Patients with autoimmune diseases are among the susceptible groups to COVID-19 infection because of the complexity of their conditions and the side effects of the immunosuppressive drugs used to treat them. They might show impaired immunogenicity to COVID-19 vaccines and have a higher risk of developing COVID-19. Using a systematic review and meta-analysis, this research sought to summarize the evidence on COVID-19 vaccine efficacy, immunogenicity, and safety in patients with autoimmune diseases following predefined eligibility criteria. Research articles were obtained from an initial search up to 26 September 2022 from PubMed, Embase, EBSCOhost, ProQuest, MedRxiv, bioRxiv, SSRN, EuroPMC, and the Cochrane Center of Randomized Controlled Trials (CCRCT). Of 76 eligible studies obtained, 29, 54, and 38 studies were included in systematic reviews of efficacy, immunogenicity, and safety, respectively, and 6, 18, and 4 studies were included in meta-analyses for efficacy, immunogenicity, and safety, respectively. From the meta-analyses, patients with autoimmune diseases showed more frequent breakthrough COVID-19 infections and lower total antibody (TAb) titers, IgG seroconversion, and neutralizing antibodies after inactivated COVID-19 vaccination compared with healthy controls. They also had more local and systemic adverse events after the first dose of inactivated vaccination compared with healthy controls. After COVID-19 mRNA vaccination, patients with autoimmune diseases had lower TAb titers and IgG seroconversion compared with healthy controls.

Pendahuluan. HIV adalah infeksi yang menyerang sistem kekebalan tubuh dengan CD4 sebagai sel targetnya. Ditemukannya Highly Active Antiretroviral Therapy (HAART) diharapkan mampu menurunkan angka morbiditas dan mortalitas HIV. Namun, kenaikan CD4 tidak sama untuk setiap pasien serta terdapat faktor lain yang berhubungan dengan kenaikan CD4 pada pasien HIV. Metode. Studi kohort retrospektif dilakukan pada pasien HIV rawat jalan di Unit Pelayanan Terpadu HIV Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta selama Mei- Juni 2014.. Data penelitian didapatkan dari rekam medis selama Januari 2004-Desember 2013. Analisis data menggunakan program SPSS dengan uji Mann Whitney, uji Chi Square atau Fisher serta analisis multivariat dengan teknik regresi logistik. Hasil. Sebanyak 818 subjek diikutsertakan pada penelitian ini. Sebanyak 368 (45%) subjek tidak mengalami kenaikan CD4 seperti yang diharapkan. Median CD4 awal sebelum terapi 56 sel/mm3 dan setelah 6 bulan terapi 130 sel/mm3. Terdapat hubungan yang bermakna antara jumlah CD4 awal, infeksi tuberkulosis dan tingkat kepatuhan dengan kenaikan CD4 dengan nilai p masing-masing <0,001, 0,010 dan <0,001. Hasil analisis multivariat didapatkan bahwa jumlah CD4 awal (p<0,001; OR: 0,996; IK 95% 0,995-0,998), tidak patuh minum obat (p<0,001; OR:2,907; IK 95%: 2,162-3,909), dan infeksi tuberkulosis (p=0,021; OR: 1,527; IK 95%: 1,065-2,190) berhubungan dengan kenaikan CD4 pada pasien HIV yang mendapat HAART. Simpulan. Jumlah CD4 awal, kepatuhan minum obat, dan infeksi tuberkulosis mempengaruhi kenaikan CD4 pada pasien HIV yang mendapat Highly Active Antiretroviral Therapy setelah 6 bulan pertama.

People living with HIV (PLHIV) are considered a high-risk population for developing a severe form of COVID-19. Vaccination is still one of the most important modalities in combating the disease due to the lack of an effective treatment. This multicenter study was performed from September to December 2021 with the aim to analyze the intention of PLHIV to receive the COVID-19 vaccination based on an integrated behavior model (IBM) in Indonesia. Of a total of 470 participants, 75.6% of patients were intent to be vaccinated. The model that was designed in this study explains 43.4% of the variance in intention to be vaccinated against COVID-19 in PLHIV (adjusted R² = 0.434). Furthermore, the determinants used included instrumental attitude (β = 0.127, p < 0.05), subjective norm (β = 0.497, p < 0.01), and perceived behavioral control (β = 0.116, p < 0.01). This study concluded that an IBM could predict the intention of PLHIV to receive COVID-19 vaccination.

