Georgina Nakafero

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.