Differences in influenza and pneumococcal vaccination coverage according to chronic respiratory diseases during the COVID-19 pandemic in France: a nationwide cohort study using the French national health data system.

BACKGROUND: Chronic respiratory diseases (CRDs) are major contributors to morbidity and mortality globally. Exacerbations, often triggered by pathogens including Streptococcus pneumoniae and influenza virus, significantly worsen outcomes. French and international guidelines recommend vaccination against pneumococcal disease and influenza for at-risk adults. Previous studies found low pneumococcal vaccine uptake in France and other countries. The COVARISQ-2 study reassessed pneumococcal and influenza vaccination coverage during the 2013-2020 period and the 2020-2021 season, respectively, aamong adults with CRDs in France using nationwide claims data. METHODS: Retrospective cohort study using the French National Health Data System (SNDS), covering 99% of the population. Adults (≥18 years) with CRDs (COPD, lung cancer, interstitial lung disease, cystic fibrosis, non-CF bronchiectasis, pulmonary hypertension, severe asthma) alive at the end of 2020 were included. Complete primary pneumococcal vaccination was defined as a dispensing of PCV13 followed within 12 months by PPSV23 between January 1, 2013 and December 31, 2020. Recommended PPSV23 booster doses were not captured. Influenza vaccination was defined as at least one dispensing during the 2020-2021 season. Multivariate logistic regression identified factors associated with vaccination. RESULTS: Among 1991,052 patients (mean age 67.5 years; 46.2% women), complete primary pneumococcal vaccination between 2013 and 2020 was observed in 16.2% (range: 13.5% pulmonary hypertension to 24.9% non-CF bronchiectasis); influenza coverage was 56.8% (range: 55.9% interstitial lung disease to 66.6% non-CF bronchiectasis). Age >65 years predicted influenza vaccination (OR = 4.09, 95% CI: 4.07-4.12) but not pneumococcal vaccination which was associated with ≥3 comorbidities (OR = 1.37, 95% CI: 1.36-1.39) and more healthcare visits. Female sex slightly reduced influenza vaccination odds. Sensitivity analyses were consistent. CONCLUSIONS: Primary pneumococcal sequence completion among French adults with CRDs was only 16% for pneumococcal vaccination over the 2013-2020 period, and seasonal influenza coverage was 56.8% for the 2020-2021 season, which is below the EU target of 75%. Older age and comorbidities were associated with higher uptake for influenza but not pneumococcal vaccination. In this high-risk population, post-pandemic monitoring of vaccination uptake is needed as well as strategies such as simplified vaccination schedules, expanded vaccinator roles, and systematic integration of vaccination into care pathways to improve protection.