Suboptimal Pneumococcal, Flu Vaccine Rates Persist Among People with HIV

Pneumococcal and influenza vaccination rates were significantly inadequate among people living with HIV (PLWH) in Belgium, according to a study published in Open Forum Infectious Diseases.¹ With study data spanning from 2017 to 2022, and COVID-19 vaccine rates being high throughout, researchers believe targeted vaccine interventions and reminders can improve rates among this population.

“Despite advances in antiretroviral therapies (ART), PLWH remain more susceptible to preventable diseases compared with the general population,” wrote authors of the study. “Given these risks, it is imperative to ensure optimal vaccine uptake among this population.”

Due to their increased risk, PLWH and their vaccination coverage have been researched significantly to understand how to better offer immunizations for this population. Like a variety of patient groups across the globe, vaccination rates among PLWH have been lacking. The reasons for this population not seeking vaccinations are also similar to many others, including a lack of provider recommendations, insufficient vaccine knowledge, barriers to access, and missing vaccine appointments.²

Researchers explored the vaccination status of people living with HIV and determined the key factors associated with uptake based on demographic, clinical, and biological data. | image credit: Rimel / stock.adobe.com

READ MORE: COVID-19 Pandemic Significantly Impacts Pneumococcal Mortality Trends

Issues in vaccine uptake arose further during the COVID-19 pandemic, when increased efforts to protect patients against SARS-CoV-2 may have resulted in a decrease in vaccination rates for flu, pneumococcal, and many others. With increased attention on access and availability of the COVID-19 vaccine, support for other vaccination schedules may have suffered.

There was also a notable jump in vaccine hesitancy throughout the pandemic, leaving a significant portion of patients worldwide with skepticism regarding immunization as a whole. “What the COVID pandemic did was expose and widen existing cracks in multiple systems in society,” said Megan Ranney, MD, MPH, according to Today.³

The complexities of PLWH and their vaccine coverage amid the pandemic have been apparent in Belgium, where COVID-19 vaccine rates reached 86.4% of the population by October 2021 due to increased efforts and nationwide initiatives. While the pandemic may be one potential factor for decreasing vaccination rates, there has also been a lack of research into PLWH and their adherence to routine immunization.¹

“This study aims to investigate pneumococcal, influenza, and COVID-19 vaccination coverage in PLWH in Belgium as well as the factors influencing these rates,” the authors of the current study said. “By identifying determinants of suboptimal vaccination uptake, we aim to support targeted strategies and informational campaigns to improve vaccine coverage in this vulnerable population.”

Conducting a retrospective study using data from 2017 to 2022, researchers explored the vaccination status of PLWH and determined the key factors associated with uptake based on demographic, clinical, and biological data. The 3 vaccines investigators explored among this population were COVID-19, influenza, and pneumococcal. The main study outcome was adherence to each vaccine, including both patients who received partial doses of at least 1 vaccine or complete vaccination with full coverage of a specific vaccine.

The final analysis included a total of 791 patients (median age, 45.2 years; 46% women) with HIV in Belgium.

“Our study provides valuable insights into vaccine coverage for respiratory infections among PLWH in Belgium, highlighting significant disparities in vaccine adherence across demographic, clinical, and socioeconomic factors,” they wrote.¹ “While COVID-19 vaccine uptake was notably high, likely due to public health initiatives, free vaccine access, and pandemic-related policies, adherence to pneumococcal and influenza vaccination guidelines remains suboptimal.”

Throughout the 5-year study period, COVID-19 vaccine rates were the highest at 89.1%, followed by flu vaccine coverage at 68%, and pneumococcal vaccine uptake at just 37.8%. Despite influenza vaccine rates being closer to COVID-19 uptake than pneumococcal, researchers still determined that COVID-19 vaccine rates significantly outperformed both pneumococcal and influenza.

Providing further understanding of skewed vaccine rates among PLWH, researchers identified demographic, clinical, and socioeconomic factors that all contributed to inefficient vaccine rates. These factors, many of which are exclusive to specific vaccines explored in the study, included gender, age, provider consultations, intravenous drug use, and others.

With their exploration of several patients’ data throughout a 5-year period in a specific locale, results of this study may not be generalizable to other populations without HIV or for different patient profiles entirely. However, results from the study provide a variety of insights into how major health-related events impact vaccine uptake and the factors that impact PLWH’s adherence to specific immunization schedules.

Future developments will explore how vaccination uptake can be boosted through improving access, furthering education, and increasing advocacy.

“The findings underscore the persistent challenges in reaching marginalized populations, such as intravenous drug users, and the need for tailored interventions, including integrating vaccinations into harm reduction programs,” concluded the authors.¹ “Additionally, addressing financial barriers, improving education about the benefits of vaccination, and implementing reminder systems could significantly enhance vaccine uptake in this vulnerable population.”

READ MORE: Immunization Resource Center

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REFERENCES

1. Destordeur LC, Lopez Delhoulle V, Papadopoulos I, et al. Factors contributing to pneumococcal, COVID-19, and influenza vaccine uptake among people living with HIV in Belgium: a retrospective study. Open Forum Infect Dis. 2025 Sep 3;12(9):ofaf513. doi: 10.1093/ofid/ofaf513.

2. Gerin L, Gir E, Neves LAS, et al. Vaccination coverage of people living with HIV: before and after interventional action. Vaccines (Basel). 2024 Aug 8;12(8):897. doi: 10.3390/vaccines12080897.

3. Jacoby S. The COVID pandemic harmed trust in childhood vaccines and public health. What that means for future outbreaks. Today. March 27, 2025. Accessed September 11, 2025. https://www.today.com/health/coronavirus/vaccination-rates-covid-pandemic-rcna194486