1 3 Rheumatol Int DOI 10.1007/s00296-016-3516-1 Rheumatology INTERNATIONAL PUBLIC HEALTH Influenza and pneumococcal vaccination in patients with rheumatoid arthritis in comparison with age- and sex-matched controls: results of a claims data analysis A. Luque Ramos 1 · F. Hoffmann 1 · J. Callhoff 2 · A. Zink 2,3 · K. Albrecht 2 Received: 25 February 2016 / Accepted: 21 June 2016 © Springer-Verlag Berlin Heidelberg 2016 pneumonia prevalence in RA patients confirms their status as a risk group. RA patients are vaccinated more frequently than controls, but vaccination rates are still low. The lower pneumonia prevalence in East Germany indicates that vac- cination may help to reduce pneumonia in RA. Keywords Rheumatoid arthritis · Vaccination · Influenza · Pneumonia Background Rheumatoid arthritis (RA) patients are at increased risk for infections [1]. Inflammation, immunosuppressive therapy with biologic disease modifying anti-rheumatic drugs (bDMARDs) and glucocorticoids as well as comorbid con- ditions independently increases the susceptibility to infec- tions [1–4]. Within the large group of infections, pneumo- nia and influenza are common in RA patients and seem to be preventable [1, 5, 6]. Vaccination is one of the most effective preventive measures against infectious disease [7]. The European League Against Rheumatism (EULAR) published recommendations for vaccination in RA patients in 2011 [8]. The efficacy and safety of vaccination in RA patients are high enough to recommend vaccina- tion, even if the patients are treated with glucocorticoids or bDMARDs [8]. Only rituximab reduces the humoral response significantly. Therefore, a gap between admin- istration and vaccination is recommended [9, 10]. It has to be kept in mind that the currently available studies are not sufficiently powered [8]. The recommendations of the German Standing Vaccination Committee (STIKO) are in accordance with the EULAR guidelines [11, 12]. Patients older than 60 or suffering from a chronic disease like RA are recommended a seasonal influenza vaccination. Abstract The aim of this study was to assess the vaccina- tion status for influenza and pneumonia and the prevalence of hospitalised pneumonia in rheumatoid arthritis (RA) patients and population controls in Germany. Members of a large statutory health insurance fund in Germany who were continuously insured between 2009 and 2013 and had a diagnosis of RA in 2013 were age and sex matched 1:5 to members without RA. Pneumococcal and influ- enza vaccinations were evaluated with regard to age, sex and region of residence. Logistic regression models were used to determine predictors for influenza vaccination in RA patients. Prevalences of pneumonia that required hos- pitalisation were compared to regional vaccination rates. The data of 111,482 RA patients and 557,410 matched con- trols were available for analysis. Compared to controls, RA patients were vaccinated more frequently against influenza (40.8 vs. 32.2 %) and pneumonia (15.0 vs. 10.0 %). Vacci- nation rates increased with older age and differed between the federal states (highest in East Germany, lowest in South Germany). The region of residence, comorbidities, rheuma- tologic care and biologic treatment was associated with a higher probability of an influenza vaccination. Prevalences of pneumonia that required hospitalisation were 2–3 times higher in patients compared to controls and tended to be higher in regions with low vaccination rates. The increased * A. Luque Ramos andres.luque.ramos@uni-oldenburg.de 1 Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany 2 Epidemiology, German Rheumatism Research Centre, Berlin, Germany 3 Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany