Pneumococcal Vaccine Use and Immunogenicity in Patients with Glomerular Disease: A Scoping Review and Analysis of Healthcare Claims Data.

Abstract

Introduction: Streptococcus pneumoniae infections are a preventable cause of morbidity and mortality in individuals with glomerular disease. There is limited immunogenicity data to inform the effectiveness of vaccination in this high-risk patient population.

Methods: We conduct a scoping review of studies evaluating pneumococcal vaccine immunogenicity in adults and children with idiopathic nephrotic syndrome, focal segmental glomerulosclerosis, IgA vasculitis, or systemic lupus erythematosus with nephritis. We summarize patient characteristics, serotypes assessed, and rates of seroprotection and/or seroconversion. We then use the Merative MarketScan® Commercial Claims and Encounters database to describe rates of adequate, partial, and inadequate pneumococcal vaccination (PCV13 and/or PPSV23) within 12 months of incident glomerular disease diagnosis from 2010 to 2018.

Results: A total of 879 citations were screened, of which 63 studies were reviewed for inclusion criteria. A final analytic set included 19 studies. Most studies reported clinically meaningful rates of seroprotection, though definitions varied widely across studies. In the analysis of commercial healthcare claims data, 1,343 children aged 2-11 years and 19,987 individuals aged 12 to <65 years with incident of GD were identified. Of those inadequately vaccinated prior to GD diagnosis, 4.0% (38/947) of the 2-11-year group and 6.8% (797/11,646) of those in the 12 to <65-year group were partially or adequately vaccinated within 12 months of diagnosis. Demographic and clinical factors more commonly identified in those with pneumococcal vaccination included sex, age, region, and prior influenza vaccination.

Conclusion: There is limited literature describing pneumococcal vaccine immunogenicity in patients with glomerular disease. Metrics of reporting seroprotection and seroconversion to pneumococcal vaccines would benefit from standardization. Healthcare claims for pneumococcal vaccines following a diagnosis of glomerular disease suggest that efforts to improve timely vaccination are needed.