Coronavirus disease 2019 in patients with inborn errors of immunity: an international study

Abstract

BACKGROUND:There is uncertainty about the impact of SARS-CoV-2 infection in individuals with rare inborn errors of immunity (IEI), a population at risk of developing severe COVID-19. This is relevant not only for these patients but also the general population, as studies of IEIs can unveil key requirements for host defense. OBJECTIVE:Describe the presentation, manifestations and outcome of SARS-CoV-2 infection in IEI to inform physicians and enhance understanding of host defense against SARS-CoV-2. METHODS:An invitation to participate in a retrospective study was distributed globally to scientific, medical and patient societies involved in the care and advocacy for patients with IEI. RESULTS:We gathered information on 94 IEI patients with SARS-CoV-2 infection. Median age was 25-34 years. 53 patients (56%) suffered from primary antibody deficiency, 9 (9.6%) had immune dysregulation syndrome, 6 (6.4%) a phagocyte defect, 7 (7.4%) auto-inflammatory disorder, 14 (15%) a combined immunodeficiency, 3 (3%) an innate immune defect, and 2 (2%) bone marrow failure. Ten were asymptomatic, 25 were treated as outpatients, 28 required admission without intensive care or ventilation, 13 required non-invasive ventilation or oxygen administration, 18 were admitted to intensive care units, 12 requiring invasive ventilation, and 3 extra corporeal membrane oxygenation. Nine patients (seven adults, two children) died. CONCLUSIONS:This study demonstrates that (1) >30% of IEI patients had mild COVID19, and (2) risk factors predisposing to severe disease/mortality in the general population also seemed to affect IEI patients, including more younger patients. Further studies will identify pathways that are associated with increased risk of severe disease and are non-redundant or redundant for protection against SARS-CoV-2.