scholarly journals AB1141 EVALUATION OF INFLUENZA AND PNEUMOCOCCAL VACCINATION RATES IN PATIENTS WITH RHEUMATOID ARTHRITIS AND SPONDYLOARTHRITIS, AND THE AWARENESS OF RHEUMATOLOGISTS ABOUT VACCINATION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1860.2-1861
Author(s):  
İ. Kurut Aysin ◽  
M. Aysin ◽  
D. Solmaz ◽  
N. Baş Tomaş ◽  
F. Koç ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Pneumococcal Vaccine ◽  
Inflammatory Arthritis ◽  
Pneumococcal Vaccination ◽  
Inflammatory Rheumatic Diseases ◽  
Pneumococcal Vaccines ◽  
Vaccination Rates ◽  
Factors Associated ◽  
Increased Risk ◽  
Rheumatology Outpatient

Background:Patients with inflammatory arthritis have increased risk of infections which may lead to morbidity and mortality. Some of those infections could be prevented by vaccination.Objectives:The main objectives of the present study were to investigate (a) the uptake rate of influenza and pneumococcal vaccination among patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) attending a rheumatology outpatient clinic, (b) the factors associated with their vaccination rate and, (c) the attitudes of Turkish rheumatologists about vaccination.Methods:Patients, followed-up in a tertiary rheumatology outpatient clinic with the diagnosis of RA and SpA, volunteered for participating to study, were included in this cross-sectional study. Data regarding the socio-demographic and disease-related characteristics (including disease duration, medications used, and comorbid conditions) of the patients, vaccination history, the knowledge about the vaccination, and the factors potentially associated with the uptake of vaccination were collected by face-to-face interview using a standardized questionnaire. 102 out of 345 rheumatologists have participated in a web-based survey.Results:In total, we collected data from 387 patients (260 with SpA and 114 with RA; 204 [52.8%] female and mean age 46.6 ± 12.7 years). Only 123 (32.3%) of our patients were responded that their disease or treatment might be related to the increased risk for infectious diseases. Influenza and pneumococcal vaccines were administered to 71 (21.4%) and 21 (6.1%) patients, respectively. Vaccination for influenza was recommended by family physicians in 26 patients and by rheumatologists in 12 patients. Rate of influenza vaccination was significantly higher in patients >65 years (p=0.021) and with any co-morbid conditions (p=0.002). The main reasons reported by patients regarding not to be vaccination were (a) the belief that they did not need the vaccine (49.4% for influenza and 26.2% for pneumococcal vaccine), (b) the absence of recommendation from their physicians (24.1% for influenza and 26.2% for pneumococcal vaccine), (c) fear of adverse event of vaccination (28.8% for influenza and 3.2% for pneumococcal vaccine), and (d) lack of knowledge about vaccination (6.1% for influenza and 12.5% for pneumococcal vaccine). Even though 50% of rheumatologists who responded to the survey were aware of the presence of national vaccination recommendations, all of them stated that patients with inflammatory arthritis need to be vaccinated for both influenza and pneumococcal infections. Influenza and pneumococcal vaccines were administered to 23 (22.5%) and 4 (3.9%) rheumatologists, respectively.Conclusion:Although the knowledge and awareness about influenza and pneumococcal vaccinations were seemed to be high among rheumatologists, vaccination rates for both were insufficient in RA and SpA patients. There remains significant effort to improve vaccination rates and to prevent morbidity and mortality due to vaccine-preventable infections in inflammatory rheumatic diseases.References:[1]Van Assen S, Agmon-Levin N, Elkayam O, Cervera R, Doran MF, Dougados M, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2011;70:414–22.[2]MTT Nguyen, H Lindegaard, O Hendricks & N Friis-Møller. Factors associated with influenza and pneumococcal vaccine uptake among rheumatoid arthritis patients in Denmark invited to participate in a pneumococcal vaccine trial (Immunovax_RA), Scandinavian Journal of Rheumatology 2017;1–8.Disclosure of Interests:None declared

scholarly journals Study to increase the pneumococcal vaccination rates of individuals aged 65 years and older

