Background/Purpose: The US Center for Disease Control and Prevention recommends that adults ages 19 years and older, with immunocompromising conditions should receive a dose of pneumococcal conjugate vaccine (PCV13) first, followed by a dose of pneumococcal polysaccharide vaccine (PPSV23) at least 8 weeks later. Additionally, those who received PPSV23 before age 65 years for any indication should receive another dose of vaccine at age 65 years or later if at least 5 years have elapsed since their previous PPSV23.¹ The objective of this project was to determine if patients with a diagnoses of systemic lupus erythematosus (SLE) and/or rheumatoid arthritis (RA) seen in our academic rheumatology practice were receiving the recommended pneumococcal vaccination schedule for immunosuppressed conditions.

Methods: A retrospective chart review was performed for patients ages 18 years and older with a diagnosis of RA and/or SLE in our academic rheumatology clinic who were on immunosuppressive medications including methotrexate, corticosteroids, azathioprine, adalimumab, etanercept, certolizumab, anakinra, baricitinib, tocilizumab, upadacitinib, apremilast, tofacitinib, rituximab, mycophenolate mofetil, or cyclophosphamide from 7/1/2019 to 1/31/2021. Data were analyzed using the chi-squared test; a p-value less than 0.05 was considered to indicate statistical significance.

Results: We reviewed the charts of 329 patients who had mean age of 56.6 ± 14.8 years, with 84.8% (279) female and 43.8% black (144). Overall, 100/329 (30.4%) patients with a diagnosis of systemic lupus erythematosus and/or rheumatoid arthritis were vaccinated with first dose of Prevnar and 38/329 (11.6%) received PPSV23 only. Higher vaccination prevalence was observed among patients ages 65 years and older. The patients who received PPSV23 or PCV 13 before initiation of immunosuppressive medications was noted to have mean age of 66 years.Only 58/329 (17.6%) of patients received PPSV23 or PCV13 before initiation of immunosuppressive medications.

Table 1 shows compliance with vaccine recommendation by age and type of medications taken.

Conclusion: This study demonstrates that about 70% of patients with a diagnosis of systemic lupus erythematosus and/or rheumatoid arthritis in an academic rheumatology clinic at Ascension St. John Hospital did not receive pneumococcal vaccination as recommended by the CDC. Educational intervention to increase awareness of the pneumococcal vaccine schedule is needed to improve pneumococcal vaccine uptake in patients with rheumatoid arthritis and SLE, particularly those less than 65 years of age.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pneumococcal-vaccination-compliance-rate-among-lupus-and-rheumatoid-arthritis-patients-in-rheumatology-fellows-cllinic/