Uptake and safety of pneumococcal vaccination in adults with immune mediated inflammatory diseases: a nationwide observational study using data from the Clinical Practice Research Datalink (Gold) in the UK.

IntroductionThe 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. MethodsAdults 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 14-day pre-vaccination, 90-days post-vaccination exposed, and the remaining unexposed period. ResultsWe included 32,277 patients, 14,151 with RA, 13,631 with IBD, 3,804 with axial spondyloarthritis and 691 with SLE. Overall, 50% of patients were vaccinated against pneumococcus. Vaccine uptake was lower in those younger than 45 years (30%), with IBD (38%), and without additional indication(s) for vaccination (43%). In the vaccine-safety study, data for 1001, 854, 424 vaccinated 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 (0.83-1.10), 1.07 (0.93-1.22), and 0.82 (0.64-1.06) respectively. ConclusionUptake of pneumococcal vaccination in UK patients with IMIDs was suboptimal. Vaccination against pneumococcal disease was not associated with disease flare.