Background/Purpose: Connective tissue disorders, including systemic sclerosis (SSc), are associated with an increased risk of infections. Infections are the most common diagnosis during hospitalizations and the leading cause of in-hospital deaths for SSc patients. A significant number of these infections are preventable through vaccination. In our study, we have measured the frequency and demographics of patients with SSc who were hospitalized with a vaccine-preventable disease (VPD) compared to patients without SSc.

Methods: We conducted a population-based descriptive cohort study using the US National Inpatient Sample (NIS) from 2016 to 2020. International classification disease (ICD-10) was used to identify cohorts. We measured the frequency of patients with SSc who were admitted to the hospital with a vaccine-preventable disease (VPD). Frequencies and demographics were determined and compared between patients with SSc and patients without SSc.

Results: We identified 1,834,149 hospitalizations with a principal diagnosis of a VPD (including influenza, Herpes Zoster Virus (HZV), pneumococcal pneumonia, hepatitis A virus, and meningococcal meningitis). Among these, 3,179 had concomitant secondary diagnosis of SSc. The most common VPDs among patients with SSc were influenza (56.1%), herpes zoster virus (HZV) (33.5%) and pneumococcal pneumonia (9.5%). Hepatitis A virus (1.7%) and meningococcal meningitis (0.3%) were less common. Patients with SSc were more likely to have HZV when compared to non-SSc patients (odds ratios [OR] = 1.65, 95% Confidence Interval [CI] = 1.39–1.97, P < 0.001). Interestingly, patients with SSc were less likely to develop influenza infection when compared to non-SSc patients (OR = 0.75, 95% CI = 0.64–0.89], P < 0.001). There was no significant difference in frequency of other VPDs between the two groups.

Conclusion: There was a significantly higher frequency of HZV infections in SSc hospitalizations compared to non-SSc admissions. This finding is pertinent as it could signify a possible low rate of vaccination versus vaccination failure in a potentially immunocompromised population, increasing the risk of infection. Most common infection in SSc patients was influenza, but observed to be less frequent than in the non-SSc group. These findings can help clinicians introduce and improve HZV vaccination programs for SSc patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/vaccine-preventable-diseases-in-hospitalized-patients-with-systemic-sclerosis-a-nationwide-cohort-analysis/