2020 ◽  
Vol 21 ◽  
Author(s):  
M. V. Biyik ◽  
I. Arslan ◽  
D. Yengil Taci
Keyword(s):  
Hepatitis B ◽  
Pneumococcal Vaccine ◽  
Pneumococcal Vaccination ◽  
Phone Call ◽  
Pneumococcal Vaccines ◽  
Knowledge Level ◽  
Vaccination Rates ◽  
Face To Face ◽  
Tetanus Vaccine ◽  
The Impact

Abstract Background: In our study, we intended to observe the impact of recommending the pneumococcal vaccine to individuals who were called on the phone or interviewed face-to-face by their doctors on vaccination rates. Methods: Two hundred individuals who were 65 years old and older were included in our study. They were questioned about their awareness regarding adult immunisation, and their knowledge level and vaccination statuses were determined regarding the tetanus, influenza, hepatitis, and pneumococcal vaccines. After they were given information about the pneumococcal vaccine, they were asked about their interest in being vaccinated. Those who agreed to be vaccinated were invited and vaccinated. Results: According to the questionnaire, 150 people (75%) knew of the influenza vaccine, 130 people (65%) knew of the tetanus vaccine, 53 people (26.5%) knew of the hepatitis B vaccine, and 49 people (24.5%) knew of the pneumococcal vaccine. A total of five people (2.5%) had received the pneumococcal vaccine. Fifty-eight of 97 patients (59.8%) who completed the questionnaire during a phone call and 84 of 103 patients (81.6%) who completed the questionnaire during a face-to-face interview received the pneumococcal vaccine. As a result, the rates of pneumococcal vaccination increased from 2.5% before the study to 73.5% after the study. Conclusion: The findings show that the vaccination rates for pneumococcus were very low among our participants. The immunisation rates increased when doctors provided consultation to participants about adult immunisation.

scholarly journals Novel gene variants associated with cardiovascular disease in systemic lupus erythematosus and rheumatoid arthritis

2018 ◽  
Vol 77 (7) ◽  
pp. 1063-1069 ◽  
Author(s):  
Dag Leonard ◽  
Elisabet Svenungsson ◽  
Johanna Dahlqvist ◽  
Andrei Alexsson ◽  
Lisbeth Ärlestig ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
General Population ◽  
Lupus Erythematosus ◽  
Risk Allele ◽  
Snp Array ◽  
Inflammatory Rheumatic Diseases ◽  
Systemic Lupus ◽  
Increased Risk

ObjectivesPatients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) have increased risk of cardiovascular disease (CVD). We investigated whether single nucleotide polymorphisms (SNPs) at autoimmunity risk loci were associated with CVD in SLE and RA.MethodsPatients with SLE (n=1045) were genotyped using the 200K Immunochip SNP array (Illumina). The allele frequency was compared between patients with and without different manifestations of CVD. Results were replicated in a second SLE cohort (n=1043) and in an RA cohort (n=824). We analysed publicly available genetic data from general population, performed electrophoretic mobility shift assays and measured cytokine levels and occurrence of antiphospholipid antibodies (aPLs).ResultsWe identified two new putative risk loci associated with increased risk for CVD in two SLE populations, which remained after adjustment for traditional CVD risk factors. An IL19 risk allele, rs17581834(T) was associated with stroke/myocardial infarction (MI) in SLE (OR 2.3 (1.5 to 3.4), P=8.5×10−5) and RA (OR 2.8 (1.4 to 5.6), P=3.8×10−3), meta-analysis (OR 2.5 (2.0 to 2.9), P=3.5×10−7), but not in population controls. The IL19 risk allele affected protein binding, and SLE patients with the risk allele had increased levels of plasma-IL10 (P=0.004) and aPL (P=0.01). An SRP54-AS1 risk allele, rs799454(G) was associated with stroke/transient ischaemic attack in SLE (OR 1.7 (1.3 to 2.2), P=2.5×10−5) but not in RA. The SRP54-AS1 risk allele is an expression quantitative trait locus for four genes.ConclusionsThe IL19 risk allele was associated with stroke/MI in SLE and RA, but not in the general population, indicating that shared immune pathways may be involved in the CVD pathogenesis in inflammatory rheumatic diseases.

