Assessing the Risk of SARS-CoV-2 Infection in Patients With Cystic Fibrosis

While a subset of people with cystic fibrosis (CF), such as those in posttransplantation, may experience a more severe clinical course of COVID-19, patients with CF are not at an increased risk of contracting SARS-CoV-2 compared with the general population, according to study results published in BMC Pulmonary Medicine.

It has been established that certain at-risk populations are at a greater risk for SARS-CoV-2 infection and more severe COVID-19. While significant morbidity was observed among people with CF during the H1N1 influenza pandemic in 2009, the association between CF status and risk for COVID-19 and associated adverse events is still unclear. Therefore, investigators conducted a systematic literature review to assess whether people with CF have an increased risk of SARS-CoV-2 infection and developing COVID-19.

The researchers reviewed 6 studies from April 28, 2020, to December 10, 2020, which included 339 patients with CF who developed COVID-19. The researchers also included information collected by the European Cystic Fibrosis Society Patient Registry (ECFSPR) on SARS-CoV-2 infection, which included data from 1236 patients from 30 countries.

One of the studies, a multinational cohort study with 40 participants with CF, reported that the incidence of SARS-CoV-2 infection was 0.07%, compared with the rate of 0.15% reported in the general population. The clinical features of COVID-19 among patients with CF were comparable with those of the general population.

Other reviewed studies had similar outcomes; however, patients with CF who were transplant recipients were at a higher risk for hospitalization compared with nontransplant patients with CF. Patients who had a forced expiratory volume in 1 second (FEV₁) <70% had significantly higher hospitalization rates than patients with FEV₁ >70% (P =.001).

In a prospective cohort study conducted in France, findings suggested that the incidence of COVID-19 in patients with CF was 0.41%, which was 93% less than the general population. Similarly, a retrospective descriptive cohort study in Spain demonstrated that the incidence of COVID-19 in patients with CF was 0.41% compared with 0.49% in the general population.

Of the 1236 patients with COVID-19 documented from the ECFSPR, 946 patients (77%) had at least partial data. The most prevalent age group was 18 to 29 years and the most common symptoms included cough, fever, and fatigue. Of the 582 patients with documented severities, the majority of patients had mild or asymptomatic symptom severity (95%); 23 (4%) cases were severe and 9 (2%) cases were critical. While 217 patients (23%) were hospitalized, 30 of whom were admitted to intensive care, 866 patients were fully recovered from infection at the time of reporting.

The study authors wrote, “Although individuals with CF are at risk of acute exacerbations of chronic lung disease, often precipitated by respiratory tract viral infections, published evidence to date indicates that incidence rates of SARS-CoV-2 infection may be lower in CF than the general population.”

“The limited cases of SARS-CoV-2 infection among the CF population is likely due to several factors that include effective physical and social distancing and the effective use of learned principles and practices of infection control stressed as parts of routine CF care,” the investigators noted.

Reference

Mathew HR, Choi MY, Parkins MD, Fritzler MJ. Systematic review: cystic fibrosis in the SARS-CoV-2/COVID-19 pandemic. BMC Pulm Med. 2021;21(1):173. doi:10.1186/s12890-021-01528-0