The effectiveness of pneumococcal vaccination in adults with common immune mediated inflammatory diseases: a UK wide study using data from the Clinical Practice Research Datalink Gold

Nakafero, Georgina; Grainge, Matthew J; Card, Tim; Mallen, Christian D; Nguyen Van-Tam, Jonathan S; Abhishek, Abhishek

Abstract

Background
The effectiveness of pneumococcal vaccination in people with common immune mediated inflammatory diseases (IMIDs) has not been evaluated. We investigated the effectiveness of pneumococcal vaccination in preventing respiratory morbidity and mortality in this population.
Methods
We conducted three nested case-control studies using data from the Clinical Practice Research Datalink Gold, linked to hospitalization and mortality records. Adults with incident common IMIDs diagnosed between 1997 and 2019 were followed up from the first diagnosis date to the occurrence of an outcome or date of last follow-up. Cases were people with IMIDs hospitalised for pneumonia, death due to pneumonia, or primary-care consultation for lower respiratory tract infection (LRTI) respectively. Cases were age and sex matched to up to ten contemporaneous controls using incidence density sampling.
We defined pneumonia using hospital discharge diagnoses, death due to pneumonia using death certification data, and primary-care consultation for LRTI as present when primary-care consultation and antibiotic prescription occurred on the same date.
Findings
1,884 patients with and 10,476 patients without pneumonia hospitalization; 781 patients that died due to pneumonia and 4,540 patients who were alive on the index date; and 10,549 patients with LRTI and 43,981 patients without were included in the nested case-control analyses.
On multivariable analysis, pneumococcal vaccination was negatively associated with hospitalisation for pneumonia (aOR (95%CI) 0.70 (0.60, 0.81), death certified due to pneumonia (aOR (95%CI) 0.60 (0.48, 0.76) and LRTI (aOR (95%CI) 0.76 (0.72, 0.80). There was no association between wellness checks (negative control exposure) and pneumonia or death due to pneumonia. Wellness check was associated positively with LRTI.
Interpretation
Pneumococcal vaccination is protective against pneumonia and death due to pneumonia without apparent residual confounding. However, residual unmeasured confounding cannot be fully excluded in observational research which includes nested case-control study.
Funding
National Institute for Health and Care Research (NIHR201973).

Citation

Nakafero, G., Grainge, M. J., Card, T., Mallen, C. D., Nguyen Van-Tam, J. S., & Abhishek, A. (2024). The effectiveness of pneumococcal vaccination in adults with common immune mediated inflammatory diseases: a UK wide study using data from the Clinical Practice Research Datalink Gold. The Lancet Rheumatology, Article keae160. https://doi.org/10.1093/rheumatology/keae160

• Journal Article Type: Article
• Acceptance Date: May 14, 2024
• Online Publication Date: Mar 13, 2024
• Publication Date: Mar 13, 2024
• Deposit Date: May 17, 2024
• Publicly Available Date: Sep 14, 2024
• Journal: The Lancet Rheumatology
• Electronic ISSN: 2665-9913
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Article Number: keae160
• DOI: https://doi.org/10.1093/rheumatology/keae160
• Keywords: Pneumococcal vaccination, rheumatoid arthritis, psoriatic arthritis, vaccine safety, vaccine uptake
• Public URL: https://nottingham-repository.worktribe.com/output/34868692