Interventions Increase Vaccination Rates in Inflammatory Bowel Disease and Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Abstract

Background: Patients with immune-mediated conditions such as IBD and RA are at risk for vaccine-preventable infections. Despite guideline recommendations, prior studies have shown suboptimal vaccination rates.

Aim: We conducted a systematic review and meta-analysis to compare the different interventions intended to increase vaccination rates.

Methods: A systematic search was conducted of MEDLINE/PubMed, Embase, CINAHL, and Cochrane Library up to 2020 for studies with interventions intended to increase vaccination rates. We performed a random-effects meta-analysis to generate pooled odds ratios (ORs) to assess all interventions against no interventions. Our primary outcome was pneumococcal vaccination (PCV) rate.

Results: Our review found 8580 articles, for which 15 IBD and 8 RA articles met the inclusion criteria; 21 articles were included in the analysis. PCV was the predominant vaccination (91%). In our analysis of patients with IBD, almost all interventions (patient-oriented, physician-oriented, or barrier-oriented) increased PCV uptake [OR, 4.74; 95% CI, 2.44-6.56, I2 = 90%] compared to no intervention. The greatest effect was seen in barrier-oriented studies [OR, 12.68; 95% CI, 2.21-72.62, I2 = 92%]. For RA data, all interventions had increased PCV uptake compared to no interventions (OR 2.74; 95% CI, 1.80-4.17, I2 = 95%).

Conclusion: Our data suggest that many different interventions can increase PCV rates. It appears that barrier-oriented interventions may have the greatest positive effect on increasing PCV uptake. However, clinicians should be encouraged to implement measures best suited to their practice. Future high-quality randomized controlled trials are needed to determine the best approach to optimize vaccination rates.

Keywords: Inflammatory bowel disease; Preventative care; Vaccinations.

Fig. 1

PRISMA flow diagram of search strategies for inflammatory bowel disease articles

Fig. 2

PRISMA flow diagram of search strategies for rheumatoid arthritis articles

Fig. 3

Pre- and Post-intervention pneumococcal vaccination rates in inflammatory bowel disease studies. There was an increase in vaccination rates noted with all interventions except one. *Feuerstein J et al. was divided into two as there were two different groups: one that was an academic practice and the other a private practice

Fig. 4

Pre- and Post-intervention pneumococcal vaccination rates in rheumatoid arthritis studies. There was an increase in vaccination rates.*Ledwich LJ et al. was divided into two as there were two different groups: one that was an academic practice and the other a community practice

Fig. 5

Pooled estimates of association between interventions and vaccination uptake in inflammatory bowel disease patients. Compared with no intervention, all interventions (patient-oriented, /physician-oriented, combined patient + physician-oriented, or barrier-oriented) increased vaccination uptake [Odds ratio 4.74; 95% confidence interval, 2.94–7.64, I2 = 90%]. The greatest effect was seen in barrier-oriented studies [Odds ratio, 12.68; 95% confidence interval, 2.21–72.62, I2 = 92%]

Fig. 6

Pooled estimates of association between interventions and vaccination uptake in rheumatoid arthritis patients. All interventions (patient-oriented, physician-oriented, combined patient + physician-oriented, or barrier-oriented) increased vaccination uptake [Odds ratio, 2.74; 95% confidence interval, 1.80–4.17, I2 = 95%] compared to no intervention