Auroux Maxime, Fabacher Thibaut, Sauleau Erik, Arnaud Laurent, Coury Fabienne
University of Lyon, University Lyon 1, F-69100 Lyon, France; Department of Rheumatology, Edouard Herriot Hospital, Hospices Civils de Lyon, F-69003 Lyon, France; University of Lyon, INSERM UMR 1033, F-69100 Lyon, France.
Public Health Department, University Hospital of Strasbourg, Strasbourg, France.
Vaccine. 2025 Aug 13;61:127439. doi: 10.1016/j.vaccine.2025.127439. Epub 2025 Jul 1.
It has been suggested that vaccinations could induce a trained immunity able to decrease COVID-19 severity. Our primary aim was to evaluate the COVID-19 severity among patients with inflammatory rheumatic diseases (IRD) vaccinated against pneumococcus and influenza compared to those not vaccinated. A secondary objective was also to determine vaccination coverage within real-life population of IRD patients in France.
We conducted a longitudinal study within the French administrative and medical data base (SNDS). We have identified patients with one following of these IRD: rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA). COVID-19 infected patients were identified using CIM-10 code and vaccination status was extracted from the database.
406,156 patients were identified, with 64.6 % women and a mean age of 62.2 years. Pneumococcal and influenza vaccination rate in this population were respectively 37.8 % and 40.5 %. We recorded 0.9 % COVID-19 hospitalizations (n = 3574), 0.24 % severe infections (n = 980), and 0.17 % deaths (n = 697). Multivariate analysis demonstrated pneumococcal vaccination's association with decreased risks of hospitalization (OR 0.84 IR95 %[0.78-0.91] p < 0.0001), severe COVID-19 forms (OR 0.83 IR95 %[0.72-0.96] p < 0.05), and death (OR 0.82 IR95 %[0.70-0.97] p < 0.05), while influenza vaccination associated with increased risks of these outcomes (OR 1.47 IR95 %[1.36-1.58] p < 0.0001, OR 1.54 IR95 %[1.33-1.78] p < 0.0001, OR 1.62 IR95 %[1.36-1.93] p < 0.0001, respectively).
Pneumococcal vaccination was associated with a reduced hospitalization rate, and occurrence of severe forms of COVID-19, including death, among infected patients. These findings suggest the possible involvement of vaccine-induced trained immunity in shaping the immune response to other infections especially COVID-19.
有人提出，接种疫苗可能会诱导一种训练有素的免疫力，从而降低新冠病毒疾病（COVID-19）的严重程度。我们的主要目的是评估接种肺炎球菌和流感疫苗的炎症性风湿性疾病（IRD）患者与未接种疫苗的患者相比，其COVID-19的严重程度。次要目标是确定法国IRD患者实际人群中的疫苗接种覆盖率。
我们在法国行政和医疗数据库（SNDS）中进行了一项纵向研究。我们确定了患有以下IRD之一的患者：类风湿性关节炎（RA）、脊柱关节炎（SpA）和银屑病关节炎（PsA）。使用国际疾病分类第十版（CIM-10）代码识别COVID-19感染患者，并从数据库中提取疫苗接种状态。
共识别出406,156名患者，其中64.6%为女性，平均年龄为62.2岁。该人群中肺炎球菌和流感疫苗接种率分别为37.8%和40.5%。我们记录了0.9%的COVID-19住院病例（n = 3574）、0.24%的严重感染病例（n = 980）和0.17%的死亡病例（n = 697）。多变量分析表明，肺炎球菌疫苗接种与住院风险降低相关（比值比[OR]0.84，95%置信区间[IR95%][0.78 - 0.91]，p < 0.0001）、严重COVID-19病例风险降低相关（OR 0.83，IR95%[0.72 - 0.96]，p < 0.05）以及死亡风险降低相关（OR 0.82，IR95%[0.70 - 0.97]，p < 0.05），而流感疫苗接种与这些结果的风险增加相关（分别为OR 1.
