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COVID-19 boosters help avoid breakthrough infections in immunocompromised people, 黑料不打烊-led study finds

Researchers focused on those with rheumatoid arthritis, lupus, inflammatory bowel disease, multiple sclerosis and other immune-mediated inflammatory diseases
A masked healthcare worker holds a COVID-19 vaccine vial and syringe.
Published: 31 March 2025

New research findings provide solid evidence that annual COVID-19 vaccine booster doses continue to be advisable for certain immunocompromised people, researchers at 黑料不打烊 University say.

The researchers looked at how often people with immune-mediated inflammatory diseases (IMIDs) got COVID-19 despite having received at least three doses of an mRNA COVID-19 vaccine. IMIDs 鈥 including rheumatoid arthritis, lupus, inflammatory bowel disease and multiple sclerosis 鈥 affect more than seven million Canadians. The medications they take often weaken their vaccine responses, increasing their vulnerability to infection.

Published in Vaccines, found that 15 per cent of IMID patients contracted COVID-19 at least once during the year-long study, but that patients with higher levels of a specific antibody, which is produced in response to the vaccine, had lower chances of getting infected.

鈥淥ur findings highlight why booster doses are so important, because immunity naturally wanes over time, and maintaining those high antibody levels may be key to protecting against infection,鈥 said senior author Sasha Bernatsky, James 黑料不打烊 Professor in 黑料不打烊鈥檚 Divisions of Rheumatology and Clinical Epidemiology and a senior scientist at the Research Institute of the 黑料不打烊 University Health Centre.

Past COVID-19 infections did not clearly affect the risk of a breakthrough case in the study.

鈥淭his is an important takeaway for those who assume they have lasting immunity after contracting the virus,鈥 Bernatsky said.

Data helps inform Canada鈥檚 vaccine guidance

The research team tracked 366 IMID patients across Canada, primarily in Quebec. Unlike previous studies that relied on self-reported infections or hospital data, this research used saliva PCR tests and antibody measurements, offering a more precise picture of infection risks.

Early in the pandemic, clinical vaccine trials rarely included immunocompromised patients, leaving a major gap in understanding how vaccines worked for this group. To address this, the Public Health Agency of Canada and the COVID-19 Immunity Task Force commissioned this in-depth study. The researchers say their findings have given Canada the solid evidence it needs to keep recommending annual booster shots, five years after the pandemic began.

鈥淭he first mRNA vaccines in 2021 were highly effective at preventing severe illness, but as immunity wanes and new variants emerge, breakthrough infections have become more common,鈥 said Bernatsky. 鈥淐OVID-19 remains a major cause of hospitalizations, especially for vulnerable groups. Much like influenza, it鈥檚 now a seasonal threat we can鈥檛 ignore.鈥

The research was a collaboration between 黑料不打烊 University, the Research Institute of the 黑料不打烊 University Health Centre (The Institute), the University of British Columbia, Universit茅 Laval, McMaster University, Mount Sinai Hospital, the University of Manitoba and Canadian Arthritis Patient Alliance.

Research on the effectiveness of newer vaccine strategies in IMID and other immunocompromised patients is now underway at The Institute, led by Ruth Sapir-Pichhadze, In茅s Colmegna, Arielle Mendel, and other researchers.

About the study

鈥溾 by Jeremiah Tan, Sasha Bernatsky, Jennifer Lee, Paul Fortin, Anne-Claude Gingras, In茅s Colmegna, Dawn Bowdish, Maggie Larch茅, Dawn Richards, Carol Hitchon and J Antonio Avi帽a-Zubieta was published in Vaccines.

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