Uptake and safety of pneumococcal vaccination in adults with immune mediated inflammatory diseases: a UK wide observational study

Georgina Nakafero; Matthew J Grainge; Tim Card; Christian D Mallen; Jonathan S Nguyen Van-Tam; Abhishek Abhishek

doi:10.1093/rheumatology/keae160

Uptake and safety of pneumococcal vaccination in adults with immune mediated inflammatory diseases: a UK wide observational study

Rheumatology (Oxford). 2024 Mar 13:keae160. doi: 10.1093/rheumatology/keae160. Online ahead of print.

Authors

Georgina Nakafero¹, Matthew J Grainge², Tim Card^{2

3}, Christian D Mallen⁴, Jonathan S Nguyen Van-Tam², Abhishek Abhishek¹

Affiliations

¹ Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK.
² Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.
³ Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
⁴ Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK.

PMID: 38479823
DOI: 10.1093/rheumatology/keae160

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 01/09/2018, 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 (SCCS) analysis investigated the association between pneumococcal vaccination and IMID flare. The SCCS observation period was up-to six-month 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, 3,804 with axial spondyloarthritis and 691 with SLE. Overall, 57% were vaccinated against pneumococcus. Vaccine uptake was lower in those younger than 45 years (32%), with IBD (42%), and without additional indication(s) for vaccination (46%). In the vaccine-safety study, data for 1,067, 935, and 451vaccinated patients with primary-care consultations for joint pain, AIRD flare and IBD flare respectively were included. Vaccination against pneumococcal pneumonia was not associated with primary-care consultations for joint pain, AIRD flare and IBD flare in the exposed period with incidence rate ratios (95% Confidence Interval) 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.

Keywords: Pneumococcal vaccination; psoriatic arthritis; rheumatoid arthritis; vaccine safety; vaccine uptake.