The COVID-19 pandemic has caused significant morbidity and mortality worldwide, especially among health-care workers. One of the most important preventive measures is vaccination. This study examined factors associated with the incidence rate of SARS-CoV-2 infection after mRNA-1273 booster vaccination (preceded by the CoronaVac primary vaccination) and the antibody profile of health-care workers at one of the tertiary hospitals in Indonesia. This was a combined retrospective cohort and cross-sectional study. Three hundred health-care workers who were given the mRNA-1273 booster vaccine a minimum of 5 months prior to this study were randomly selected. Participants were then interviewed about their history of COVID-19 vaccination, history of SARS-CoV-2 infection, and comorbidities. Blood samples were taken to assess IgG sRBD antibody levels. The median antibody level was found to be 659 BAU/mL (min 37 BAU/mL, max 5680 BAU/mL, QIR 822 BAU/mL) after the booster, and this was not related to age, sex, comorbidities, or adverse events following immunization (AEFI) after the booster. SARS-CoV-2 infection after the booster was correlated with higher antibody levels. In sum, 56 participants (18.6%) experienced SARS-CoV-2 infection after the mRNA-1273 booster vaccination within 5 months. Incidence per person per month was 3.2%. Age, sex, diabetes mellitus type 2, hypertension, obesity, and post-booster AEFI were not related to COVID-19 incidence after the booster. History of SARS-CoV-2 infection before the booster vaccination was significantly associated with a reduced risk of SARS-CoV-2 infection after booster vaccination, with a relative risk (RR) of 0.21 (95% CI 0.09–0.45, p < 0.001).

Aim: To investigate the effect of influenza vaccination with or without probiotic supplementation on the immune response and incidence of influenza-like illness (ILI) in the elderly. Methods: A randomized double-blind, placebo-controlled trial with a modified factorial design was conducted in 554 healthy elderly subjects aged 67 ± 5.6 (ranging from 60–90) years old in the Primary Health Care Center (Puskesmas area) of the Pulo Gadung District East Jakarta. Subjects received either a trivalent influenza vaccine or placebo at the start of the study, and a probiotic supplement (Lactobacillus helveticus R0052 and Lactobacillus rhamnosus R0011) or a placebo for 6 months. Subjects were randomly assigned into four intervention groups: influenza vaccine and probiotics (n = 141), influenza vaccine and placebo (n = 136), placebo and probiotics (n = 140), and both placebo (n = 137). The primary outcome was ILI incidence within 6 months. The secondary outcomes were seroprotection and seroconversion rates at 1, 4, and 6 months after administering the interventions. Results: This study showed that the trivalent influenza vaccine increased seroprotection (RR 3.6 [95%CI 2.92–4.47]; p<0.010) and seroconversion (RR 29.8 [95%CI 11.1–79.5]; p<0.010) rates 1 month after vaccination in elderly people while the probiotic supplement did not alter influenza antibody titers (p = 1.000 and p = 0.210). The relative ILI incidence risk was similar between vaccinated and non-vaccinated groups, as well as in the probiotic group compared to the non-probiotic group. Conclusion: The tested trivalent influenza vaccine significantly induced seroprotection and seroconversion in the vaccinated subjects, while probiotics administration did not influence these parameters. Vaccinated individuals displayed a similarly low ILI incidence as those in the Control Group. However, the observed trend towards a reduction of ILI incidence with probiotics supplementation warrants further assessments in a larger, at-risk population. Clinical trial registry number: NCT03695432.

Vaccine hesitancy can be a challenge for those with autoimmune diseases. This study investigated the acceptance of COVID-19 vaccination by patients with autoimmune diseases in Indonesia using the integrated behavioral model (IBM). This cross-sectional study was conducted from December 2021 to February 2022. A total of 404 patients with autoimmune diseases completed the survey. The majority of respondents (57.9%) said they intended to get vaccinated against COVID-19. The IBM model with added demographic variables explained 54.1% of the variance of vaccination intention (R² = 0.541). Self-efficacy, perceived norms, experiential attitude, and instrumental attitude are significantly correlated with vaccination intention in components of health behavior theories. Self-efficacy is the most critical factor influencing vaccination intention in patients with autoimmune diseases (F(2, 401) = 96.9, p < 0.001, R² = 0.326). In the multivariate analysis, vaccine intention was found to be positively associated with patients’ occupation as health-care workers (β = 0.105). Meanwhile, having a personal history of contracting COVID-19 and having co-morbidities other than autoimmune diseases were negatively correlated to the willingness to be vaccinated against COVID-19. This study confirms the viability of the IBM model for predicting the COVID-19 vaccination intention of patients with autoimmune diseases. It is essential to provide patients with autoimmune diseases with information that is clear and supported by evidence-based medicine.