Background/Purpose: Children with rheumatic diseases (RD) have an increased incidence of infections and their complications, both from underlying disease activity and immunosuppressive treatments. Vaccines have been well-established as effective intervention in combating these. Studies assessing vaccination barriers remain limited.

To assess the vaccination status of children with RD and identify immunization facilitators and barriers of families compared to healthy controls (HC)

Methods: A cross-sectional study of children with RD and HC (fracture clinic) at a single tertiary care center was performed. Demographics, diagnosis, and current treatments were obtained from health records. Children with RD were considered immunosuppressed, if they were currently received corticosteroids, nonbiologic or biologic disease-modifying agent. A unique provincial electronic database that records accurate vaccine history was used to obtain actual patient vaccination history. Perceived immunization barriers, concerns, factors promoting vaccination, and satisfaction with information received were captured from a caregiver questionnaire. Descriptive statistical methods were used to analyze the data.

Results: A total of 144 children with RD (76% considered immunosuppressed) and 111 HC were recruited into the study. Vaccination database: Both, children with RD and HC received most of the provincial recommended vaccines at rates of 85% or above, except for Influenza. Influenza vaccine had the lowest adherence rate at 34% RD vs 21% HC: 25% vs 43% in the 1 – 4 years old group, 32% vs 24% in the 5 – 11 years old group, and 38% vs 10% in the 12+ years old group. Caregiver questionnaire: In 31% of children with RD at least one vaccination was withheld, most commonly for active disease (27%), recommendation against receiving vaccinations by health care provider (25%), concerns about side effects post vaccination (18%) and/or disease flare (14%). In 27% of HC at least one vaccination was withheld, most commonly for concerns about side effects post vaccination (13%). Several sources of information were utilized. Both groups listed the primary vaccination information source as the family doctor (66% in RD vs 69% in HC). At least 85% of survey respondents in each group felt satisfied by the amount of information received. The following information gaps were identified: 1) risks and contraindications of vaccinations in general and in children with rheumatic diseases, 2) age-appropriate vaccination schedules and modalities, 3) best practice of vaccination documentation. Vaccination reminders were identified as useful, with several comments indicating that e-mail alerts, reminders, and a method to track this information would be useful.

Conclusion: Most children with RD and HC equally received the recommended vaccines. Immunization gaps were identified for Influenza in both groups and presents an area of improvement. Knowledge regarding contraindications to vaccination is well understood. Concerns about perceived safety limit vaccination completeness in both groups.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/vaccination-coverage-and-caregiver-perspectives-for-children-with-rheumatic-diseases-compared-to-healthy-controls/