, and increased incidence of herpes zoster virus among
immunosuppressants, which makes them predisposed patients with IMIDs. For example, Furer et al. [18]
to COVID-19. The American College of Rheumatology have reported that the incidence of herpes zoster after
[3] recommends priority vaccination for Rheumatic and BNT162b2 mRNA COVID-19 vaccination among IMID
Musculoskeletal Diseases patients because they have patients (n = 491) was 1.2%, while that in the control
a higher risk of COVID-19 and a worse outcome after group (n = 99) was 0%. No herpes zoster virus infec-
infection than healthy controls. Studies also have shown tion was observed in our study, whether the participants
that patients with rheumatic disease possess higher were inoculated with inactivated vaccine or the recom-
rates of hospitalization and severe illness after contract- binant subunit vaccine. In addition, Machado et al. have
ing COVID-19 [4, 5]. After the systemic rheumatic dis- reported that adverse events were observed in 37% of
ease patients were vaccinated, their prognosis was better cases, with serious events in 0.5%, and SARS-CoV-2
than that of unvaccinated patients, and the hospitaliza- vaccines were safe for rheumatic and musculoskeletal
tion rate and mortality were significantly reduced [6]. In disease (RMD) patients [19]. Likewise, in our study, the
some studies, it has been shown that SLE, pSS, and vas- prevalence of adverse events in the IMID group was
culitis patients may have more severe courses of COVID- 18.4%, and no serious adverse events occurred. Interest-
19, and the use of prednisone at doses of ≥ 10 mg/day, ingly, the incidence of adverse events in the IMID group
mycophenolate mofetil, and rituximab has been associ- was less than that in the control group, which may be due
ated with poorer outcomes [5, 7–11]. Therefore, vaccina- to the use of nonsteroidal anti-inflammatory drugs and
tion may be more necessary for such patients to reduce glucocorticoids. Overall, IMID patients who received
the risk of contracting COVID-19 and to avoid serious COVID-19 vaccines rarely experience vaccine-related
adverse outcomes. side effects.
Vaccine efficacy, safety, immunogenicity must be care- Do COVID-19 vaccines induce autoimmune diseases?
fully studied. Safety, which is mainly represented by Do they cause stable autoimmune diseases to flare? Theo-
vaccine-related side effects and the risk of IMID disease retically, vaccination may induce an autoimmune disease
activity, is a possible factor for the hesitancy of patients flare, which is probably caused by molecular mimicry of
with systemic autoimmune rheumatic disease to receive the vaccine components, overstimulation of the immune
vaccination [12]. There are some reports of adverse system, and pathogenic effects of adjuvants. According to
events from COVID-19 vaccines. On March 18, 2021, previous studies, there have been sporadic cases showing
the European Medicines Agency announced the discov- SLE disease flares after vaccination. For instance, Li et al.
ery of thrombosis with thrombocytopenia syndrome [20] have reported two cases of women presenting with
following the administration of the ChAdOx1 nCoV-19 SLE after measles vaccination. Moreover, Soybilgic et al.
vaccine (Vaxzevria, Oxford/AstraZeneca), which uses [21] have demonstrated that the disease recurrence rate
a recombinant replication-defective chimpanzee ade- among SLE patients after human papillomavirus (HPV)
novirus vector [13]. After six cases of cerebral venous vaccination reached 30%, while no increase in the risk of
sinus thrombosis with thrombocytopenia were reported disease activity in RMD patients was detected. Further-
among Janssen vaccine recipients between April 13 and more, Milanovic et al. [22] observed that no significant
23, 2021, the US Centers for Disease Control and Fed- worsening of underlying disease occurred after influenza
eral Drug Administration recommended suspending the vaccination in 47 patients with SLE, RA, or pSS com-
use of the Janssen vaccine [14], but there were no IMID pared with 52 controls. Additionally, a large cohort study
patients in those case reports. According to previous by Miranda et al. [23] showed that there was no differ-
experiences of vaccination in IMID patients, includ- ence in the probability of SLE between individuals who
ing vaccines against influenza, hepatitis B and hepatitis received the HPV vaccine and those who were not vac-
A, no serious adverse events like herpes rash, pneumo- cinated. In a study with a large sample size, there were
nia, human papillomavirus, and tickborne encepha- also no cases of disease activity in IMID patients who
litis have been observed [15]. Similarly, COVID-19 received mRNA COVID-19 vaccines [16]; however, no
vaccines, whether in inactivated or mRNA forms, have data on the disease activity related to CoronaVac have
been shown to be safe for IMID patients in studies with been reported [17]. In another study [19], there were
Yanfang et al. Advances in Rheumatology (2023) 63:54 Page 5 of 6

rare reports of an inflammatory/autoimmune rheumatic Conclusion

and musculoskeletal disease (I-RMD) flare after vacci- COVID-19 vaccination is safe for subjects with IMIDs,
nation (Pfizer/BioNTech vaccine, AstraZeneca/Oxford, the adverse events are mild, and the vaccine does not
and Moderna vaccine). A flare following vaccination was increase the risk of disease activity. Meanwhile, COVID-
reported in 4.4% of I-RMD cases, with 29 cases (0.6%) of 19 vaccines can effectively reduce the incidence of this
severe flares, implying that a higher disease activity may disease in IMID patients. In the future, studies with a
be associated with a higher flare rate. larger sample size and a longer duration are needed.
