Publication date: Jan 10, 2025

Limited data are available to assess breakthrough SARS-CoV-2 infections, medical utilization, and mortality in patients with tuberculosis (TB). The aim of this study was to examine the risk of COVID-19 and severe outcomes in patients with TB between January 2020 and March 2022. US electronic medical records were used to identify TB and non-TB patients who completed the primary series of vaccination and had no prior COVID-19. Breakthrough infections and severe adverse outcomes, defined by the Centers for Disease Control and Prevention as hospitalization, need for mechanical ventilation and/or intensive care unit admission, or in-hospital mortality, following a positive SARS-CoV-2 polymerase chain reaction (PCR) test. Follow-up began 14 days after the primary vaccination series was completed and continued for 365 days. The study included 15,541 TB and 15,541 non-TB patients. The risk of breakthrough infection was significantly higher in the TB group than in the non-TB group after controlling for age, sex, ethnicity, socioeconomic status, and lifestyles (adjusted HR, 1. 444; 95 % CI, 1. 321-1. 579). Similar trends were observed in pre-specified subgroup analyses stratified by age, sex, and status of TB. Patients in the TB group had higher risks of emergency room visit and critical care admission [adjusted HRs, 1. 244 (95 % CI, 1. 175-1. 316) and 1. 404 (95 % CI, 1. 182-1. 668)]. Our study revealed a higher risk of COVID-19 breakthrough infections and adverse outcomes among patients with TB. Thus, besides priority COVID-19 vaccination, healthcare providers should continue vigilance for patients with TB.

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