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Pneumonia Vaccine May Not Protect RA Patients

Like many RA patients, I take certain drugs that suppress my immune system and therefore make me more vulnerable to infections. To help counteract that risk, I’m careful about washing my hands, staying away from sick people, and getting my flu shot every year. My first pneumonia vaccination was given at my rheumatologist’s office as a condition to starting a biologic.

It was, therefore, somewhat alarming to read a recent study wherein the pneumonia vaccine wasn’t any more effective than the placebo in protecting RA patients from contracting pneumonia. In fact, there were actually two more vaccinated patients that got pneumonia than those who got the placebo. This is even more serious when you consider that pneumonia ranks fairly high in the cause of death of those of us who have RA. Considering that the researchers started out with the hypothesis that the vaccine was effective in preventing pneumonia in RA patients, I’m sure the outcome of the study was quite startling to them as well.

PCV13 and PPSV23

There are two pneumonia vaccines in use in the US today: PCV13 and PPSV23 for short. The PCV13 vaccine combats 13 kinds of pneumonia while the PPSV23 targets 23. PPSV23 is recommended for high-risk people older than 65 and younger people who have various medical conditions. The study used the broader PPSV23. Approximately half of the 900 patients were given the vaccine (464 patients) and the other half of the patients (436) were given salt solution.

In the half that received the vaccine, 17 contracted pneumonia and 15 of the non-vaccinated population contracted the disease. There was, therefore, no discernable difference between the two groups. It seemed to make no difference whether a patient received the vaccine or not.

Many vaccines work by causing your body to build up antibody defenses against various diseases. My initial reaction when I read the headline was that perhaps biologics or other medications kept RA patients from building this immune response. However, according to the research, neither using biologics nor glucosteroids (such as prednisone) seemed to predict whether or not the patient came down with pneumonia.

So what does this mean for the RA patient?

Honestly, I don’t know. There’s obviously more research that needs to be done on the pneumonia vaccines as well as others. I’ve never had any issues with getting the pneumonia vaccine. For most people, it’s a one-time vaccination but for people at high-risk (older individuals and those with a medical condition), many doctors recommend a five-year and 10-year booster. I’ve had my five-year booster and I’ll talk to my doctor about getting the 10-year update next year when it’s due.

Like all decisions surrounding your treatment plan (including preventative treatments such as vaccines), you should discuss pneumonia and other vaccines carefully with your doctor.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Richard Faust moderator
    2 years ago

    Wren and Rick, the study results have the potential to be troubling, but there are a couple of things that should be noted – all of which point towards what Carla noted here abut the need for more study.

    This is the first study of its kind and it only focused on one form of pneumonia vaccine. The authors note that “The effectiveness of PPSV23 in preventing pneumococcal pneumonia remains controversial, especially in high-risk individuals [14]. Although several studies have demonstrated the effectiveness of PPSV23 [15], few studies have focused on patients with autoimmune diseases.”

    Concerning the fact that the study was on the one form of the vaccine and looking at other studies of pneumonia vaccine effectiveness the authors state “sequential administration of PCV13 and PPSV23 could also be an appropriate approach for the prevention for pneumonia in RA patients receiving immunosuppresssive treatments.”

    In addition, by the parameters established and statistical tools used by the researchers the sample size was too small. They note that “Further high-quality trials with sufficient sample size would be useful to confirm our findings.”

    The authors also ran into a difficulty with pneumonia diagnosis unreliability.

    None of this is to say the study does not have considerable usefulness – research is difficult and unknown/unintended problems arise. Like any good research team, they offer up the problems themselves stating “However, we could not reserve sufficient sample size, and the possibility of an underpowered study cannot be denied. Third, our RA population consisted of groups at high risk for infections, and thus our results may not be generalizable to other RA populations. Fourth, we cannot rule out the imprecision of our complete data due to unreliability in the diagnosis of pneumonia.”

    The study does, as noted, indicates a potential problem for utilization of the PPSV23 vaccination for RA patients. Hopefully further study can clear up the unknowns and if further research points towards ineffectiveness, maybe some research into what the authors suggest about combinations can be pursued. Best, Richard ( Team)

  • Wren moderator
    2 years ago

    This is pretty alarming, but it’s also just one study. I’m interested to know if any other studies are in the works or in progress, and what their results are.
    Like you, Carla, I’ve gotten the initial PPSV23 vaccine, along with its 5-year booster. I’ll get the next one too, when the time comes, and in the meantime do what I can to avoid getting pneumonia and keep my fingers crossed.
    Fascinating article! Thanks for sharing this news! 🙂

  • Lawrence 'rick' Phillips moderator
    2 years ago

    I have always pneumonia vaccines as a bit of a crap shoot largely because I know an RA patient who used them (as I do) and nearly died from pneumonia. Perhaps you have told me why that happened.

  • Carla Kienast author
    2 years ago

    Rick/Wren: To Wren’s point, there needs to be more research done, but it is a bit startling. I, too, will no doubt get the booster. I figure it can’t hurt and it might even help. I’m hoping when they figure this out, they’ll learn a great deal more about how RA works and maybe even come up with some new treatment plans! (Or at least more effective vaccines!)

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