J Crohns Colitis. 2021 Jan 25;jjab017. doi: 10.1093/ecco-jcc/jjab017. Online ahead of print.

Bryan L Love ¹, Christopher J Finney ², Jill K J Gaidos ³

Author information

• ¹Department of Clinical Pharmacy and Outcome Sciences, Center for Outcomes Research and Evaluation, College of Pharmacy, University of South Carolina, Columbia, SC and William Jennings Bryan Dorn VA Medical Center, Columbia, SC.
• ²William Jennings Bryan Dorn VA Medical Center, Columbia, SC.
• ³Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA.

Abstract

Background: Streptococcus pneumoniae is an important pathogen responsible for severe pneumococcal diseases, including pneumonia, bacteremia/sepsis, and meningitis. Inflammatory bowel disease (IBD) patients have an increased risk for infections due to an altered immune system and treatment with immunosuppressive medications. The aim of this study was to assess the prevalence of severe pneumococcal disease (SPD) and evaluate the impact of pneumococcal vaccination on the risk of SPD in Veterans with IBD.

Methods: Subjects with IBD and SPD were identified from the VA Health Administration database using ICD9/10 codes. Pneumococcal vaccination and use of immunosuppressant medications were collected. Risk of SPD was evaluated using an adjusted Cox proportional hazards model controlling for demographics, medications, vaccination, and comorbidities.

Results: A total of 1798 cases of SPD were identified (283 pneumonia, 1,513 bacteremia, and 2 meningitis). SPD patients were older (60.9 years vs 59.4 years; p<0.001), had more comorbidities (Charlson Comorbidity Index of 2.11 vs. 0.96; p<0.001) and had increased mortality (4.6% vs. 1.5%, p<0.001). The risk of SPD was increased in Crohn's disease (HR 1.15; 95% CI 1.05-1.27) and with more comorbidities (HR 1.45; 95% CI 1.42-1.48). Use of immunosuppressive medications increased the risk of SPD. Receipt of PCV13 either alone or in combination with PPSV23 predicted a five-fold decreased risk of SPD compared with no vaccination.

Conclusion: Vaccination with PCV13 alone or in combination with PPSV23 and revaccination with PPSV23, was protective against SPD. All IBD patients should be evaluated for pneumococcal vaccination, particularly those receiving or expected to receive immunosuppressive therapies.