scholarly journals Implementing a Multidisciplinary Approach to Enhance Compliance With Guideline-Recommended Prechemotherapy Pneumococcal Vaccination in a Military-Based Medical Oncology Practice

2017 ◽  
Vol 13 (11) ◽  
pp. e966-e971 ◽  
Author(s):  
Wilfred Delacruz ◽  
Sandra Terrazzino ◽  
Michael Osswald ◽  
Casey Payne ◽  
Brian Haney
Keyword(s):  
Pneumococcal Vaccination ◽  
Standard Of Care ◽  
Baseline Period ◽  
Community Acquired Pneumonia ◽  
Vaccination Rates ◽  
Patients With Cancer ◽  
Single Person ◽  
Increased Risk ◽  
Oncology Practice ◽  
Current Guidelines

Purpose: Patients with cancer are at increased risk for invasive pneumococcal disease, including community-acquired pneumonia. Current Advisory Committee on Immunization Practices and National Cancer Comprehensive Network guidelines recommend pneumococcal vaccination for immunocompromised patients, including patients with cancer. Methods: We conducted a quality improvement (QI) project to enhance compliance with pneumococcal vaccination in patients before their chemotherapy. Baseline pneumococcal vaccination rates were gathered from July 2013 to June 2014. We reviewed the current guidelines for pneumococcal vaccinations in patients with cancer with physicians and encouraged them to prescribe the pneumococcal vaccination to patients before therapy. We also recruited our clinic nurse practitioner, who meets all patients for chemotherapy teaching, to prescribe the vaccine to patients younger than 65 years of age. Results: During the baseline period, of the 110 patients younger than 65 years who received chemotherapy, seven (6.4%) received the pneumococcal vaccine. Of the 90 patients (median age, 60 years; range, 20 to 86 years) who received chemotherapy during the study period, 58 were younger than 65 years, of whom three patients were already vaccinated before their diagnosis. Twenty-five (45.5%) patients were vaccinated through our QI project. We have improved our compliance with pneumococcal vaccination by 39% ( P < .001). Conclusion: We have improved compliance with pneumococcal vaccination in patients with cancer receiving chemotherapy in our clinic through a QI project. We found that screening is best accomplished by a single person who is able to screen all patients. This practice is now a standard of care in our clinic.

scholarly journals A Multifaceted Intervention to Improve Influenza, Pneumococcal, and Herpes Zoster Vaccination among Patients with Rheumatoid Arthritis

2016 ◽  
Vol 43 (6) ◽  
pp. 1030-1037 ◽  
Author(s):  
David W. Baker ◽  
Tiffany Brown ◽  
Ji Young Lee ◽  
Amanda Ozanich ◽  
David T. Liss ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Insurance Coverage ◽  
Pneumococcal Vaccination ◽  
Vaccination Rate ◽  
Rate Of Change ◽  
System Level ◽  
Vaccination Rates ◽  
Order Sets ◽  
Vaccination History ◽  
Patient Outreach

Objective.Vaccination rates for influenza, pneumococcus, and zoster in patients with rheumatoid arthritis (RA) have remained low. Simple electronic or paper reminders have produced only small increases in vaccination rates. We sought to identify a more effective approach to improve vaccination rates.Methods.We conducted a system-level intervention at an academic rheumatology clinic that included electronic reminders with linked order sets, physician auditing and feedback, patient outreach, and optional printed prescriptions for zoster vaccination at an outside pharmacy.Results.We targeted 1255 eligible patients with RA. There was no change in patients’ self-reported influenza vaccination rates, although the baseline self-reported rate was already high and much higher than that documented in the electronic health record. Pneumococcal vaccination rates increased from 28.7% to 45.8%; in regression analysis, the rate of change in pneumococcal vaccination increased by 9.4% per year above baseline trends (95% CI 3.9–15.5, p = 0.002). The rate of zoster vaccination increased from 2.5% to 4.5% overall (p = 0.01) and from 3.0% to 6.6% among patients not receiving biologic therapy that precluded zoster vaccination.Conclusion.Although the intervention improved pneumococcal and zoster vaccination rates, the improvement in pneumococcal vaccination rate was less than expected, and the zoster vaccination rate remained low even for ideal candidates. Likely barriers include lack of familiarity and difficulty using electronic reminders and order sets, uncertainty about the value and safety of recommended vaccines, and uncertainty about patients’ insurance coverage and prior vaccination history. Future interventions should include strategies to address these.

