Inflammatory bowel disease (IBD) patients are at higher risk for pneumonia because  immune-system impairment and frequent treatment with immunosuppressive medications.

A new study in the Journal of Crohn’s & Colitis examines how effective pneumococcal vaccination is for protecting against severe pneumococcal disease in a population of older, mostly male patients.

Researchers from the University of South Carolina College of Pharmacy, the William Jennings Bryan Dorn Veterans Affairs (VA) Medical Center, both in Columbia, and colleagues noted that Streptococcus pneumoniae is an important pathogen responsible for severe pneumococcal diseases, including pneumonia, bacteremia/sepsis, and meningitis.

The study team identified patients with IBD and severe pneumococcal disease (SPD) from the VA Health Administration database, using ICD9/10 codes. They gathered information on pneumococcal vaccination and use of immunosuppressant medications, while also taking into account  demographics, medications, vaccination, and comorbidities.

Ultimately, the authors identified 1,798 cases of SPD—283 pneumonia, 1,513 bacteremia, and two meningitis. They determined that SPD patients were older—60.9 years versus 59.4 years; P <.001—and had more comorbidities (Charlson Comorbidity Index of 2.11 vs. 0.96; P <.001). Those patients also had increased likelihood of mortality (4.6% vs. 1.5%, P <.001), according to the report.

Results indicate that the risk of SPD was increased in Crohn’s disease (hazard ratio [HR] 1.15; 95% CI. 1.05-1.27) and with more comorbidities (HR 1.45; 95% CI, 1.42-1.48). Furthermore, the use of immunosuppressive medications increased the risk of SPD.

On the other hand, receipt of PCV13 either alone or in combination with PPSV23 predicted a five-fold decreased risk of SPD compared with no vaccination.

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

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