Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD

Abstract

ObjectivesThe aims of this study were to update the evidence on the incidence and prevalence rates of vaccine preventable infections (VPI) in patients with autoimmune inflammatory rheumatic diseases (AIIRD) and compare the data to the general population when available.MethodsA literature search was performed using Medline, Embase and Cochrane library (October 2009 to August 2018). The primary outcome was the incidence or prevalence of VPI in the adult AIIRD population. Meta-analysis was performed when appropriate.ResultsSixty-three publications out of 3876 identified records met the inclusion criteria: influenza (n=4), pneumococcal disease (n=7), hepatitis B (n=10), herpes zoster (HZ) (n=29), human papillomavirus (HPV) infection (n=13). An increased incidence of influenza and pneumococcal disease was reported in patients with AIIRD. HZ infection-pooled incidence rate ratio (IRR) was 2.9 (95% CI 2.4 to 3.3) in patients with AIIRD versus general population. Among AIIRD, inflammatory myositis conferred the highest incidence rate (IR) of HZ (pooled IRR 5.1, 95% CI 4.3 to 5.9), followed by systemic lupus erythematosus (SLE) (pooled IRR 4.0, 95% CI 2.3 to 5.7) and rheumatoid arthritis (pooled IRR 2.3, 95% CI 2.1 to 2.6). HPV infection-pooled prevalence ratio was 1.6, 95% CI 0.7 to 3.4 versus general population, based on studies mainly conducted in the SLE population in Latin America and Asia. Pooled prevalence of hepatitis B surface antigen and hepatitis B core antibody in patients with AIIRD was similar to the general population, 3%, 95% CI 1% to 5% and 15%, 95% CI 7% to 26%, respectively.ConclusionCurrent evidence shows an increased risk of VPI in patients with AIIRD, emphasising that prevention of infections is essential in these patients.

Efficacy, immunogenicity and safety of vaccination in adult patients with autoimmune inflammatory rheumatic diseases: a systematic literature review for the 2019 update of EULAR recommendations

“…Infectious diseases and associated complications comprise an important cause of morbidity and mortality in patients with autoimmune inflammatory rheumatic diseases (AIIRD). Increased susceptibility to infectious diseases in these patients is most likely due to an immunomodulating effect of the disease itself and/or by use of immunosuppressive medications 1…”

“…The current report presents the results of an SLR on efficacy, immunogenicity and safety of vaccination in adult patients with AIIRD, including those using immunomodulating agents. Together with the results of an SLR on incidence and prevalence of VPIs in patients with AIIRD,1 the current SLR provided the task force with a basis for updating the recommendations 3…”

Vaccination in rheumatology (the 2019 update of EULAR recommendations)

“…По данным систематического обзора, относительный риск HZ-инфекции у больных ИВРЗ повышен в 2,9 раза по сравнению с популяцией. Максимальная частота развития данной инфекции отмечается при СКВ и дерматомиозите/полимиозите (18,9 и 5,1 на 1000 пациенто-лет соответственно) [60]. С учетом этого, а также принимая во внимание данные двух крупных исследований по эффективности и безопасности иммунизации более 450 тыс.…”

“…Инфекция, вызванная ВПЧ, при СКВ встречается чаще (12-30%), чем при других ИВРЗ [60]. Установлено, что наличие СКВ само по себе является независимым предиктором развития ВПЧ-инфекции, повышая риск последней в 2,2-2,7 раза [63,64].…”

Safety and Immunogenicity of the Quadrivalent Human Papillomavirus Vaccine in Patients with Juvenile Dermatomyositis: A Real-World Multicentre Study

“…Despite vaccination is the most effective resource to prevent infections, there are concerns regarding the safety and e cacy of vaccines related to AID and their immunosuppressive treatments, such as a potential risk of causing an exacerbation of the underlying disease, a possibility of inducing an infection (in case of a live-attenuated vaccine), or ine cacy due to the impaired immune response (1)(2)(3)(4)(5)(6)(7)9). The uncertainties surrounding this issue may directly impact on the vaccination cover in this group of patients (2,(15)(16)(17)(18).…”