Uptake, safety and effectiveness of inactivated influenza vaccine in inflammatory bowel disease: a UK-wide study.

Objective: To investigate (1) the UK-wide inactivated influenza vaccine (IIV) uptake in adults with inflammatory bowel disease (IBD), (2) the association between vaccination against influenza and IBD flare and (3) the effectiveness of IIV in preventing morbidity and mortality.
Design: Data for adults with IBD diagnosed before the 1 September 2018 were extracted from the Clinical Practice Research Datalink Gold. We calculated the proportion of people vaccinated against seasonal influenza in the 2018-2019 influenza cycle. To investigate vaccine effectiveness, we calculated the propensity score (PS) for vaccination and conducted Cox proportional hazard regression with inverse-probability treatment weighting on PS. We employed self-controlled case series analysis to investigate the association between vaccination and IBD flare.
Results: Data for 13 631 people with IBD (50.4% male, mean age 52.9 years) were included. Fifty percent were vaccinated during the influenza cycle, while 32.1% were vaccinated on time, that is, before the seasonal influenza virus circulated in the community. IIV was associated with reduced all-cause mortality (aHR (95% CI): 0.73 (0.55,0.97) but not hospitalisation for pneumonia (aHR (95% CI) 0.52 (0.20-1.37), including in the influenza active period (aHR (95% CI) 0.48 (0.18-1.27)). Administration of the IIV was not associated with IBD flare.
Conclusion: The uptake of influenza vaccine was low in people with IBD, and the majority were not vaccinated before influenza virus circulated in the community. Vaccination with the IIV was not associated with IBD flare. These findings add to the evidence to promote vaccination against influenza in people with IBD.
Competing Interests: Competing interests: AA has received personal fees from UpToDate (royalty), Cadilla Pharmaceuticals (lecture fees), NGM Bio (consulting), Limbic (consulting) and Inflazome (consulting) unrelated to this work. CDM is the director of the NIHR School for Primary Care Research. Keele University has received research funding for CDM from NIHR, MRC, Versus Arthritis and BMS. JSN-V-T was seconded to the Department of Health and Social Care (DHSC) from October 2017 to March 2022. Since March 2022, he has received personal fees from CSL Seqirus (lectures, writing and consulting), AstraZeneca (lecture) and Sanofi Pasteur (lectures and speaking), all of whom manufacture influenza vaccines. He consults for Moderna Therapeutics who are developing influenza vaccines. The views expressed in this manuscript are those of its authors and not necessarily those of DHSC or any other entity mentioned above. The other authors have no conflict of interest to declare
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