Background/Purpose: Infections are a leading cause of morbidity and mortality in patients with childhood-onset systemic lupus erythematosus (cSLE). Vaccination is a powerful tool to prevent infections. Despite guidelines outlining recommended vaccinations among immunocompromised persons, and robust evidence supporting safety and efficacy, many young immunosuppressed patients’ vaccinations are not optimized. This gap leads to important risk, and thus an opportunity to improve the quality of care delivered to these patients.

Methods: We aimed to assess the proportion of patients attending the YASLE clinic at Mount Sinai Hospital who had completed vaccinations recommended for immunocompromised persons as the first step of a Quality Improvement process. In the first Plan-Do-Study-Act (PDSA) cycle, vaccination records were requested of all the patients attending the clinic, via EMR-based secure messaging (Accuro). Vaccination status for all recommended vaccinations was recorded (Y/N), along with date of administration, in the patient’s chart, and on an anonymized spreadsheet. The second PDSA cycle addressed the dearth of responses gathered from the first cycle, and engaged non-responding patients’ primary care providers in requesting patient vaccination records. Data from these two PDSA cycles were analyzed with a view towards tailoring a vaccination intervention to address care gaps.

Results: 168 patients were approached via secure patient portal to share their vaccination record. Twenty (11.9%) responded, with four among these declining participation in the study. Twenty additional vaccination records were obtained from the non-responding patients’ primary care providers (n=100). The cumulative response rate from these two steps was 23.8%, with complete vaccination records available for 21.4%. Of the 36 patients whose records were available, only one (2.7%) received the Pneumococcal polysaccharide vaccine (Pneumovax 23®), six (16.7%) received the Pneumococcal conjugated vaccine (PCV13®), and two (5.6%) received the Pneumococcal 20-valent conjugate vaccine (Prevanar 20®). Also, only twelve (33.3%) patients received the Measles-Mumps-Rubella (MMR) vaccine, six (16.7%) received the influenza vaccine in 2023, and only two (5.6%) patients received the Human Papilloma Virus vaccine. Seven (19.4%) patients received the herpes zoster vaccine. Most patients (52.7%) received the hepatitis B vaccine. The hepatitis A and the meningococcal vaccines were administered in 12 (33%) of the patients. At least 16 (44.4%) of the patients had missing vaccination information and were labelled as unknown vaccination status.

Conclusion: These findings confirm our hypothesis of suboptimal scheduled and recommended vaccinations in young patients with cSLE who have transitioned to adult care. Furthermore, we have learned that ascertaining vaccination status is time-consuming and ineffective. Given the gaps in vaccination evident from this pursuit, we plan to collaborate with a clinical pharmacist, and with primary care providers, to administer the vaccines of highest priority during follow-up visits at the YASLE clinic. We will also work in collaboration with Sickkids hospital to request a vaccine record for each

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheum-to-improve-have-patients-attending-the-young-adult-systemic-erythematosus-yasle-clinic-received-all-appropriate-vaccinations-a-quality-improvement-initiative/