UPDATED and booster COVID-19 vaccines have been linked to substantially lower odds of COVID-19-related hospitalisation among patients with autoimmune rheumatic conditions, a large US cohort study has found.
Patients with autoimmune rheumatic conditions often face heightened vulnerability to severe COVID-19 due to underlying disease and immunosuppressive treatment. Whether ongoing vaccination, including updated and booster doses, continues to provide meaningful protection against COVID-19-related hospitalisation in this population has remained an important question for clinicians and policymakers. Researchers have therefore examined outcomes across vaccination status using large-scale, real-world clinical data.
This retrospective cohort study used National Clinical Cohort Collaborative data on adults with autoimmune rheumatic conditions and incident COVID-19 between December 2020 and August 2024. Vaccination status was categorised as unvaccinated, initial series, booster, or updated 2023 to 2024 vaccine. The primary outcome was COVID-19-related hospitalisation, defined as an inpatient visit occurring three days before to 14 days after confirmed SARS-CoV-2 infection; secondary outcomes included mechanical ventilation or ECMO and death.
Among 60,980 patients (median age 62 years; 76% female; 74% non-Hispanic White), 6,336 (10%) had received an updated vaccine. Adjusted odds of hospitalisation fell progressively with vaccination compared with no doses: initial series (aOR 0.59, 95% CI 0.56 to 0.63), booster (aOR 0.29, 95% CI 0.27 to 0.31), and updated vaccine (aOR 0.31, 95% CI 0.28 to 0.34). Absolute hospitalisation risk was 18.3% among unvaccinated patients or those with only an initial series, versus 8.2% among those boosted or updated, an absolute risk reduction of 10.1% and a number needed to treat of 10. Comparing initial series alone with booster or updated vaccination, the absolute risk reduction was 5.6% and the number needed to treat was 18.
These findings have demonstrated that updated and booster COVID-19 vaccination is associated with substantially lower odds of hospitalisation in this medically vulnerable population, with benefits consistent across age, sex, condition type, immunosuppressive exposure, and social vulnerability.
As an observational cohort study, causation cannot be firmly established, but the results support continued clinician, policymaker, and patient advocacy backing for updated vaccination in autoimmune rheumatic conditions.
Reference
Jackson LE et al. Updated COVID-19 vaccines and health outcomes in patients with autoimmune rheumatic conditions. Arthritis Rheumatol. 2026;DOI:10.1002/art.70290.
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