Uptake and Safety of Pneumococcal Vaccination in Adults with Immune-mediated Inflammatory Diseases: a UK Wide Observational Study

Overview

Journal Rheumatology (Oxford)

Publisher Oxford University Press

Specialty Rheumatology

Date 2024 Mar 13

PMID 38479823

Authors

Georgina Nakafero

Matthew J Grainge

Tim Card

Christian D Mallen

Jonathan S Nguyen Van-Tam

Abhishek Abhishek

Affiliations

Soon will be listed here.

Abstract

Objective: The uptake and safety of pneumococcal vaccination in people with immune-mediated inflammatory diseases (IMIDs) is poorly understood. We investigated the UK-wide pneumococcal vaccine uptake in adults with IMIDs and explored the association between vaccination and IMID flare.

Methods: Adults with IMIDs diagnosed on or before 1 September 2018, prescribed steroid-sparing drugs within the last 12 months and contributing data to the Clinical Practice Research Datalink Gold, were included. Vaccine uptake was assessed using a cross-sectional study design. Self-controlled case series analysis investigated the association between pneumococcal vaccination and IMID flare. The self-controlled case series observation period was up to 6 months before and after pneumococcal vaccination. This was partitioned into a 14-day pre-vaccination induction, 90 days post-vaccination exposed and the remaining unexposed periods.

Results: We included 32 277 patients, 14 151 with RA, 13 631 with IBD, 3804 with axial SpA and 691 with SLE. Overall, 57% were vaccinated against pneumococcus. Vaccine uptake was lower in those younger than 45 years old (32%), with IBD (42%) and without additional indication(s) for vaccination (46%). In the vaccine safety study, data for 1067, 935 and 451 vaccinated patients with primary-care consultations for joint pain, autoimmune rheumatic disease flare and IBD flare, respectively, were included. Vaccination against pneumococcal pneumonia was not associated with primary-care consultations for joint pain, autoimmune rheumatic disease flare and IBD flare in the exposed period, with incidence rate ratios (95% CI) 0.95 (0.83-1.09), 1.05 (0.92-1.19) and 0.83 (0.65-1.06), respectively.

Conclusion: Uptake of pneumococcal vaccination in UK patients with IMIDs was suboptimal. Vaccination against pneumococcal disease was not associated with IMID flare.

References

Malhi G, Rumman A, Thanabalan R, Croitoru K, Silverberg M, Steinhart A . Vaccination in inflammatory bowel disease patients: attitudes, knowledge, and uptake. J Crohns Colitis. 2015; 9(6):439-44. DOI: 10.1093/ecco-jcc/jjv064. View

Puges M, Biscay P, Barnetche T, Truchetet M, Richez C, Seneschal J . Immunogenicity and impact on disease activity of influenza and pneumococcal vaccines in systemic lupus erythematosus: a systematic literature review and meta-analysis. Rheumatology (Oxford). 2016; 55(9):1664-72. DOI: 10.1093/rheumatology/kew211. View

Lawson E, Trupin L, Yelin E, Yazdany J . Reasons for failure to receive pneumococcal and influenza vaccinations among immunosuppressed patients with systemic lupus erythematosus. Semin Arthritis Rheum. 2015; 44(6):666-71. PMC: 4464934. DOI: 10.1016/j.semarthrit.2015.01.002. View

Nakafero G, Grainge M, Card T, Mallen C, Nguyen Van-Tam J, Williams H . Is vaccination against COVID-19 associated with autoimmune rheumatic disease flare? A self-controlled case series analysis. Rheumatology (Oxford). 2022; 62(4):1445-1450. PMC: 10070057. DOI: 10.1093/rheumatology/keac484. View

van Aalst M, Lotsch F, Spijker R, van der Meer J, Langendam M, Goorhuis A . Incidence of invasive pneumococcal disease in immunocompromised patients: A systematic review and meta-analysis. Travel Med Infect Dis. 2018; 24:89-100. DOI: 10.1016/j.tmaid.2018.05.016. View

Costello R, Winthrop K, Pye S, Brown B, Dixon W . Influenza and Pneumococcal Vaccination Uptake in Patients with Rheumatoid Arthritis Treated with Immunosuppressive Therapy in the UK: A Retrospective Cohort Study Using Data from the Clinical Practice Research Datalink. PLoS One. 2016; 11(4):e0153848. PMC: 4838312. DOI: 10.1371/journal.pone.0153848. View

