Real-World Coverage With Influenza, Pneumococcal, and Herpes Zoster Vaccines Among Patients With Rheumatic Diseases in a Nationwide Healthcare Plan

Abstract

ObjectiveVaccination against preventable infections is important for rheumatic diseases management. This study assessed the vaccination coverage and predictors among patients with rheumatic diseases using real-world data from Israel.MethodsThis retrospective cross-sectional study, based on a Maccabi Healthcare Services database, included adult patients diagnosed with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and systemic lupus erythematosus (SLE), as of 30/04/2019. Age-specific vaccination coverage for influenza (past year), pneumococcal (PPSV23 and/or PCV13), and live attenuated HZ vaccines (past 5 years) was reported. Logistic regression was used to investigate predictors of vaccination.ResultsThe study included 14,528 patients (RA: n=6,932; PsA: n=4,395; SLE: n=1,951). Influenza vaccine coverage among patients with RA, PsA, SLE was 45.1%, 36.2%, 33.7%, respectively. For PPSV23, corresponding rates were 19.6%, 16.2%, 12.6%, respectively. In the elderly population (≥65 years), 63.2% had influenza vaccine in the past year and 83.4% had a PPSV23 vaccine in the past 5 years or provided at age ≥ 65. For PCV13 and HZ, coverage in the overall study population was low, 4.8% and 3.6%, respectively. Central residence and treatment with corticosteroids and biologic or targeted synthetic DMARDs within past 5 years were significant predictors of vaccination coverage across all vaccines (p<0.05). Other predictors varied by vaccine, including female sex (influenza, PPSV23. PCV13), age (influenza, PPSV23), chronic comorbidities (influenza, PPSV23, PCV 13), shorter disease duration (PCV13), and high socioeconomic status (PCV 13, HZ).ConclusionThis study demonstrated suboptimal coverage of influenza, pneumococcal, and HZ vaccination in patients with RA, PsA and SLE, in particular among younger adults in Israel.