COVID-19 Symptoms Mild for Medium, High-risk Patients in Study

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by Patricia Inacio PhD |

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Infection by SARS-CoV-2, the virus that causes COVID-19, led to mild symptoms and no hospitalizations in people diagnosed with Pompe disease, a small Dutch study reports.

However, since the patients had mild disease and were relatively young, more study is needed to assess outcomes in this population, the researchers said.

The results were published in a letter to the editor, “Mild disease course of SARS-CoV-2 infections and mild side effects of vaccination in Pompe disease: a cohort description,” in Orphanet Journal of Rare Diseases.

People with Pompe disease are believed to be at risk of more severe outcomes from SARS-CoV-2 infection due to weakened respiratory muscle function and a tendency for being overweight, but the researchers noted that “so far little is known about the course of SARS-CoV-2 infection and side effects of COVID-19 vaccinations in patients” with Pompe disease.

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The researchers at Erasmus University Medical Center, the Netherlands, analyzed the outcomes of 169 people with Pompe disease, 146 with late-onset Pompe disease (LOPD) and 21 with classic infantile-onset Pompe disease.

The majority (125 patients) were being treated with enzyme replacement therapy (ERT), the standard treatment approach for Pompe disease. Of note, 32% of the patients were dependent on a ventilator to breathe properly.

At the start of the COVID-19 pandemic, all the patients had been asked to inform their clinicians about a SARS-CoV-2 infection. Patients who became infected were followed regularly by telephone until their symptoms eased. The 122 patients eligible for a COVID-19 vaccine were asked to complete a questionnaire.

By November 2021, 15 patients (8.9%) — five with classic infantile Pompe disease and 10 with LOPD — were infected with the SARS-CoV2 virus, with only two reporting the infection after their first dose of a COVID-19 vaccine. Of the 15 patients, 13 were treated with ERT and 10 had mild Pompe and didn’t need walking aids or ventilators. The other five showed moderate to severe symptoms. In total, 13 participants had impaired pulmonary function before their infection.

None of the infected patients required hospitalization or additional ventilation, and none were prescribed medication to treat the infection, but two infusions with ERT had to be cancelled and two others postponed.

Three patients experienced more shortness of breath while doing physical activities, such as walking or climbing stairs.

Disease duration varied from two to 19 days, after which all the patients resumed their normal lives. Symptoms included coughing, partial or full loss of smell and diminished taste, fever, runny or stuffy nose, sore throat, headache, muscle pain, chest pain, nausea, and diarrhea.

Nine patients had longer-lasting symptoms of up to four months.

Fifty patients were vaccinated and returned their vaccination questionnaire. Thirty-seven of them received two doses of the Moderna vaccine, eight of Pfizer and three the AstraZeneca vaccine. More than half (60%) experienced side effects of the vaccination. These included pain at the injection site (16 patients), headache (12), muscle pain (11), fever (nine), fatigue (eight), and swollen lymph nodes (three).

One patient had to undergo longer ventilation during the day of vaccination. Another patient developed perimyocarditis — an acute inflammation of the fluid-filled sack that surrounds the heart and of the heart muscle— two weeks after the first Moderna dose, likely as a vaccine side effect, the team said. The patient recovered and received her second dose as scheduled.

Overall, despite being “regarded to be at medium to high risk for severe COVID-19, patients generally showed mild symptoms of the infection,” the researchers wrote, noting that they didn’t know if patients who were severely affected by Pompe disease “have an increased risk for severe COVID-19.”

“Until this is clarified, we recommend to regard Pompe disease as a risk factor for severe COVID- 19 and treat patients accordingly, and strongly recommend vaccination for all patients, as vaccination has been proven to be safe and effective in preventing severe COVID-19,” they said.