In our study, none of the patients showed significant
Acknowledgements
IMID activity. Noticeably, there was one SLE patient who Not applicable.
developed new-onset proteinuria after vaccination. This
patient had a SLEDAI score of 4 and had repeated pro- Author contributions
WY analyzed and interpreted the patient data regarding the IMIDs and the
teinuria before vaccination, which means that her kidney SARS-CoV-2 vaccines. LC and WY were responsible for follow-up and data col-
disease was not in complete remission, and there were no lection, and WY and CJ were major contributors to writing the manuscript. All
other changes in her disease at the end of the follow-up. authors read and approved the final manuscript.
Therefore, this case was considered as no disease activ- Funding
ity. All patients in our study ensured disease stability for Not applicable.
at least three months before vaccination, and our results
Availability of data and materials
suggest that the likelihood of disease activity occurrence All data generated or analyzed during this study are included in this published
after vaccination is extremely low. In sum, although there article.
is a theoretical risk of disease activity after receiving a
COVID-19 vaccine, the benefits of vaccination overweigh Declarations
the risks of disease activity and side effects.
Ethics approval and consent to participate
Due to the long-term use of glucocorticoids and immu- The experimental protocol was established according to the ethical guidelines
nosuppressive drugs, IMID patients are immunosup- of the Helsinki Declaration and was approved by the Human Ethics Commit-
pressed, which may lead to a decreased vaccine efficacy. tee of Changsha Hospital of Traditional Chinese Medicine. Written informed
consent was obtained from each participant or their guardian.
Our data showed that there were no cases of COVID-19
in the two groups, which supports the protective effects Consent for publication
of vaccination against COVID-19, no matter which vac- Not applicable.
cine is utilized. In a phase IV trial of CoronaVac [17], Competing interests
the seroconversion(SC) and the positive rate of neutral- The authors declare that they have no competing interests.
izing antibody in the autoimmune rheumatic diseases
group were less than those in the control group (70.4% vs. Received: 8 November 2022 Accepted: 23 October 2023
95.5% and 56.3% vs. 79.3%, respectively), and the rate of
seropositivity of the mRNA vaccine among autoimmune
rheumatic disease patients also was less than that of the
healthy controls (86% vs. 100%) [16], which suggests the
low immunogenicity of the COVID-19 vaccine in auto- References
immune rheumatic disease patients. Additionally, a phase 1. Al Kaabi N, Zhang Y, Xia S, et al. Effect of 2 inactivated SARS-CoV-2 vac-
cines on symptomatic COVID-9 infection in adults: a randomized clinical
IV clinical study of CoronaVac revealed that patients
trial. JAMA. 2021;326(1):35–45. https://​doi.​org/​10.​1001/​jama.​2021.​8565.
with autoimmune rheumatic diseases receiving biologics, 2. Guidelines to COVID- 19 Vaccination Techniques (Version 1). Retrieved
rituximab, or abatacept had the greatest negative impact from the website of the Health Committee of the People’s Republic of
China. http://​www.​nhc.​gov.​cn/​xcs/​yqfkdt/​202103/​c2feb​fd04f​c5498​f916b​
on immunogenicity [17], which was attributed to drug-
1be08​09057​71.​shtml. Accessed 29 March 2021.
induced immunogenicity. Among the immunosuppres- 3. Curtis JR, Johnson SR, Anthony DD, et al. American College of Rheumatol-
sive drugs, methotrexate and mycophenolate mofetil had ogy guidance for COVID-19 vaccination in patients with rheumatic and
musculoskeletal diseases: version 1. Arthritis Rheumatol. 2021;73(7):1093–
the greatest negative impact on immunogenicity.
