This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
The pneumococcal vaccine protects against pneumonia, meningitis and sepsis. Among people with inflammatory diseases (such as arthritis and inflammatory bowel disease), researchers found that the vaccine:
- reduced the risk of hospitalisation and death from pneumonia
- had low uptake
- was not linked with disease flares.
The findings reassure that the vaccine is effective and safe for people with these conditions. They highlight the need to increase vaccine uptake.
More information on the pneumococcal vaccine can be found on the NHS website.
The issue: people with inflammatory diseases are at risk of pneumonia
In the UK, 1 in 30 adults has an inflammatory disease such as inflammatory bowel disease (IBD), lupus, rheumatoid arthritis and spondylarthritis (a group of arthritic conditions). Inflammatory diseases are caused by inappropriate and excessive inflammation driven by the immune system. They are treated with drugs that dampen the immune system.
These medicines reduce the immune response. People taking them are therefore at increased risk of infections, such as pneumonia and meningitis. A pneumococcal vaccine is recommended for people with inflammatory diseases.
In this study, the researchers evaluated the effectiveness, uptake and safety of the pneumococcal vaccine in this group of people.
What’s new?
The researchers analysed patient records for adults with inflammatory diseases in the UK from 1997 to 2019. All participants were taking medicine that dampened the immune system.
The researchers compared data for:
- 1,884 people who were hospitalised due to pneumonia versus 10,476 who were not
- 781 who died of pneumonia versus 4,540 who did not die
- 10,549 who were prescribed antibiotics for a lower respiratory tract infection in primary care versus 43,981 who were not.
Participants were matched according to age and sex; differences in smoking status, deprivation and other factors were accounted for. People were followed up from their first diagnosis of an inflammatory disease either until 2019, or until they were hospitalised or had died from pneumonia, received antibiotics for a lower respiratory tract infection in primary care, or their primary care record ended.
Compared with not having a pneumococcal vaccine, being vaccinated was associated with:
- 30% reduced risk of hospitalisation due to pneumonia
- 40% reduced risk of death from pneumonia
- 24% reduced risk of a lower respiratory tract infection.
In a related study, the researchers analysed vaccine uptake among 32,277 people with inflammatory diseases. Just over half (57%) had the pneumococcal vaccine; uptake was lower in those younger than 45 years (32%) and those with inflammatory bowel disease (42%). A separate analysis involved people who were vaccinated and presented to primary care with joint pain or a joint condition flare up (2,002 people) or an IBD flare (451). In this group, vaccination was not associated with joint pain or rheumatic or IBD flares.
Why is this important?
The research suggests that the pneumococcal vaccine protects against hospitalisation and death due to pneumonia in people with inflammatory diseases; it also provides reassurance that the vaccine is not associated with disease flares.
However, vaccine uptake is low. A fear of flares can be a barrier to vaccination; clinicians could therefore discuss the reassuring findings with people who have these conditions and are considering vaccination.
The researchers caution that the link between vaccination and a reduction in lower respiratory tract infections requiring antibiotics should be interpreted with caution, as some of the data are uncertain. It is possible that some people were prescribed antibiotics for a viral rather than a bacterial infection they say, due to risk-averse prescribing for those with weakened immune systems.
The study shows a link between vaccination and a reduction in hospitalisation and death but was not set up to prove that the vaccine was the cause. The researchers cannot be certain that the deaths and hospitalisations due to pneumonia were caused by the bacteria the vaccine targets.
What’s next?
The researchers are talking with patient partners and patient organisations about how to share the findings of the study with patients and the wider public. Based on their advice, the team is co-producing patient information leaflets, infographics and animations on the benefit of vaccination for those with inflammatory conditions. They will be translated into the 5 most spoken non-English languages to ensure the information is accessible to diverse UK populations.
Can I act on this new knowledge?
You may be interested to read
This is a summary of: Nakafero G, and others. Effectiveness of pneumococcal vaccination in adults with common immune-mediated inflammatory diseases in the UK: a case–control study. Lancet Rheumatology 2024; 6: 615 – 624.
The uptake and safety study: Nakafero G, and others. Uptake and safety of pneumococcal vaccination in adults with immune-mediated inflammatory diseases: a UK wide observational study. Rheumatology 2024. DOI: 10.1093/rheumatology/keae160.
A study exploring barriers and enablers of vaccine uptake for people with inflammatory diseases: Fuller A, and others. Barriers and facilitators to vaccination uptake against COVID-19, influenza, and pneumococcal pneumonia in immunosuppressed adults with immune-mediated inflammatory diseases: A qualitative interview study during the COVID-19 pandemic. PLOS One 2022; 17: 1 – 14.
A video with information about pneumococcal vaccines.
Information and support from Versus Arthritis, Crohn’s and Colitis UK, and Lupus UK.
Information on taking part in NIHR research on inflammatory diseases.
Funding: This study was funded by the NIHR Research for Patient Benefit Programme.
Conflicts of Interest: Some authors have received fees and funding from pharmaceutical companies. See paper for full details.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
NIHR Evidence is covered by the creative commons, CC-BY licence. Written content and infographics may be freely reproduced provided that suitable acknowledgement is made. Note, this licence excludes comments and images made by third parties, audiovisual content, and linked content on other websites.
