From the Department of Medicine, McGill University, Montreal; Division of Rheumatology, McGill University Health Center, Montreal; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center, Montreal; Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Internal Medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno, Buenos Aires, Argentina.
T. Qendro, MSc, Department of Medicine, McGill University; M.L. de la Torre, MD, Internal medicine, Rheumatology and Immunology, Centro de Educacion Medica e Investigaciones Clinicas Norberto Quirno; P. Panopalis, MD, Division of Rheumatology, McGill University Health Center; E. Hazel, MD, Division of Rheumatology, McGill University Health Center; B.J. Ward, MD, DTM&H, Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Center; I. Colmegna, MD, Division of Rheumatology, McGill University Health Center; M. Hudson, MD, MPH, FRCPC, Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital.
J Rheumatol. 2020 May 1;47(5):770-778. doi: 10.3899/jrheum.181376. Epub 2019 Jul 15.
To assess vaccination coverage and predictors of vaccination among a Canadian population of rheumatology patients in routine clinical care.
In this cross-sectional study, consecutive adult patients presenting to a tertiary rheumatology clinic at the McGill University Health Center between May and September 2015 were asked to fill a survey on vaccination. Patients self-identified as having rheumatoid arthritis (RA), systemic autoimmune rheumatic diseases (SARD), spondyloarthropathies (SpA), or other diseases (OD). Multivariate logistical regression analyses were performed to evaluate patient and physician factors associated with various vaccinations [for influenza, pneumococcus, and hepatitis B virus (HBV)]. Published Quebec general population influenza and pneumococcal vaccination rates in those aged ≥ 65 years were used as comparative baseline rates.
Three hundred fifty-two patients were included in the analysis (RA: 136, SARD: 113, SpA: 47, OD: 56). Vaccination rates were reported as follows: (1) influenza: RA 48.5%, SARD 42.0%, SpA 31.9%, OD 88.9%, Quebec general population 58.5%; (2) pneumococcal: RA 42.0%, SARD 37.8%, SpA 29.7%, OD 33.3%, Quebec general population 53.2%; (3) HBV: RA 33.6%, SARD 55.6%, SpA 73.5%, OD 36.8%; and (4) herpes zoster: RA 5.6%, SARD 28.6%, SpA 25.0%, OD 16.7%. Physician recommendation was the strongest independent predictor of vaccination across all vaccine types (influenza: OR 8.56, 95% CI 2.80-26.2, p < 0.001; pneumococcal: OR 314, 95% CI 73.0-1353, p < 0.001; HBV: OR 12.8, 95% CI 5.27-31.1, p < 0.001). Disease group, disease duration, comorbidities, treatment type, and being followed by a primary care physician were not significantly associated with vaccination.
There is suboptimal immunization coverage among ambulatory rheumatology patients. An important role for patient and physician education is highlighted in our study, especially because physician recommendation of vaccination was strongly predictive of vaccine uptake.
评估加拿大常规临床护理中风湿科患者的疫苗接种率及其影响因素。
本横断面研究纳入了 2015 年 5 月至 9 月在麦吉尔大学健康中心就诊的成年风湿科患者。患者填写了一份关于疫苗接种的调查问卷。患者自我诊断为类风湿关节炎（RA）、系统性自身免疫性风湿病（SARD）、脊柱关节炎（SpA）或其他疾病（OD）。采用多变量逻辑回归分析评估与各类疫苗接种相关的患者和医生因素[流感、肺炎球菌和乙型肝炎病毒（HBV）]。以≥65 岁的魁北克普通人群的流感和肺炎球菌疫苗接种率作为比较基准率。
共纳入 352 例患者（RA：136 例，SARD：113 例，SpA：47 例，OD：56 例）。报告的疫苗接种率如下：（1）流感：RA 48.5%、SARD 42.0%、SpA 31.9%、OD 88.9%、魁北克普通人群 58.5%；（2）肺炎球菌：RA 42.0%、SARD 37.8%、SpA 29.7%、OD 33.3%、魁北克普通人群 53.2%；（3）HBV：RA 33.6%、SARD 55.6%、SpA 73.5%、OD 36.8%；（4）带状疱疹：RA 5.6%、SARD 28.6%、SpA 25.0%、OD 16.7%。在所有疫苗类型中，医生推荐均为疫苗接种的最强独立预测因素（流感：比值比 8.56，95%置信区间 2.80-26.2，p<0.001；肺炎球菌：比值比 314，95%置信区间 73.0-1353，p<0.001；HBV：比值比 12.8，95%置信区间 5.27-31.1，p<0.001）。疾病类型、疾病持续时间、合并症、治疗类型以及是否接受初级保健医生治疗与疫苗接种无显著相关性。
门诊风湿科患者的免疫接种率不理想。本研究强调了患者和医生教育的重要作用，尤其是因为医生推荐疫苗接种对疫苗接种率有很强的预测作用。
Zotero 插件