Pneumococcal Vaccination Among Lupus Patients

Abstract

PurposePneumococcal vaccination (PV) is indicated for the elderly (age ≥65 years) and those with chronic disease or who are immunosuppressed. We aimed to study the rate and predictors of recommendation/receipt of 23 valent pneumococcal polysaccharide vaccine (PPSV23) in immunosuppressed systemic lupus erythematosus (SLE) patients.MethodsData were obtained through self-report questionnaires and medical chart review of 150 SLE patients. Information on rheumatologist recommendation or receipt of PPSV23 in the preceding 5 years was collected if self-reported in a questionnaire or documented in the medical chart. Chart review was also done to collect data on patient demographics, physician characteristics (if patients had a primary care physician and rheumatologist's SLE patient volume), and the disease characteristics of SLE. Comparisons using χ2 or t tests and logistic regression analyses were conducted for predictors of recommendation/receipt of PV.ResultsThe mean (SD) age was 47.4 (15.9) years; 90% were women. Sixty-five of 94 eligible patients for PV (based on immunosuppressive medications use or age) had been either recommended or administered PPSV23. On univariate logistic regression analysis, age, duration of disease, current use of hydroxychloroquine or mycophenolate, and rheumatologist's SLE patient volume were significant correlates of recommendation/receipt of PPSV23. However, on multivariate analysis, the only significant predictor was rheumatologist's SLE patient volume after adjusting for the above correlates such that with every 50 patients increase in SLE patient clinic volume, the odds of recommendation/receipt of PPSV23 increased by 2.37 times.ConclusionsThe volume of lupus patients that rheumatologists see is strongly associated with the likelihood that their SLE patients will have PPSV23 recommended and delivered, suggesting a volume outcome relationship.

A survey of systemic lupus erythematosus patients' attitudes toward influenza and pneumococcal vaccination in Southwest China

“…As for the pneumococcal vaccine, the lack of awareness of the vaccine that can be received by SLE patients was listed as the main reason for not taking the pneumococcal vaccine. The most common reason cited by patients who did not receive PPSV23 was “not recommended” (72%), followed by “no reason given” (24%) and “do not like shots” (4%) ( 28 ). These were similar to what was reported in another study: lack of recommendation (87%), lack of time (7%) and efficacy or safety concerns (4%) ( 16 ).…”

“…However, most of the primary care staff have insufficient knowledge on the management of SLE and have difficulty proposing suggestions on vaccination. A recent study found that the volume of SLE patients seen by rheumatologists is strongly associated with the likelihood that the patients will have PPSV23 recommended and delivered ( 28 ). Rheumatologists usually have a larger SLE patient volume than physicians, which makes the former more experienced with the management of SLE complexities and more sensitive to the importance of preventive care ( 28 ).…”

“…A recent study found that the volume of SLE patients seen by rheumatologists is strongly associated with the likelihood that the patients will have PPSV23 recommended and delivered ( 28 ). Rheumatologists usually have a larger SLE patient volume than physicians, which makes the former more experienced with the management of SLE complexities and more sensitive to the importance of preventive care ( 28 ). The rheumatology team and primary care team can cooperate in assessing the risk of infection, identifying the indications for vaccinations and informing the patients about the risk/benefit ratio of vaccines.…”

Hesitancy for SARS-CoV-2 vaccines and post-vaccination flares in patients with systemic lupus erythematosus

“…Barriers to vaccination were the lack of doctor recommendation (57.4 %) and concerns over the safety or efficacy of the vaccine (12.7 %). A questionnaire study in US revealed that 69 % of 94 eligible SLE patients had either been recommended or administered the 23-polyvalent pneumococcal vaccine [27] . Age, SLE duration, current use of hydroxychloroquine or mycophenolate mofetil, and rheumatologist's patient volume were correlates of the recommendation or receipt of the vaccine.…”

Improving Pneumococcal Vaccination Rates in Rheumatology Clinics

“…19 Another study found that the volume of patients with SLE seen by a rheumatologist is strongly associated with receipt of PPSV23. 20 The best practice alert used by Sheth and colleagues was not just a simple alert but rather had embedded clinical decision support; this allowed clinicians to reference vaccine eligibility based on CDC guidelines, order pneumococcal vaccines, and document refusal or deferral reasons. 19 A recent systematic review and metaanalysis of 108 studies found that clinical decision support in most projects led to small-to-moderate improvements in the intended care.…”