Office of Research, William Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA.
Department of Clinical Pharmacy and Outcome Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.
J Crohns Colitis. 2021 Aug 2;15(8):1279-1283. doi: 10.1093/ecco-jcc/jjab017.
Streptococcus pneumoniae is an important pathogen responsible for severe pneumococcal diseases, including pneumonia, bacteraemia/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.
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.
A total of 1798 cases of SPD were identified [283 pneumonia, 1513 bacteraemia, and two 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 (hazard ratio [HR] 1.15; 95% confidence interval [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 5-fold decreased risk of SPD compared with no vaccination.
Risk factors for severe pneumococcal disease include having Crohn's disease, more comorbidities, and exposure to combination immunosuppression. 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.
肺炎链球菌是一种重要的病原体，可导致严重的肺炎球菌病，包括肺炎、菌血症/败血症和脑膜炎。炎症性肠病（IBD）患者由于免疫系统改变和免疫抑制药物治疗，感染风险增加。本研究旨在评估 IBD 退伍军人中严重肺炎球菌病（SPD）的患病率，并评估肺炎球菌疫苗接种对 SPD 风险的影响。
使用 ICD9/10 代码从 VA 健康管理数据库中确定 IBD 和 SPD 患者。收集肺炎球菌疫苗接种和免疫抑制药物使用情况。使用调整后的 Cox 比例风险模型评估 SPD 风险，该模型控制了人口统计学、药物、疫苗接种和合并症。
共确定了 1798 例 SPD 病例[283 例肺炎、1513 例菌血症和 2 例脑膜炎]。SPD 患者年龄较大[60.9 岁 vs 59.4 岁；p<0.001]，合并症更多[Charlson 合并症指数为 2.11 与 0.96；p<0.001]，死亡率更高[4.6%与 1.5%；p<0.001]。克罗恩病（危险比 [HR] 1.15；95%置信区间 [CI] 1.05-1.27）和更多合并症（HR 1.45；95% CI 1.42-1.48）会增加 SPD 风险。免疫抑制药物的使用增加了 SPD 的风险。与未接种疫苗相比，单独使用 PCV13 或与 PPSV23 联合使用 PCV13 可预测 SPD 风险降低 5 倍。
严重肺炎球菌病的危险因素包括患有克罗恩病、更多合并症和接触联合免疫抑制。单独使用 PCV13 或与 PPSV23 联合使用 PCV13 以及用 PPSV23 进行再接种可预防 SPD。所有 IBD 患者都应评估肺炎球菌疫苗接种情况，尤其是那些正在接受或预期接受免疫抑制治疗的患者。