107. https://​doi.​org/​10.​1002/​art.​41734.
Our study had some limitations that must be addressed. 4. Gianfrancesco M, et al. Characteristics associated with hospitaliza-
On the one hand, only the COVID-19 rate after vaccina- tion for COVID-19 in people with rheumatic disease: data from the
COVID-19 Global Rheumatology Alliance physician-reported registry.
tion was utilized to evaluate the efficacy of the vaccine,
Ann Rheum Dis. 2020;79(7):859–66. https://​doi.​org/​10.​1136/​annrh​
while the levels of neutralizing antibodies and anti- eumdis-​2020-​217871.
SARS-CoV-2 IgG were not tested due to the restricted 5. Strangfeld A, et al. Factors associated with COVID-19-related death
in people with rheumatic diseases: results from the COVID-19 Global
conditions in our center. In addition, the sample size of
Rheumatology Alliance physician-reported registry. Ann Rheum Dis.
this study was insufficient, and a study with a much larger 2021;80:930–42. https://​doi.​org/​10.​1136/​annrh​eumdis-​2020-​219498.
sample size will be conducted in the future.
Yanfang et al. Advances in Rheumatology (2023) 63:54 Page 6 of 6

6. Papagoras C, Fragoulis GE, Zioga N, et al. Better outcomes of COVID-19 in young girls in France. Vaccine. 2017;35:4761–8. https://​doi.​org/​10.​1016/j.​
vaccinated compared to unvaccinated patients with systemic rheumatic vacci​ne.​2017.​06.​030.
diseases. Ann Rheum Dis. 2022;81(7):1013–6. https://​doi.​org/​10.​1136/​
annrh​eumdis-​2021-​221539.
7. Nuño L, Navarro MN, Bonilla G, et al. Clinical course, severity and mortal- Publisher’s Note
ity in a cohort of patients with COVID-19 with rheumatic diseases. Springer Nature remains neutral with regard to jurisdictional claims in pub-
Ann Rheum Dis. 2020;79:1659–61. https://​doi.​org/​10.​1136/​annrh​ lished maps and institutional affiliations.
eumdis-​2020-​218054.
8. Santos CS, Morales CM, Álvarez ED, et al. Determinants of COVID-19
disease severity in patients with underlying rheumatic disease. Clin Rheu-
matol. 2020;39:2789–96. https://​doi.​org/​10.​1007/​s10067-​020-​05301-2.
9. Favalli EG, Agape E, Caporali R. Incidence and clinical course of COVID- 19
in patients with connective tissue diseases: a descriptive observational
analysis. J Rheumatol. 2020;47:1296. https://​doi.​org/​10.​3899/​jrheum.​
200507.
10. Avouac J, Airo P, Carlier N, et al. Severe COVID-19-associated pneumonia
in 3 patients with systemic sclerosis treated with rituximab. Ann Rheum
Dis. 2021;80(3):e37. https://​doi.​org/​10.​1136/​annrh​eumdis-​2020-​217864.
11. Guilpain P, Le Bihan C, Foulongne V, et al. Rituximab for granulomatosis
with polyangiitis in the pandemic of COVID-19: lessons from a case with
severe pneumonia. Ann Rheum Dis. 2021;80: e10. https://​doi.​org/​10.​
1136/​annrh​eumdis-​2020-​217549.
12. Gaur P, Agrawat H, Shukla A. COVID-19 vaccine hesitancy in patients
with systemic autoimmune rheumatic disease: an interview-based
survey. Rheumatol Int. 2021;41(9):1601–5. https://​doi.​org/​10.​1007/​
s00296-​021-​04938-9.
