Flu and Pneumococcal Vaccine Coverage in Scleroderma Patients Still Need to Be Prompted: A Systematic Review

Abstract

Systemic sclerosis (scleroderma, SSc) is an autoimmune connective tissue disease characterized by excessive production of collagen and multiorgan involvement. Scleroderma patients are at increased risk of influenza complications and pneumonia; thus, vaccinations are recommended. This systematic review evaluated the influenza and pneumococcus vaccination coverage for SSc patients. We included all studies from Pubmed reporting on influenza and pneumococcal vaccination rate in Scleroderma patients up to May 2021. The 14 studies thus selected identified a suboptimal vaccination rate in autoimmune and SSc patients, ranging from 28 to 59% for the flu vaccine, and from 11 to 58% for the pneumo vaccine in absence of specific vaccination campaigns, variously considering also other variables such as age, gender, vaccination settings, and possible vaccination campaigns. We also considered the reasons for low coverage and the approaches that might increase the vaccination rates. A lack of knowledge about the importance of vaccination in these patients and their doctors underlined the need to increase the awareness for vaccination in this patients’ category. Current guidelines recommend vaccination in elderly people and people affected by particular conditions that widely overlap with SSc, yet autoimmune diseases are not always clearly mentioned. Improving this suboptimal vaccination rate with clear guidelines is crucial for SSc patients and for clinicians to immunize these categories based principally on the pathology, prior to the age. Recommendations by the immunologist and the direct link to the vaccine providers can highly improve the vaccine coverage.

Do Not Leave Your Patients in the Dark—Using American College of Rheumatology and European Alliance of Associations for Rheumatology Recommendations for Vaccination in Polish Adult Patients with Autoimmune Inflammatory Rheumatic Diseases

“…Among the main reasons against getting vaccinated, AIIRD patients mentioned, in addition to the lack of knowledge that vaccination is recommended, concerns about potential adverse effects, the exacerbation of rheumatic disease, and lack of concerns regarding contracting illness. This is in line with the literature data that shows the factor mainly affecting vaccination uptake is lack of recommendation by physicians, followed by lack of knowledge that vaccination is required and the fear of their side effects [ 7 , 15 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 40 , 50 ].…”

“…The low vaccination rate among AIIRD patients found in our study is not surprising in this context but fits into the available literature data. The vaccination rate among AIIRD patients varies between different countries and is between 1.5 and 92.4% for influenza vaccines [6,7,, 5.8 and 71.2% for the pneumococcal vaccine [13,[15][16][17][18][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]37,38,[41][42][43][44][45][46], 24.3 and 83.7% for tetanus vaccination (booster within 10 years) [26,27,29,33,41,42], and 35.8 and 98.1% for the COVID-19 vaccine (following the recommendations applicable at the time of this study) [6,[40][41][42][43][47][48][49]. An additional problem is the fact that vaccination coverage in Polish AIIRD patients is comparably low as in the general Polish population, even though AIIRD patients constitute a group of particular ...…”

“…The low vaccination rate among AIIRD patients found in our study is not surprising in this context but fits into the available literature data. The vaccination rate among AIIRD patients varies between different countries and is between 1.5 and 92.4% for influenza vaccines [ 6 , 7 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ], 5.8 and 71.2% for the pneumococcal vaccine [ 13 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ,…”

Active vaccination campaign to increase seasonal influenza vaccination coverage: a monocenter experience in a cohort of Italian patients with systemic autoimmune diseases

“…It has been proposed that a direct link with the vaccine providers or the introduction of influenza vaccination as a routine practice in rheumatology outpatient wards may be a useful approach to improve vaccination coverage [ 6 , 18 ]. In line with this observation and following the scientific reference societies’ recommendations, an active vaccination campaign was implemented in the years 2019/2020 and 2020/2021 within the clinical practice of the Rheumatology Department of the Niguarda Hospital (Milan, Italy) to increase the seasonal influenza vaccination coverage in patients with inflammatory arthritis.…”

Vaccination of Elderly People Affected by Chronic Diseases: A Challenge for Public Health

“…As reported above, specific protocols for these population sub-groups are recommended [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Unfortunately, the evidence reported in the literature shows that the vaccination coverage achieved in these population sub-groups is not satisfactory [ 18 , 19 , 20 , 21 , 22 ].…”