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Abstract Number: 343

Low Rates of Immunizations in Cohort of Immunocompromised Patients in an Academic Rheumatology Practice

Dmitriy Cherny1, Najia Shakoor2, Todd Beck3 and Sonali Khandelwal4, 1Internal Medicine, Rush University Medical Center, Chicago, IL, 2Division of Rheumatology, Rush University Medical Center, Chicago, IL, 3Bioinformatics, Rush University Medical Center, Chicago, IL, 4Rheumatology, Rush University Medical Center, Chicago, IL

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: immunosuppressants, Infection, population studies and vaccines

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Session Information

Date: Sunday, October 21, 2018

Session Title: Measures and Measurement of Healthcare Quality Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Patients with rheumatologic disorders often require immunosuppression (e.g. DMARDs, biologics, or high doses of prednisone). These patients are at increased risk for infections. While live vaccines are contraindicated in the immunosuppressed, 2018 CDC guidelines support inactivated vaccine administration [1]. Despite recommendations for immunization [2], there is lack of evidence on whether vaccination rates are optimal. The purpose of this study was to investigate the rates of influenza, pneumococcal, and tetanus/diphtheria/pertussis (Tdap) vaccination in immunosuppressed individuals with rheumatologic disorders seen from 2012-2017 at a large academic rheumatology clinic.

Methods:

Patients seen at a large urban academic medical center’s rheumatology clinic between 2012-2017 were included if they had a diagnosis of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or vasculitis in addition to any of the following: prednisone ≥20mg/day, a DMARD (except hydroxychloroquine), and/or a biologic agent. Deceased patients were excluded. Immunizations, medications, and comorbidities were recorded. Vaccination administration for Prevnar, Pneumovax, Influenza, or Tdap was assessed. Chi squared tests evaluated immunization patterns based on various factors including sex, comorbidities, physician experience level (< 10 years, ≥ 10 years), diagnosis, and age group (< 65 years, ≥ 65 years).

Results:

Of 2366 patients reviewed, 1239 met inclusion/exclusion criteria. Results are shown in the Table. Vaccination rates were below 50% (except for receipt of flu vaccine once during the study period). More patients aged ≥ 65 years received Prevnar/Pneumovax than those <65 years of age. Patients with SLE had higher rates of immunization versus those with RA or vasculitis. Presence of cardiopulmonary comorbidities generally increased rates. No significant difference was found in rates based on ethnicity, sex, non-cardiopulmonary comorbidities, or physician experience.

Conclusion:

Infections contribute to morbidity and mortality for immunosuppressed patients, and guidelines recommend vaccination. The above results show strikingly low vaccination rates in this vulnerable population. Other risk factors for infection, including older age and cardiopulmonary comorbidities, were associated with higher vaccination rates. Rheumatologists may not be considering vaccination during their busy clinical practice. Education and quality improvement initiatives are needed to improve vaccination rates in Rheumatology clinics.

REFERENCE

  1. CDC- Immunization schedules. https://www.cdc.gov/vaccines/schedules/hcp/adult.html. May 31, 2018
  2. Van Assen S, Agmon-Levin N, Elkayam O, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2011;70:414e22.

Table 1. Vaccination rates in immunocompromised patients

Prevnar

Pneumovax

Td/Tdap

Flu (Ever)

Flu

(Past Year, 2017)

Total [n (%)]

268 (22%)

558 (45%)

320 (26%)

747 (60%)

468 (38%)

Age [n (%)]

≤ 65 years

144 (16%)

358 (40%)

230 (26%)

523 (59%)

326 (37%)

> 65 years

124 (35%)

200 (57%)

90 (26%)

224 (64%)

142 (41%)

p-value

<0.01*

<0.01*

0.95

0.09

0.20

Diagnosis [n (%)]

SLE

98 (25%)

187 (47%)

120 (30%)

246 (62%)

165 (42%)

RA

149 (20%)

314 (43%)

182 (25%)

431 (59%)

269 (37%)

Vasculitis

21 (18%)

57 (50%)

18 (16%)

70 (61%)

34 (30%)

p-value

0.15

0.21

<0.01*

0.54

0.04*

Cardiac co-morbidity [n (%)]

Yes

16 (33%)

35 (73%)

17 (35%)

36 (75%)

26 (54%)

No

252 (21%)

523 (44%)

303 (25%)

711 (60%)

442 (37%)

p-value

0.04*

<0.01*

0.12

0.03*

0.02*

Pulmonary co-morbidity [n (%)]

Yes

29 (44%)

47 (71%)

27 (41%)

52 (79%)

34 (52%)

No

239 (20%)

511 (44%)

293 (25%)

695 (59%)

434 (37%)

p-value

<0.01*

<0.01*

<0.01*

<0.01*

0.02*

* Significant result

SLE = Systemic lupus erythematosus , RA = Rheumatoid arthritis


Disclosure: D. Cherny, None; N. Shakoor, Dr. Comfort/DJO, 7; T. Beck, None; S. Khandelwal, None.

To cite this abstract in AMA style:

Cherny D, Shakoor N, Beck T, Khandelwal S. Low Rates of Immunizations in Cohort of Immunocompromised Patients in an Academic Rheumatology Practice [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/low-rates-of-immunizations-in-cohort-of-immunocompromised-patients-in-an-academic-rheumatology-practice/. Accessed April 13, 2021.
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