Nakafero G, Grainge M, Myles P, Mallen C, Zhang W, Doherty M . Predictors and temporal trend of flu vaccination in auto-immune rheumatic diseases in the UK: a nationwide prospective cohort study. Rheumatology (Oxford). 2018; 57(10):1726-1734. PMC: 6152422. DOI: 10.1093/rheumatology/key156. View

Singh J, Saag K, Bridges Jr S, Akl E, Bannuru R, Sullivan M . 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2015; 68(1):1-25. DOI: 10.1002/acr.22783. View

Shea K, Edelsberg J, Weycker D, Farkouh R, Strutton D, Pelton S . Rates of pneumococcal disease in adults with chronic medical conditions. Open Forum Infect Dis. 2015; 1(1):ofu024. PMC: 4324183. DOI: 10.1093/ofid/ofu024. View

10.

Desalermos A, Pimienta M, Kalligeros M, Shehadeh F, Diamantopoulos L, Karamanolis G . Safety of Immunizations for the Adult Patient With Inflammatory Bowel Disease-A Systematic Review and Meta-analysis. Inflamm Bowel Dis. 2021; 28(9):1430-1442. DOI: 10.1093/ibd/izab266. View

11.

Lopez A, Mariette X, Bachelez H, Belot A, Bonnotte B, Hachulla E . Vaccination recommendations for the adult immunosuppressed patient: A systematic review and comprehensive field synopsis. J Autoimmun. 2017; 80:10-27. DOI: 10.1016/j.jaut.2017.03.011. View

12.

van Assen S, Agmon-Levin N, Elkayam O, Cervera R, Doran M, Dougados M . EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2010; 70(3):414-22. DOI: 10.1136/ard.2010.137216. View

13.

Loubet P, Kerneis S, Groh M, Loulergue P, Blanche P, Verger P . Attitude, knowledge and factors associated with influenza and pneumococcal vaccine uptake in a large cohort of patients with secondary immune deficiency. Vaccine. 2015; 33(31):3703-8. DOI: 10.1016/j.vaccine.2015.06.012. View

14.

Musher D, Manof S, Liss C, McFetridge R, Marchese R, Bushnell B . Safety and antibody response, including antibody persistence for 5 years, after primary vaccination or revaccination with pneumococcal polysaccharide vaccine in middle-aged and older adults. J Infect Dis. 2010; 201(4):516-24. DOI: 10.1086/649839. View

15.

Migita K, Akeda Y, Akazawa M, Tohma S, Hirano F, Ideguchi H . Opsonic and Antibody Responses to Pneumococcal Polysaccharide in Rheumatoid Arthritis Patients Receiving Golimumab Plus Methotrexate. Medicine (Baltimore). 2015; 94(52):e2184. PMC: 5291602. DOI: 10.1097/MD.0000000000002184. View

16.

Hua C, Barnetche T, Combe B, Morel J . Effect of methotrexate, anti-tumor necrosis factor α, and rituximab on the immune response to influenza and pneumococcal vaccines in patients with rheumatoid arthritis: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2013; 66(7):1016-26. DOI: 10.1002/acr.22246. View

17.

Adams L, Nakafero G, Grainge M, Card T, Mallen C, Nguyen Van-Tam J . Is vaccination against COVID-19 associated with psoriasis or eczema flare? Self-controlled case series analysis using data from the Clinical Practice Research Datalink (Aurum). Br J Dermatol. 2023; 188(2):297-299. DOI: 10.1093/bjd/ljac061. View

18.

Rezende R, Ribeiro F, Albuquerque E, Gayer C, Andrade L, Klumb E . Immunogenicity of pneumococcal polysaccharide vaccine in adult systemic lupus erythematosus patients undergoing immunosuppressive treatment. Lupus. 2016; 25(11):1254-9. DOI: 10.1177/0961203316636472. View

19.

Herrett E, Gallagher A, Bhaskaran K, Forbes H, Mathur R, van Staa T . Data Resource Profile: Clinical Practice Research Datalink (CPRD). Int J Epidemiol. 2015; 44(3):827-36. PMC: 4521131. DOI: 10.1093/ije/dyv098. View

20.

Loubet P, Verger P, Abitbol V, Peyrin-Biroulet L, Launay O . Pneumococcal and influenza vaccine uptake in adults with inflammatory bowel disease in France: Results from a web-based study. Dig Liver Dis. 2018; 50(6):563-567. DOI: 10.1016/j.dld.2017.12.027. View