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Article Abstract
Introduction: 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.
Methods: 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.
Results: 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).
Conclusions: 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.
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