Epidemiology and Health

Brief Communication

Vaccination coverage according to immunosuppression level among adults with non-rheumatoid arthritis rheumatic diseases: a retrospective observational study in Korea: Choseok Yoon, Kiho Jeong, Wooyoung Jang, Jinnam Kim, Se Yoon Park, Bongyoung Kim; Epidemiol Health. 2026;48:e2026018. Published online April 23, 2026; DOI: https://doi.org/10.4178/epih.e2026018

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Abstract Summary PDF Supplementary Material: Abstract
Patients with autoimmune inflammatory rheumatic diseases are particularly vulnerable to infectious diseases. Accordingly, a broader range of vaccines and, in some cases, additional doses are recommended for these patients compared with the general population. This study investigated the vaccination status of adult patients with non-rheumatoid arthritis rheumatic diseases (NRRDs). This retrospective study was conducted in the rheumatology outpatient department of a tertiary care hospital and included adult patients (aged ≥19 years) with NRRDs who received glucocorticoids and/or disease-modifying antirheumatic drugs from January 2023 to March 2023. Among these patients, we compared vaccination rates between high-level immunosuppression (HLI) and non-HLI groups. HLI was defined as current biologic use or prednisolone equivalent at a dose of ≥20 mg/day for ≥14 days. Of the 4,070 patients with NRRDs, 1,522 (37.4%) were in the HLI group. Overall vaccination rates (complete plus partial vaccination) were significantly lower in the HLI group than in the non-HLI group for influenza (20.2 vs. 31.0%, p<0.001), hepatitis B (59.5 vs. 68.8%, p<0.001), pneumococcal disease (12.9 vs. 26.9%, p<0.001), and herpes zoster (4.3 vs. 10.8%, p<0.001). Overall, vaccination rates were low among patients with NRRDs, with especially low rates in the HLI group. These findings highlight the need for systematic vaccination strategies.; Summary

Korean summary
비류마티스관절염 류마티스 질환(NRRDs)을 가진 대부분의 성인 환자들은 일반 환자들에 비해 감염 위험이 더 높음에도 불구하고 권장되는 성인 예방접종을 완료하지 못한 것으로 확인되었다. 또한 인플루엔자, 폐렴구균, 대상포진 등 주요 백신 예방접종률은 고도 면역억제(high-level immunosuppression, HLI) 군에서 비고도면역억제(non-HLI) 군보다 유의하게 낮았다. 이러한 결과는 비교적 관련 연구가 많이 이루어진 RA 환자군에서뿐만 아니라 NRRDs 가 진단된 국내 면역저하 환자에서 예방의료의 중요한 공백을 보여주며, 이 취약한 집단을 위한 체계적이며 정책이 뒷받침된 예방접종 전략의 필요성을 강조한다.

Key Message
Despite being at high risk for infection, most adult patients with non-rheumatoid arthritis rheumatic diseases (NRRDs) did not complete the recommended adult vaccinations. Vaccination rates, including those for the influenza, pneumococcal, and herpes zoster vaccines, were significantly lower in the high-level immunosuppression (HLI) group than in the non-HLI group. Overall, these findings reveal a critical gap in the preventive care of immunocompromised patients with NRRDs and underscore the need for systematic vaccination strategies in this vulnerable population.

COVID-19: Original Article

Risk of lymphadenopathy from SARS-CoV-2 vaccination in Korea: a self-controlled case series analysis: Mi-Sook Kim, Bongyoung Kim, Jeong Pil Choi, Nam-Kyong Choi, Jung Yeon Heo, Jun Yong Choi, Joongyub Lee, Sang Il Kim; Epidemiol Health. 2023;45:e2023090. Published online October 13, 2023; DOI: https://doi.org/10.4178/epih.e2023090

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
To assess the risk of lymphadenopathy following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination.
METHODS
A self-controlled case series design was used to determine whether the risk of lymphadenopathy was higher in the 1-day to 42-day risk interval after coronavirus disease 2019 (COVID-19) vaccination compared to the control period. In addition, subgroup analyses were conducted according to baseline characteristics, time since vaccination, and sensitivity analyses adjusted for the length of the risk interval.
RESULTS
The risk of developing lymphadenopathy in the risk interval (1-42 days) after COVID-19 vaccination compared to the control period was significantly increased, with a relative incidence (RI) of 1.17 (95% confidence interval [CI], 1.17 to 1.18) when the first, second, and third doses were combined. The RI was greater on the day of vaccination (1.47; 95% CI, 1.44 to 1.50). In subgroup analyses by baseline characteristics, a significantly increased risk or trend toward increased risk was observed in most subgroups except for those aged 70 years and older, with a significant increase in risk in younger individuals, those with a Charlson’s comorbidity index <5, and those who received mRNA vaccines (mRNA-1273>BNT162b2). Within the 1-day to 42-day post-dose risk period, the relative risk was highest during the 1-day to 7-day post-dose period (1.59; 95% CI, 1.57 to 1.60) compared to the control period, and then the risk declined. In the sensitivity analysis, we found that the longer the risk window, the smaller the RI.
CONCLUSIONS
SARS-CoV-2 vaccination is associated with a statistically significant increase in the risk of lymphadenopathy, and this risk was observed only with mRNA vaccines.; Summary

Korean summary
질병관리청의 코로나19 예방접종자료와 국민건강보험공단 자료를 이용하여 수행한 본 자기대조환자군 연구에서 코로나19 백신접종은 42일 내 림프절병증 발생위험을 1.17배 (95% 신뢰구간, 1.17-1.18) 증가시키는 것으로 나타났다. 이러한 위험의 증가는 mRNA 백신에 국한하여 관찰되었으며 연령이 낮을수록, 여성일수록 상대위험도가 높은 것으로 나타났다.

Key Message
This self-controlled case series study, using the Korea Disease Control and Prevention Agency COVID-19 vaccination database and the National Health Insurance Service database, showed an increased risk of developing lymphadenopathy following vaccination (RR 1.17; 95% CI, 1.17 to 1.18). The elevated risk of lymphadenopathy is specifically associated with mRNA platform vaccines, not viral vector vaccines, and is more pronounced in younger individuals and females.

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