COVID-19 in patients with primary and secondary immunodeficiency: The United Kingdom experience

J Allergy Clin Immunol. 2021 Mar;147(3):870-875.e1. doi: 10.1016/j.jaci.2020.12.620. Epub 2020 Dec 15.


Background: As of November 2020, severe acute respiratory syndrome coronavirus 2 has resulted in 55 million infections worldwide and more than 1.3 million deaths from coronavirus disease 2019 (COVID-19). Outcomes following severe acute respiratory syndrome coronavirus 2 infection in individuals with primary immunodeficiency (PID) or symptomatic secondary immunodeficiency (SID) remain uncertain.

Objectives: We sought to document the outcomes of individuals with PID or symptomatic SID following COVID-19 in the United Kingdom.

Methods: At the start of the COVID-19 pandemic, the United Kingdom Primary Immunodeficiency Network established a registry of cases to collate the nationwide outcomes of COVID-19 in individuals with PID or symptomatic SID and determine risk factors associated with morbidity and mortality from COVID-19 in these patient groups.

Results: A total of 100 patients had been enrolled by July 1, 2020, 60 with PID, 7 with other inborn errors of immunity including autoinflammatory diseases and C1 inhibitor deficiency, and 33 with symptomatic SID. In individuals with PID, 53.3% (32 of 60) were hospitalized, the infection-fatality ratio was 20.0% (12 of 60), the case-fatality ratio was 31.6% (12 of 38), and the inpatient mortality was 37.5% (12 of 32). Individuals with SID had worse outcomes than those with PID; 75.8% (25 of 33) were hospitalized, the infection-fatality ratio was 33.3% (11 of 33), the case-fatality ratio was 39.2% (11 of 28), and inpatient mortality was 44.0% (11 of 25).

Conclusions: In comparison to the general population, adult patients with PID and symptomatic SID display greater morbidity and mortality from COVID-19. This increased risk must be reflected in public health guidelines to adequately protect vulnerable patients from exposure to the virus.

Keywords: COVID-19; SARS-CoV-2; primary immunodeficiency; secondary immunodeficiency.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19* / immunology
  • COVID-19* / mortality
  • Female
  • Humans
  • Male
  • Middle Aged
  • Primary Immunodeficiency Diseases* / immunology
  • Primary Immunodeficiency Diseases* / mortality
  • Primary Immunodeficiency Diseases* / virology
  • Registries*
  • Risk Factors
  • SARS-CoV-2 / immunology*
  • United Kingdom / epidemiology