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. 2019 Sep 19;5(2):e001041.
doi: 10.1136/rmdopen-2019-001041. eCollection 2019.

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

Victoria Furer  1   2 , Christien Rondaan  3   4 , Marloes Heijstek  5 , Sander van Assen  6 , Marc Bijl  7 , Nancy Agmon-Levin  2   8 , Ferdinand C Breedveld  9 , Raffaele D'Amelio  10 , Maxime Dougados  11 , Meliha Crnkic Kapetanovic  12 , Jacob M van Laar  13 , Annette Ladefoged de Thurah  14 , Robert Landewé  15   16 , Anna Molto  11 , Ulf Müller-Ladner  17 , Karen Schreiber  18   19 , Leo Smolar  20 , Jim Walker  21 , Klaus Warnatz  22 , Nico M Wulffraat  23 , Ori Elkayam  1   2
Affiliations

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

Victoria Furer et al. RMD Open. .

Abstract

Objectives: The 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.

Methods: A 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.

Results: Sixty-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.

Conclusion: Current evidence shows an increased risk of VPI in patients with AIIRD, emphasising that prevention of infections is essential in these patients.

Keywords: autoimmune diseases; epidemiology; infections; vaccination.

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Conflict of interest statement

Competing interests: MD reports grants and personal fees from Pfizer, grants and personal fees from Abbvie, grants and personal fees from UCB, grants and personal fees from Novartis, grants and personal fees from Lilly, grants and personal fees from Merck, grants and personal fees from Roche, grants from BMS, outside the submitted work. OE reports grants and personal fees from Pfizer, grants, personal fees from Abbvie, grants and personal fees from Roche, grants and personal fees from Janssen, personal fees from Novartis and Lilly. AM reports grants and personal fees from Abbvie, grants and personal fees from Pfizer, grants and personal fees from BMS, grants and personal fees from UCB, grants and personal fees from Merck, during the conduct of the study. KW reports personal fees from Pfizer, during the conduct of the study; grants and personal fees from Biotest, grants and personal fees from CSL Behring, personal fees from LFB, personal fees from Grifols, grants from BMS, personal fees from Baxter, personal fees from Roche, personal fees from Octapharma, outside the submitted work.

Figures

Figure 1
Figure 1
Flow chart of the literature search. HPV, human papillomavirus; HVB, hepatitis B virus.
Figure 2
Figure 2
Forest plot of the meta-analysis of pooled incidence rate ratios (IRRs) of herpes zoster in patients with autoimmune inflammatory rheumatic diseases compared with the general population. GCA, giant cell arteritis; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus.
Figure 3
Figure 3
Forest plot of the meta-analysis of pooled prevalence ratio (PR) of human papillomavirus in patients with autoimmune inflammatory rheumatic diseases compared with the general population. RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; SSc, systemic sclerosis.
Figure 4
Figure 4
Forest plot of pooled prevalence of hepatitis B surface antigen virus in patients with autoimmune inflammatory rheumatic diseases. AS, ankylosing spondylitis; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus.
See this image and copyright information in PMC

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