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Vaccine. 2015 Mar 17;33(12):1446-52. doi: 10.1016/j.vaccine.2015.01.065. Epub 2015 Feb 7.

Low rate of influenza and pneumococcal vaccine coverage in rheumatoid arthritis: data from the international COMORA cohort.

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Paris Descartes University, APHP Cochin Hospital, Rheumatology Department, Paris, France; Mohammed V University, Faculty of Medicine, Laboratory of Biostatistics, Clinical Research and Epidemiology, El Ayachi Hospital, Rheumatology Department, Rabat, Morocco. Electronic address:
Division of Infectious Diseases, Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA. Electronic address:
Paris Descartes University, AP-HP Cochin Hospital, CIC Cochin Pasteur, Inserm, CIC 1417, Paris, France. Electronic address:
Paris Descartes University, APHP Cochin Hospital, Rheumatology Department, Paris, France. Electronic address:



Rheumatoid Arthritis (RA) patients are at increased risk of suffering from respiratory infections than the general public. Vaccinations against Streptococcus pneumococcus and influenza are recommended, but not often used in RA. Our objectives were: (1) to describe pneumococcal and influenza vaccine coverage in RA patients across various countries and (2) to identify factors associated with their usage.


Using data from the COMORA cohort, 3920 RA patients were enrolled across 17 countries. We collected patient demographic and disease characteristics, and reported vaccine use over a six month time period. We used logistic regression to evaluate factors related to pneumococcal and influenza vaccine coverage.


Overall vaccination coverage within the recommendations was low with huge disparities between countries: 17.2% (95%CI: 16.0-18.4) for pneumococcal vaccination (from 0% in Morocco to 56.5% in France) and 25.3% (95%CI: 23.8-26.5) for influenza vaccination (less than 1% in Morocco and Egypt to 66.2% in Japan). In countries where immunization was more frequent, we found that predictive factors of vaccination were older age, lower disease activity, higher educational level, use of biotherapy, absence of corticosteroid therapy, and presence of comorbidities.


Despite international recommendations for influenza and pneumococcal vaccination, we observed a low prevalence of these vaccinations among RA patients, with huge disparity between countries. Efforts are needed to better inform patients and physicians regarding the need for vaccinations.


Comorbidities; Influenza; Pneumococcus; Rheumatoid arthritis; Vaccine

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