13. World Health Organization. Global Advisory Committee on Vaccine Safety
(GACVS) review of latest evidence of rare adverse blood coagulation
events with AstraZeneca COVID- 19 Vaccine (Vaxzevria and Covishield).
https://​www.​who.​int/​news/​item/​16-​04-​2021-​global-​advis​ory-​commi​
ttee-​on-​vacci​ne-​safety-​(gacvs)-​review-​of-​latest-​evide​nce-​of-​rare-​adver​
se-​blood-​coagu​lation-​events-​with-​astra​zeneca-​covid-​19-​vacci​ne-​(vaxze​
vria-​and-​covis​hield). Accessed 24 April 2021.
14. CDC; Food and Drug Administration. Joint CDC and FDA statement on
Johnson & Johnson COVID- 19 vaccine. Atlanta, GA: US Department of
Health and Human Services, CDC; Silver Spring, MD: US Department
of Health and Human Services, Food and Drug Administration; 2021.
https://​www.​cdc.​gov/​media/​relea​ses/​2021/​s0413-​JJ-​vacci​ne.​html.
15. Rondaan C, Furer V, Heijstek MW, et al. Efficacy, immunogenicity and
safety of vaccination in adult patients with autoimmune inflammatory
rheumatic diseases: a systematic literature review for the 2019 update of
EULAR recommendations. RMD Open. 2019;5:e001035. https://​doi.​org/​
10.​1136/​rmdop​en-​2019-​001035.
16. Furer V, Eviatar T, Zisman D, et al. Immunogenicity and safety of the
BNT162b2 mRNA COVID-19 vaccine in adult patients with autoimmune
inflammatory rheumatic diseases and in the general population: a
multicenter study. Ann Rheum Dis. 2021;80(10):1330–8. https://​doi.​org/​
10.​1136/​annrh​eumdis-​2021-​220647.
17. Medeiros-Ribeiro AC, Aikawa NE, Saad CGS, et al. Immunogenicity and
safety of the CoronaVac inactivated vaccine in patients with autoim-
mune rheumatic diseases: a phase 4 trial. Nat Med. 2021;27(10):1744–51.
https://​doi.​org/​10.​1038/​s41591-​021-​01469-5.
18. Furer V, Zisman D, Kibari A, et al. Herpes zoster following BNT162b2 mRNA
Covid-19 vaccination in patients with autoimmune inflammatory rheu-
matic diseases: a case series. Rheumatology (Oxford). 2021;60(SI):SI90–5.
https://​doi.​org/​10.​1093/​rheum​atolo​gy/​keab3​45.
19. Machado PM, et al. Safety of vaccination against SARS-CoV-2 in people
Ready to submit your research ? Choose BMC and benefit from:
with rheumatic and musculoskeletal diseases: results from the EULAR
Coronavirus Vaccine (COVAX) physician-reported registry. Ann Rheum
• fast, convenient online submission
Dis. 2021. https://​doi.​org/​10.​1136/​annrh​eumdis-​2021-​221490.
20. Li JX, et al. 2 case of relapse of SLE following measles vaccine inoculation. • thorough peer review by experienced researchers in your field
Chin J Rheumatol. 2010;08:579–80. • rapid publication on acceptance
21. Soybilgic A, Onel KB, Utset T, et al. Safety and immunogenicity of the
• support for research data, including large and complex data types
quadrivalent HPV vaccine in female Systemic Lupus Erythematosus
patients aged 12 to 26 years. Pediatr Rheumatol Online J. 2013;11:29. • gold Open Access which fosters wider collaboration and increased citations
https://​doi.​org/​10.​1186/​1546-​0096-​11-​29. • maximum visibility for your research: over 100M website views per year
22. Milanovic M, Stojanovich L, Djokovic A, et al. Influenza vaccina-
tion in autoimmune rheumatic disease patients. Tohoku J Exp Med. At BMC, research is always in progress.
2013;229(1):29–34. https://​doi.​org/​10.​1620/​tjem.​229.​29.
23. Miranda S, Chaignot C, Collin C, et al. Human papilloma-virus vaccination Learn more biomedcentral.com/submissions
and risk of autoimmune diseases: a large cohort study of over 2 million