Background/Purpose: Rates of adult vaccination are low in patients with autoimmune disease despite broad recommendations for many years. In the U.S., pneumococcal vaccination is recommended for people age 65 or older or with a risk factor (e.g. immunosuppression); herpes zoster (HZ) vaccination is recommended for adults aged 60 years and older, and influenza vaccination has been recommended for all persons aged ≥ 6 months. Despite many studies showing patients with rheumatic diseases or treated with immunosuppressive medications are at an increased risk of infections, but factors associated with receive recommended immunizations are not well known. We evaluated the pattern of pneumococcal, HZ, and seasonal influenza vaccination and factors associated with receiving these vaccinations among patients participating in a national US. registry.

Methods: We examined patient self-reported survey responses among participants in the National Data Bank for Rheumatic Diseases (NDB) from 2006-2015. After excluding patients who never answered vaccine questions, all adult patients in the registry with a rheumatologist-diagnosed rheumatic disease were eligible for analysis. Patients <60 years old or who enrolled after 2007 were excluded from the analysis of the HZ vaccine use due to incomplete vaccine history. Vaccine administrations and potential confounders were time-varying and updated at the time of each 6 month survey. For pneumococcal and HZ vaccine, follow-up started at the first survey that all required criteria were met and ended at the earlier date of either vaccination, death, or exited the registry. For influenza, patients were allowed to have multiple vaccinations. A generalized estimating equation model with repeated measures was used to evaluate the factors associated with receipt of each vaccine.

Results: Among 21,522 patients (72.8% with RA, 16.9% with OA, 10.1% with Fibromyalgia, 7% with SLE, patients were allowed to have multiple conditions) who were eligible for pneumococcal and influenza vaccination analysis, we identified 9,162 and 84,991 vaccinations, respectively. Of the cohort, 74.7% had at least one influenza vaccination during the 10 years of study period.The proportion of patients receiving the influenza vaccine in each year is on the average of 60%. ). 9,867(45.8%) patients never had pneumococcal vaccination and 5,438 (25.2%) patients never had influenza vaccination.  Of 11,947 eligible patients for HZ vaccine analysis, 1,724 (14.4%) received the HZ vaccine over a median (IQR: 6 years) of 4.5 years of follow-up.  After multivariable adjustment, older age, African American race, biologic use, cardiovascular disease, and prior hospitalization were significantly associated with all three vaccinations.  Factors associated with each vaccine vary (see Table). 

Conclusion: Overall rates of pneumococcal, HZ, and influenza vaccinations were low among patients with rheumatic diseases. For each type of vaccination, more efforts on different associated factors are needed to improve the vaccination rate. Table: Multivariable factors associated with vaccination among patients with rheumatic diseases in the NDB