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. 2025 Feb;53(1):317-327.
doi: 10.1007/s15010-024-02373-z. Epub 2024 Aug 22.

Patients with immune mediated inflammatory diseases are insufficiently protected against vaccine-preventable infections

Natasja van de Pol  1 , C Janneke van der Woude  1 , Marijn Vis  2 , Martijn B A van Doorn  3 , Saskia L Schrauwen  4 , Fatos Cetinözman-Teunissen  5 , Rachel L West  6 , Annemarie C de Vries  7
Affiliations

Patients with immune mediated inflammatory diseases are insufficiently protected against vaccine-preventable infections

Natasja van de Pol et al. Infection. 2025 Feb.

Abstract

Background: Patients with Immune Mediated Inflammatory Diseases (IMIDs) using immunosuppressive therapy are at increased risk of infections, including vaccine-preventable infections. In this study, we aimed to evaluate whether patients with IMIDs on systemic immunosuppressive therapy are vaccinated according to current guidelines.

Methods: A survey was sent out, between August 2022 and March 2023, to all patients with IMIDs that visited the departments of dermatology, rheumatology and gastroenterology at an academic and regional hospital in Rotterdam, the Netherlands. Patient-reported vaccination status was compared to the Dutch guidelines on vaccinations in patients with chronic inflammatory diseases.

Results: A total of 1,905/5,987 patients responded to the survey (response rate 32%). After exclusion of patients without systemic immunosuppressive medication, the study population comprised 1,390 patients, median age 56 years (IQR 42-66) and 41% male. Most patients (92%) had been vaccinated according to the Dutch National Immunization Program. Before starting immunosuppressive therapy, 2% of the patients who were still considered at risk according to the Dutch guideline were vaccinated for measles, and 4% for diphtheria/tetanus/polio (DT-IPV). Additionally, 62% of patients received an annual influenza vaccine, 16% received a five-yearly pneumococcal vaccine, and 91% were fully vaccinated against COVID-19.

Conclusion: Patients with IMIDs on immunosuppressive therapy are not vaccinated in accordance with the guidelines. Implementation strategies to improve the vaccination rates for patients with IMIDs should specifically focus on vaccinating against measles and diphtheria/tetanus/polio, and periodic vaccination against pneumococcal and influenza infections.

Keywords: Immune mediated inflammatory diseases; Immunocompromised patients; Vaccination care; Vaccine coverage.

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Conflict of interest statement

Declarations. Ethics approval: This study was approved by the Institutional Review Board (IRB) of the EMC, MEC-2022-0196. Competing interests: CJW received grants from ZonMW, Falk and Pfizer, has received consulting fees from Janssen, Galapagos, and Pfizer, has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Ferring and AbbVie and had leadership roles in the European Crohn’s & Colitis organisation, United European Gastroenterology council and the Dutch Association for Gastroenterology (NVGE); MV received research funding/advisory board fees from Novartis, UCB, Janssen, AbbVie, Lilly, and Pfizer; MBAvD reports grants and has served on the advisory board or as a speaker for Novartis and Janssen-Cilag. He has also has served on the advisory board or as a speaker for Abbvie, Leopharma, BMS, Celgene, Lilly, MSD, Pfizer, and Sanofi-Genzyme; RLW has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Ferring, Pfizer, Galapagos, AbbVie and Janssen; ACV has served on advisory boards for Takeda, Janssen, Bristol Myers Squibb, Abbvie, Pfizer, and Galapagos and has received unrestricted research grants from Takeda, Janssen, and Pfizer; all other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the selection process. Abbreviations: EMC, Erasmus MC; FGV, Franciscus Gasthuis & Vlietland; IMIDs, Immune Mediated Inflammatory Diseases
Fig. 2
Fig. 2
Vaccination status in patients with IMIDs (n = 1,390). Note: the vaccination rates are described as a percentage of the total population (n = 1,390). The different panels describe the vaccination status according to patients self-report for (A) within the Dutch National Immunization Program, (B) Travel vaccinations, (C) Vaccinations prior to initiation of immunosuppressive therapy (D) additional vaccinationsa. * = fully vaccinated describes patients which received the childhood vaccinations based on birth year and implementation date. Partially vaccinated describes the patients who only received a subset of the childhood vaccinations. a = Other reasons includes e.g. work-related vaccinations, catch-up vaccinations for people who missed the routine children vaccinations according to the NIP, and after an abrasion or bite wound. Abbreviations: aP, Whooping cough; D, Diphtheria; HAV, Hepatitis A; HBV, Hepatitis B; Hib, Haemophilus influenzae type b; HPV, Human Papillomavirus; H1N1, Influenza (Mexican/Spanish flu); IPV, Polio; JE, Japanese encephalitis; Men, Meningococcal; MenC, Meningococcal type C; MMR, Mumps, Measles and Rubella; PCV, Pneumococcal; Pox, Smallpox; R, Rubella; T, Tetanus TBC, Tuberculosis; TBE, Tick-borne encephalitis; Ty, Typhoid fever; VZV, Varicella Zoster virus; YF, Yellow fever
Fig. 3
Fig. 3
Methods of patient education. Note: the information rates are described as a percentage of the patients who received/searched for information
Fig. 4
Fig. 4
Patient preferences for receiving information. Note: the preference rates are described as a percentage of the patients who were dissatisfied with the information they received
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