scholarly journals Improving pneumococcal vaccine uptake in veterans with chronic lymphocytic leukemia through a virtual clinic

2018 ◽  
Vol 25 (1) ◽  
pp. 95
Author(s):  
E.C. Church ◽  
R. Banks ◽  
B. Wilson ◽  
L. Arfons ◽  
F. Perez ◽  
...  
Keyword(s):  
High Risk ◽  
Chronic Lymphocytic Leukemia ◽  
Medical Record ◽  
Pneumococcal Vaccine ◽  
High Risk Patient ◽  
Lymphocytic Leukemia ◽  
Vaccine Uptake ◽  
Pneumococcal Vaccines ◽  
Vaccination Rates ◽  
Virtual Clinic

Through a “virtual clinic,” we used the electronic medical record to identify and intervene upon patients with chronic lymphocytic leukemia (cll) who were not current for pneumococcal vaccines. Within 180 days, 100/160 patients (62%) received the recommended pneumococcal vaccine. A virtual clinic may improve vaccination rates among high-risk patient populations.

scholarly journals SAT0064 VACCINATION RATE AND RISK FACTORS FOR NON-VACCINATION IN RHEUMATOID ARTHRITIS: A CROSS-SECTIONAL PROSPECTIVE MULTICENTRIC OBSERVATIONAL STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 965.2-965
Author(s):  
C. Rempenault ◽  
T. Barnetche ◽  
M. Magnol ◽  
B. Castagne ◽  
M. Pugibet ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Observational Study ◽  
Vaccination Rate ◽  
University Hospitals ◽  
Research Support ◽  
Cross Sectional ◽  
Vaccination Rates ◽  
Increased Risk ◽  
Chi Squared ◽  
Patient’S Information

