Pneumococcal Vaccination Rates Have Risen in Patients With Rheumatic Diseases

Nearly half (49.1%) of patients with an autoimmune inflammatory rheumatic disease (AIIRD) were vaccinated against pneumococcal infection, according to a 2021 cross-sectional study conducted in Germany that was published in Vaccines. Among patients, 68.5% were vaccinated against influenza and 13.1% were vaccinated against herpes zoster (HZ), suggesting that vaccination rates for influenza and Streptococcus pneumoniae, or pneumococcus, have improved in recent years.

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Vaccination rates for influenza and pneumococcus are typically low in patients with AIIRD, despite this population having a higher risk of infection and related mortality. The European League Against Rheumatism (EULAR) recommends vaccination against these viruses for patients with rheumatic diseases, including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).

The German Standing Committee on Vaccination (STIKO) recommends vaccination againstinfluenza and Streptococcus pneumoniae for patients aged 60 years and older with chronic disease or other immune diseases. They also recommended the HZ vaccine to patients with RA and SLE who are aged 50 years and older.

German investigators conducted a cross-sectional study to understand vaccination rates for influenza, pneumococcus ,and HZ among patients with AIIRD. From June and August 2021, investigators enrolled 222 patients with AIIRD who were attending the outpatient clinic at Leipzig University. The team collected data on patient characteristics and vaccination status for any of the 3 diseases.

Investigators found that 33.2% of patients with RA had a pneumococcal vaccination; 53.2% had an influenza vaccination. However, less patients with SLE were vaccinated against pneumococcusand influenza (20.6 and 48.5%, respectively). Investigators suggest that the younger age of patients with SLE contributes to lower vaccination rates; the STIKO guidelines specifically recommend vaccination for older adults with SLE.

The study authors also suggests that COVID-19 may affect vaccination outcomes. In a pre-pandemic study of vaccination rates, 20% of patients with RA received the influenza vaccine, while 30.4% received pneumococcal vaccination. Further, patient education at the outpatient visits was associated with increased vaccination rates against influenza and pneumococcus.

Additionally, female patients were more likely than male patients to be vaccinated against pneumococcus. People who were aged 60 years and older, had the influenza vaccine, or used gulucocortoids were factors that are independently associated with pneumococcus vaccination.

The study authors noted that influenza vaccination rates appear to be higher than pneumococcal vaccination rates because “[it] is much more common in clinical practice and better known among patients,” wrote study authors in the article. Conversely, HZ vaccination may be lower among at-risk patients because it is a fairly new innovation—it was only approved in Europe in 2018 (2017 in the United States), and is only available as a live vaccine.

Investigators suggest that vaccination rates need to continue increasing, especially for patients with SLE. They recommend using best practice alerts and other techniques to increase vaccination rates in this immunocompromised patient population.

Reference

Krasselt M, Wagner U, Seifert O. Influenza, Pneumococcal and Herpes Zoster Vaccination Rates in Patients with Autoimmune Inflammatory Rheumatic Diseases. Vaccines 2023. doi.org/10.3390/vaccines11040760