Association between inactivated influenza vaccine and primary care consultations for autoimmune rheumatic disease flares: a self-controlled case series study using data from the Clinical Practice Research Datalink

Nakafero, Georgina; Grainge, Matthew J.; Myles, Puja; Mallen, Christian D.; Zhang, Weiya; Doherty, Michael; Nguyen-Van-Tam, Jonathan S.; Abhishek, Abhishek

Abstract

Objectives To examine the association between inactivated influenza vaccine (IIV) administration and primary care consultation for joint pain, rheumatoid arthritis (RA) flare, corticosteroid prescription, vasculitis, and unexplained fever in people with autoimmune rheumatic diseases (AIRDs).

Methods: We undertook within-person comparisons using self-controlled case-series methodology. AIRD cases who received the IIV and had an outcome of interest in the same influenza cycle were ascertained in Clinical Practice Research Datalink. The influenza cycle was partitioned into exposure periods (1-14 days pre-vaccination, and 0-14, 15-30, 31-60, and 61-90 days post-vaccination), with the remaining time-period classified as non-exposed. Incidence rate ratios (IRR) and 95% confidence intervals (CI) for different outcomes were calculated.

Results: Data for 14,928 AIRD cases (69% women, 80% with RA) were included. There was no evidence for association between vaccination and primary-care consultation for RA flare, corticosteroid prescription, fever or vasculitis. On the contrary, vaccination associated with reduced primary-care consultation for joint pain in the subsequent 90-days [IRR (95%CI) 0.91(0.87-0.94)].

Conclusion: This study found no evidence for a significant association between vaccination and primary-care consultation for most surrogates of increased disease activity or vaccine adverse-effects in people with AIRDs. It adds to the accumulating evidence to support influenza vaccination in AIRDs.

Citation

Nakafero, G., Grainge, M. J., Myles, P., Mallen, C. D., Zhang, W., Doherty, M., …Abhishek, A. (2019). Association between inactivated influenza vaccine and primary care consultations for autoimmune rheumatic disease flares: a self-controlled case series study using data from the Clinical Practice Research Datalink. Annals of the Rheumatic Diseases, 78(8), 1122-1126. https://doi.org/10.1136/annrheumdis-2019-215086

• Journal Article Type: Article
• Acceptance Date: Apr 7, 2019
• Online Publication Date: Apr 29, 2019
• Publication Date: 2019-08
• Deposit Date: Apr 8, 2019
• Publicly Available Date: Apr 9, 2019
• Journal: Annals of the Rheumatic Diseases
• Print ISSN: 0003-4967
• Electronic ISSN: 1468-2060
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 78
• Issue: 8
• Pages: 1122-1126
• DOI: https://doi.org/10.1136/annrheumdis-2019-215086
• Keywords: Immunology; General Biochemistry, Genetics and Molecular Biology; Immunology and Allergy; Rheumatology
• Public URL: https://nottingham-repository.worktribe.com/output/1764618
• Publisher URL: https://ard.bmj.com/content/78/8/1122