Background:Rheumatoid arthritis (RA) patients are at increased risk of infections, some of which could be prevented in part by vaccination (1). Influenza and pneumococcal vaccines are recommended in RA (2). However, vaccination coverage of these patients remains very low. Five years ago, we found in a previous study that vaccination rates in France were 55% for pneumococcal and 60% for influenza vaccines (3).Objectives:The aim of our study was to evaluate the vaccination rate among RA patients, compare it with our previous results, and identify factors associated with non-vaccination.Methods:We conducted a cross sectional multicentric observational study in the rheumatology departments of 5 university hospitals in France. Data were collected from December 2018 to July 2019. Outpatients and hospitalized adult patients with RA according to the ACR/EULAR 2010 criteria were included. Data were collected during a single visit through an anonymous questionnaire completed by the patients. Pearson Chi-squared analysis and multivariable logistic regression were used to compare characteristics of vaccinated versus non vaccinated patients.Results:584 patients (77.9% of women, mean age 61.8±12.6 years old) were included. 81.7% were RF and/or ACPA positive, with a mean RA duration of 15.7±10.5 years, 58.2% were treated with methotrexate (MTX), and 68.6% with a biologic. Vaccination rate against pneumococcal was 78.9% (versus 55% in 2013, p<0.0001) and 60.4% for influenza (versus 60% in 2013). The main reason for non-vaccination was absence of vaccine proposal (59.2%) for pneumococcal, and fear of vaccines (56.7%) for influenza. In the multivariate analysis, a higher level of education (OR [CI95] 4.4 [2.3-8.4], p<0.0001), a very good opinion on vaccination (2.1 [1.1-4.1], p=0.003), vaccination against influenza done (2.3 {1.3-4.2], p=0.006), and exposure to biologics (4.0 [2.2-7.4], p<0.0001) were associated with vaccination against pneumococcal. Age over 65 years old (2.0 [1.2-3.2], p=0.006), participation in a patients’ association (3.6 [1.4-8.9], p=0.006), vaccination against pneumococcal done (2.4 [1.3-4.5], p=0.004), exposure to biologics (2.1 [1.2-3.7], p=0.006), a good (3.3 [1.4-8.9], p=0.03) and a very good opinion on vaccination (6.6 [2.8-15.6], p<0.0001) were associated with vaccination against influenza.Conclusion:Vaccination rate against pneumococcal increased over the last 5 years but remained stable for influenza vaccine in French RA patients. This could be improved with patient’s information and education, especially in patients age under 65, biologic naïve and with a bad opinion about vaccination.References:[1] Doran MF, Crowson CS et al. Arthritis Rheum. 2002 Sep;46(9):2287–93.[2]van Assen S, Agmon-Levin N et al. Ann Rheum Dis. 2011 Mar;70(3):414–22.[3] Hua C, Morel J et al. Rheumatol Oxf Engl. 2015 Apr;54(4):748–50.Disclosure of Interests:Claire Rempenault: None declared, Thomas Barnetche: None declared, Marion Magnol: None declared, Benjamin Castagne: None declared, marine pugibet: None declared, Eleonore Berard: None declared, Marie-Elise Truchetet: None declared, Pascale Vergne-Salle: None declared, Anne Tournadre: None declared, Adeline Ruyssen-Witrand Grant/research support from: Abbvie, Pfizer, Consultant of: Abbvie, BMS, Lilly, Mylan, Novartis, Pfizer, Sandoz, Sanofi-Genzyme, Cédric Lukas: None declared

scholarly journals Association between Hidradenitis Suppurativa and Inflammatory Arthritis: A Systematic Review and Meta-Analysis

Dermatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Nouf Almuhanna ◽  
Alexandra Finstad ◽  
Raed Alhusayen
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Ankylosing Spondylitis ◽  
Odds Ratio ◽  
Inflammatory Arthritis ◽  
Hidradenitis Suppurativa ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Increased Risk ◽  
High Prevalence

<b><i>Background:</i></b> Several studies report a high prevalence of inflammatory arthritis among hidradenitis suppurativa (HS) patients. <b><i>Objectives:</i></b> To study the association between HS and inflammatory arthritis. <b><i>Methods:</i></b> The systematic review and meta-analysis were performed according to the PRISMA guidelines to identify the association between HS and inflammatory arthritis, spondyloarthritis, ankylosing spondylitis (AS), and rheumatoid arthritis (RA). <b><i>Results:</i></b> Seven studies were entered in the analysis, with 200,361 HS patients and 385,599 controls. Pooled analysis illustrated a significantly increased risk of inflammatory arthritis in HS patients compared to controls (odds ratio [OR] 3.44; 95% confidence interval [CI] 1.92–6.17). There was also a statistically significant association between HS and spondyloarthritis (OR 2.10; 95% CI 1.40–3.15), and between HS and AS (OR 1.89; 95% CI 1.14–3.12). Moreover, pooled analysis showed a statistically significant association between HS and RA (OR 1.96; 95% CI 1.28–2.98). <b><i>Conclusions:</i></b> Our findings show that HS patients have a 3-fold increased risk of developing inflammatory arthritis. HS patients are specifically at a higher risk for spondyloarthritis, its subtype AS, and RA.

scholarly journals Drug-induced cutaneous vasculitis developing during Etanercept treatment for rheumatoid arthritis

2021 ◽  
Vol 97 (4) ◽  
pp. 113-119
Author(s):  
Maria N. Chamurlieva ◽  
Yulia L. Korsakova ◽  
Stefka G. Radenska-Lopovok ◽  
Tatiana V. Korotaeva
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Tnf Inhibitors ◽  
Cutaneous Vasculitis ◽  
Inflammatory Rheumatic Diseases ◽  
Tnf Inhibitor ◽  
Drug Induced ◽  
Etanercept Treatment ◽  
Increased Risk

