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

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.

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