A large study of real-world data shows the effectiveness of the 23-valent vaccine.
The 23-valent pneumococcal polysaccharide vaccine can reduce severe illness and deaths from pneumonia in people with common autoimmune diseases, a large UK case-control study has found.
In the first large-scale evaluation of the question, researchers from the University of Nottingham used linked primary care data to find adults diagnosed with rheumatoid arthritis, inflammatory bowel disease, lupus or spondyloarthritis (psoriatic arthritis, reactive arthritis or ankylosing spondylitis) between 1997 and 2019 and receiving at least one immunosuppressive drug.
In three analyses involving a total of more than 72,000 patients, they compared rates of 1) hospitalisation due to any-cause pneumonia, 2) deaths from any-cause pneumonia and 3) primary care visits for respiratory infections requiring antibiotics.
The vaccinated patients had 30%, 40% and 34% lower risk of those three outcomes compared with those were unvaccinated.
When stratified by disease and comorbidity burden, all the associations remained significant except among patients with spondyloarthritis (hospitalisations), IBD (deaths) and high comorbidity burden (deaths).
The associations held whether patients had been prescribed glucocorticoid-sparing immunosuppressive drugs, methotrexate, or glucocorticoids, and regardless of comorbidity burden, age and sex.
The vaccine, known as PPV23 in the study and 23vPPV in Australia, is the one provided for free under the NHS, whereas here the default vaccine is the 13-valent conjugate vaccine (Prevenar). 23vPPV is covered under the NIP as an additional vaccine only for children and adults at risk of worse outcomes from pneumococcal infection, which does not include people immunosuppressed for autoimmune conditions.
The authors noted that their sample included only the common autoimmune conditions, their outcomes did not distinguish between causes of pneumonia and that they had no data on biologics use.
Earlier this year the same team published a study using the same dataset showing that the 23vPPV was not associated with disease flares in people with autoimmune conditions, but that, likely because of this fear, vaccination rates among these patients were “suboptimal” at around 50%.
