Background Due to autoinflammation and immunosuppressive therapy, patients with rheumatoid arthritis (RA) are at increased risk of developing pneumonia. The German Standing Vaccination Committee recommends standard vaccination against pneumococcal infections from age 60 onwards and for all persons with an increased health risk [1]. In patients with immunosuppression, booster vaccination is recommended every 5 years.

Objectives To assess the vaccination status for pneumonia and the prevalence of hospitalised pneumonia in patients with RA and unaffected population controls in Germany using claims data.

Methods This cross sectional study based on data of a large German statutory health insurance fund (Barmer GEK). The members had to be continuously insured between 2009 and 2013 and had to be between 18 and 99 years old. Insurants who had a diagnosis of RA (ICD-10 codes M05 or M06) in at least two quarters of the year 2013 were matched by age and sex in a ratio of 1: 5 to members without RA. Pneumococcal vaccination (once between 2009 and 2013) was evaluated with regard to age, sex, comorbidities, biologic treatment, primary or rheumatologic care and region of residence. Prevalences of inpatient pneumonia were compared to regional vaccination rates.

Results The data of 111,482 RA patients and 557,410 matched controls were available for analysis. The mean age was 66.2 years and 79.7% were female. Compared to controls, RA patients were vaccinated more frequently (15.0% vs. 10.0%). Vaccination rates were comparable between male and female insurants and increased with older age. In proportion, RA patients <60 years were vaccinated 4–11 times and patients >60 years 1.2–1.5 times more frequently than controls. In East Germany, pneumonia vaccination rates were highest, the lowest rates were found in Southern Germany. Inpatient pneumonia prevalence was 2–3 times higher in RA patients compared to controls and tended to be higher in regions with low vaccination rates.

Conclusions The increased pneumonia prevalence in RA patients confirms their status as a risk group. In consequence, they are vaccinated more frequently than controls, especially if they do not meet the generally recommended age criterion or if other additional risk factors are present. Overall, vaccination rates are still low. Historically, vaccination was performed more frequently in East Germany due to stricter regulations, and the lower pneumonia prevalences in these areas indicate that consequent vaccination may help to reduce pneumonia in RA.

1. Wiese-Posselt M1, Tertilt C, Zepp F. Vaccination recommendations for Germany. Dtsch Arztebl Int. 2011 Nov;108(45):771–9.

Acknowledgement This study was funded by the German Federal Ministry of Education and Research (01EC1405).

Disclosure of Interest None declared