FRI0658 INCIDENCE AND PREVALENCE OF VACCINE PREVENTABLE INFECTIONS IN ADULT PATIENTS WITH AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES (AIIRD): A SYSTEMIC LITERATURE REVIEW INFORMING THE 2019 UPDATE OF THE EULAR RECOMMENDATIONS FOR VACCINATION IN ADULT PATIENTS WITH AIIRD

Abstract

Background Despite the well-established fact of a high burden of infections among patients with autoimmune inflammatory rheumatic diseases (AIIRD)1, little evidence is available regarding the real incidence and prevalence of vaccine preventable infections (VPI) in this population. Objectives To update the evidence on the incidence and prevalence rates of VPI in patients with AIIRD and compare the data to the general population when available. Methods A systematic literature review was performed using Medline, Embase, and Cochrane library, from October 2009 to August 2018. Search terms were defined for AIIRD and VPI. Observational studies including cohort studies for incidence rates and cross-sectional studies for prevalence rates were included, as well as systematic reviews of cohort studies and meta-analyses. The primary outcome was the incidence or prevalence of VPI in the adult AIIRD population. Meta-analysis was performed when appropriate. Results The search identified 3876 records, out of which 63 met the inclusion criteria. Data on the following VPI rates was retrieved and analyzed: influenza (incidence; n=4), pneumococcal disease (incidence; n=7), hepatitis B virus (HBV) (incidence and prevalence; n=10), herpes zoster (HZ) (incidence; n=29), human papilloma virus (HPV) (incidence and prevalence; n=13). For influenza, limited data pointed to an increased incidence (409.33 vs 306.12 cases per 100,000 patient-years in patients with rheumatoid arthritis (RA) vs controls, respectively) and influenza-related complications in patients with AIIRD. Data on pneumococcal disease, available mainly for patients with systemic lupus erythematosus (SLE), showed a substantially increased risk in all age groups compared to controls (incidence rate ratio (IRR) 4.7, 95% confidence interval (CI) 3.7-6.0). For HZ, an increased risk was observed across all patients with AIIRD in comparison to the general population: pooled incidence rate ratio 2.4, 95% CI 2.05-2.76, with the highest incidence rate (IR) observed in inflammatory myositis (pooled IR 35.98, 95% CI 32.33-39.64), followed by SLE (pooled IR 18.87, 95% CI 8.7-29.64), and RA (pooled IR 11.64, 95% 9.37-13.91). Studies on HPV mainly investigated the SLE population in the Latin America and Asia: HPV pooled prevalence 26%, 95% CI 17%-36% and pooled prevalence ratio 1.58, 95% CI 0.74-3.36 in comparison with the general population. In RA, limited data showed a similar prevalence of HPV in patients and controls: pooled prevalence ratio 0.72, 95% CI 0.46-1.12. For hepatitis B virus, pooled prevalence of hepatitis B surface antigen in patients with AIIRD was similar to the general population, 3%, 95% CI 1%-5%. Conclusion Current evidence shows an increased risk of vaccine-preventable infections in patients with AIIRD, emphasizing that prevention of infections is essential in these patients.