Department of Rheumatology, Saint Vincent's University Hospital, Dublin 4, Ireland.
Department of Infectious Diseases, Saint Vincent's University Hospital, Dublin 4, Ireland.
Clin Rheumatol. 2020 Mar;39(3):747-754. doi: 10.1007/s10067-019-04841-6. Epub 2019 Dec 9.
Pneumococcal and influenza vaccination rates have been suboptimal in studies of immunosuppressed patients. We aimed to assess barriers to and increase rates of 23-valent pneumococcal polysaccharide vaccine (PPSV23) and influenza vaccination in this group. The primary endpoint was a statistically significant increase in adequate PPSV23 and influenza vaccination.
In 2017, rheumatology outpatients completed an anonymous questionnaire recording vaccination knowledge, status, and barriers. Simultaneously, a low-cost multifaceted quality improvement (QI) intervention was performed. All outpatients on oral steroids, immunosuppressant conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologics disease-modifying antirheumatic drugs (bDMARDs) were included in the study. In 2018, post-intervention, the clinic was re-assessed. Demographics, diagnosis, medications, smart phone access, and willingness to use this for vaccination reminders were assessed for independent vaccination predictors using binary logistic regression analysis.
Four hundred twenty-five patients were included (72.6% rheumatoid arthritis, 74% women, 45.6% ≥ 60 years old). From 2017 to 2018, PPSV23 vaccination rates changed from 41.0 to 47.2% (P = 0.29) and influenza from 61.8 to 62.1% (P = 0.95). The most common reason for non-vaccination was lack of awareness. Following the intervention, this changed for influenza (36.7 to 34.2%) and PPSV23 (82.1 to 76.4%). General practitioners performed most vaccinations, only 3.6% were delivered in the hospital. Significant predictors of PPSV23 vaccination were older age {≥ 80 years had an OR 41.66 (95% CI 3.69-469.8, P = 0.003), compared with ≤ 39 years}, bDMARD use (OR 2.80, 95% CI 1.24-6.32, P = 0.013), and adequate influenza vaccination (OR 9.01, 95% CI 4.40-18.42, P < 0.001). Up-to-date PPSV23 vaccination (OR 8.93, 95% CI 4.39-18.17, P < 0.001) predicted influenza vaccination.
PPSV23 and influenza vaccination rates were suboptimal. The intervention did not cause a statistically significant change in vaccination rates. Point-of-care vaccination may be more effective.Key Points• Low vaccination rates amongst immunosuppressed inflammatory arthritis outpatients• Less than 5% of vaccinations occurred in hospital• There was no statistically significant difference in the rates of adequate PPSV23 (41.0 to 47.2%) or influenza (61.8 to 62.1%) vaccination following our intervention.
在免疫抑制患者的研究中，肺炎球菌和流感疫苗的接种率一直不理想。我们旨在评估该人群中 23 价肺炎球菌多糖疫苗（PPSV23）和流感疫苗接种的障碍，并提高其接种率。主要终点是统计学上显著增加适当的 PPSV23 和流感疫苗接种率。
2017 年，风湿科门诊患者完成了一份匿名问卷，记录了疫苗接种知识、状况和障碍。同时，还进行了一项低成本的多方面质量改进（QI）干预。所有口服类固醇、免疫抑制剂传统合成疾病修饰抗风湿药物（csDMARDs）或生物疾病修饰抗风湿药物（bDMARDs）的门诊患者均纳入研究。2018 年，干预后，再次评估了诊所。使用二元逻辑回归分析评估了人口统计学、诊断、药物、智能手机的使用情况以及是否愿意使用智能手机进行疫苗接种提醒，以确定独立的疫苗接种预测因素。
共纳入 425 例患者（72.6%为类风湿关节炎患者，74%为女性，45.6%年龄≥60 岁）。从 2017 年到 2018 年，PPSV23 疫苗接种率从 41.0%变为 47.2%（P=0.29），流感疫苗接种率从 61.8%变为 62.1%（P=0.95）。未接种疫苗的最常见原因是缺乏意识。在干预之后，这种情况在流感（从 36.7%变为 34.2%）和 PPSV23（从 82.1%变为 76.4%）中发生了变化。全科医生进行了大部分疫苗接种，只有 3.6%在医院进行。PPSV23 疫苗接种的显著预测因素包括年龄较大（≥80 岁的患者与≤39 岁的患者相比，OR 为 41.66（95%CI 3.69-469.8，P=0.003））、使用 bDMARD（OR 为 2.80，95%CI 1.24-6.32，P=0.013）和充分接种流感疫苗（OR 为 9.01，95%CI 4.40-18.42，P<0.001）。最新的 PPSV23 疫苗接种（OR 为 8.93，95%CI 4.39-18.17，P<0.001）预测了流感疫苗接种。
免疫抑制性炎症性关节炎门诊患者的 PPSV23 和流感疫苗接种率不理想。干预并没有导致疫苗接种率的统计学显著变化。在护理点进行疫苗接种可能更有效。
免疫抑制性炎症性关节炎门诊患者的疫苗接种率较低。
不到 5%的疫苗接种在医院进行。
在我们的干预之后，适当的 PPSV23（41.0 至 47.2%）或流感（61.8 至 62.1%）疫苗接种率没有统计学上的显著差异。
