Pneumococcal Vaccine Associated With Reduced COVID-19 Severity, Hospitalizations

Pneumococcal vaccination was associated with reduced hospitalizations and reduced severity of COVID-19 course and outcomes in people with inflammatory rheumatic diseases (IRD).¹

“A number of studies have investigated the relationship between influenza and pneumococcal vaccinations and COVID-19 outcomes²… However, none of these studies focused specifically on patients with inflammatory rheumatic diseases, nor did they consistently assess the role of immunosuppressive or biologic therapies. This gap highlights the importance of generating evidence in immunocompromised populations, where vaccine response and protection mechanisms may differ,” lead investigator Maxime Auroux, PhD, University of Lyon, and Department of Rheumatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France, and colleagues wrote.¹

Auroux and colleagues conducted a longitudinal study within the French administrative and medical data base (SNDS) and identified 406,156 patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) or psoriatic arthritis (PsA). They excluded patients with COVID-19 and collected vaccination data.

Participants were 64.6% women, had a mean age of 62.2 years, and had a Pneumococcal vaccination rate of 37.8% and influenza vaccination rate of 40.5%. Investigators recorded 0.9% COVID-19 hospitalizations (n = 3574), 0.24% severe infections (n = 980), and 0.17% deaths (n = 697).¹

Among patients hospitalized for COVID-19, the proportion vaccinated against pneumococcus was lower compared to those not hospitalized (33.7% vs. 37.9%; P <.0001), as well as among those who experienced a severe form (32.1% vs. 37.9%; P <.0001) or died from COVID-19 (31.1% vs. 37.9%; P <.0001). Conversely, a higher proportion of patients vaccinated against influenza was observed among those hospitalized for COVID-19 compared to those not hospitalized (59.7% vs. 40.34%; P <.0001). The same trend was seen among patients with severe forms (67.7% vs. 40.5; P <.0001) and those who died from COVID-19 (72.3% vs. 40.5%; P <.0001).¹

In 75,803 participants who received both the influenza and COVID-19 vaccines, there were 163 deaths (0.21%), compared to 341 deaths among 88,735 patients who received the influenza vaccine alone (0.38%). Similar patterns were seen across other COVID-19 outcomes, with lower rates of severe infections (0.31% vs. 0.48%) and hospitalizations (1.02% vs. 1.52%) in the dual-vaccinated group. Interestingly, patients who received 1 or 2 vaccinations had higher rates of death, severe COVID-19, and hospitalization than unvaccinated individuals.¹

The investigators suggest that the higher rate of COVID-19 infections among vaccinated individuals is likely influenced by confounding factors. Supporting this theory, those at highest risk, including those above the age of 65 years and/or with comorbidities such as cardiovascular disease, cancer, pulmonary diseases and renal failure, were more likely to be vaccinated against influenza and to a lesser extent, pneumococcus.

Using multivariate analysis, they found that pneumococcal vaccination was associated with decreased risks of hospitalization (odds ratio [OR], 0.84; 95% CI, 0.78–0.91; P <.0001), severe COVID-19 forms (OR, 0.83; 95% CI, 0.72–0.96; P <.05), and death (OR, 0.82; 95% CI, 0.70–0.97; P <.05), while influenza vaccination associated with increased risks of these outcomes (OR, 1.47; 95% CI, 1.36–1.58; P <.0001; OR, 1.54 95% CI, 1.33–1.78; P <.0001; OR, 1.62; 95% C, 1.36–1.93; P <.0001, respectively).¹

“We have observed a protective effect of pneumococcal vaccination and a negative impact of influenza vaccination on COVID-19 outcomes in a population of patients with inflammatory arthritis. Our findings underscore the multifaceted nature of the immune response in this population and suggest potential role of a trained immunity in COVID-19 outcomes reinforcing the place of vaccinations in the management of patients with IRD,” Auroux and colleagues concluded.¹

REFERENCES

1. Maxime Auroux, Fabacher T, Sauleau E, Arnaud L, Coury F. Pneumococcal and influenza vaccination coverage and impact on COVID-19 infection severity in patients with inflammatory rheumatic diseases: A French National Healthcare Database analysis. Vaccine. 2025;61:127439-127439. doi: 10.1016/j.vaccine.2025.127439

2. Noale M, Trevisan C, Maggi S, et al. The Association between Influenza and Pneumococcal Vaccinations and SARS-Cov-2 Infection: Data from the EPICOVID19 Web-Based Survey. Vaccines. 2020;8(3):471. Doi: 10.3390/vaccines8030471