Booster or updated COVID-19 vaccines were linked to fewer hospital admissions in rheumatic disease

Design

Retrospective cohort, national electronic health records (N3C)

Population

60,980 adults with autoimmune rheumatic conditions and COVID-19, 2020–2024

Primary outcome

COVID-19-related hospitalisation

Effect

Booster aOR 0.29 (95% CI 0.27–0.31); updated vaccine aOR 0.31 (0.28–0.34) vs unvaccinated

A US national electronic records cohort identified 60,980 adults with autoimmune rheumatic conditions who developed COVID-19 between December 2020 and August 2024, and compared hospitalisation by vaccination status, adjusting for age, clinical risk, social vulnerability and medications.

Compared with no vaccination, the odds of hospitalisation were lower after the initial series (aOR 0.59), and lower still after a booster (aOR 0.29) or an updated 2023–24 vaccine (aOR 0.31). The absolute risk reduction for booster or updated vaccine over the initial series alone was 5.6 percentage points. Only 10% had received an updated vaccine.

This is observational, and people who get boosters may differ in ways that also protect them. But the gradient is consistent and the absolute difference is meaningful for immunosuppressed patients. It was published in September 2026.

• Recommend up-to-date COVID-19 vaccination for patients with autoimmune rheumatic disease.
• Check vaccination status at routine reviews, especially in those on immunosuppression.
• Uptake of updated vaccines was low in this cohort; ask rather than assume.
• Time vaccination around rituximab where possible to improve response.

Why it matters

Vaccine uptake falls with each round, yet protection in this group appeared to depend on staying current.

Don't overread it

People who choose boosters may differ from those who do not; this cannot show the full effect is due to the vaccine.

The statistics, in plain English

An adjusted odds ratio of 0.29 means about 70% lower odds of hospitalisation compared with the unvaccinated. The absolute risk reduction of 5.6 points means roughly one fewer hospitalisation for every 18 infected patients who had a booster rather than only the initial series.

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