Biological disease-modifying anti-rheumatic drugs (bDMARDs) are widely used for the treatment of chronic inflammatory rheumatic diseases. Since the introduction of tumor necrosis factor alpha (TNF-) inhibitors, the treatment of rheumatoid arthritis has been revolutionized. The approach of targeting TNF- has considerably improved the success of the treatment of rheumatoid arthritis. Their effectiveness has been extensively proven in randomized clinical trials and in clinical practice. Randomized clinical trials and post-marketing studies proved that patients undergoing TNF- inhibitors therapy are at increased risk of infectious disease, bacterial, viral, fungal, opportunistic, oncology and skin adverse effects such as psoriasis and angiitis of the skin. In this case report drug-induced cutaneous vasculitis developing during TNF- inhibitor (Etanercept) treatment for rheumatoid arthritis is described.

scholarly journals IMMUNOGENICITY AND SAFETY OF 23-VALENT POLYSACCHARIDE PNEUMOCOCCAL VACCINE IN PATIENTS WITH RHEUMATOID ARTHRITIS: RESULTS OF A TWO-YEAR FOLLOW-UP STUDY

2017 ◽  
Vol 54 (6) ◽  
pp. 674-680 ◽  
Author(s):  
M. S. Naumtseva ◽  
B. S. Belov ◽  
E. N. Aleksandrova ◽  
G. M. Tarasova ◽  
A. A. Novikov ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Enzyme Immunoassay ◽  
Pneumococcal Vaccine ◽  
Control Group ◽  
Inflammatory Rheumatic Diseases ◽  
Low Grade ◽  
Follow Up Study ◽  
Tnf Α ◽  
Polysaccharide Pneumococcal Vaccine

Objective: to investigate the immunogenicity, safety, and clinical efficacy of 23-valent polysaccharide pneumococcal vaccine in patients with rheumatoid arthritis (RA) during a two-year follow-up study.Subjects and methods. The prospective open-label comparative study enrolled 110 people, of them there were 81 (73.6%) women and 29 (26.4%) men at the age of 23 to 76 years, including 79 patients with RA, as well as 31 subjects without systemic inflammatory rheumatic diseases (RD) (a control group). The group of RA patients exhibited a predominance of middle-aged women who had > 3 years’ disease duration and a moderate inflammatory activity (the mean value of DAS28, 4.32). 52 patients received methotrexate (MTX), 14 had Leflunomide (LEF), and 13 were treated with tumor necrosis factor-α (TNF-α) inhibitors + MTX.The 23-valent polysaccharide pneumococcal vaccine Pneumo-23 (Sanofi Pasteur, France) was administered in a single dose of 0.5 ml subcutaneously during continuous MTX or LEF therapy for the underlying disease or 3–4 weeks before the use of TNF-α inhibitors. Clinical examinations of the patient and conventional clinical and laboratory studies were performed during control visits (1, 3, 12, and 24 months after vaccination). Clinical effectiveness and safety were evaluated in all the patients included in the study. The serum levels of anti-pneumococcal capsular polysaccharide antibodies (Ab) were measured in 72 patients with RA and in 30 individuals in the control group during a 12-month follow-up study, including in 25 patients with RA for a 24-month follow-up study by enzyme immunoassay using commercial VaccZymeTM Anti-PCP IgG Enzyme Immunoassay kits (The Binding Site Group Ltd, Birmingham, United Kingdom). Along with this, the post-immunization response coefficient was calculated for each patient as the ratio of postvaccination Ab levels during Visits 2, 3, 4, and 5 to the baseline Ab level.Results and discussion. No clinical and radiological symptoms of pneumonia were recorded in any case during the follow-up period. The patients with RA and the control group showed a more than double significant increase of anti-pneumococcal Ab level during 3 months following vaccination. Despite the decrease in their concentration by month 12, the latter remained at the appropriate level and significantly increased at 24-month follow-up. Vaccination was well tolerated. A favorable course of the postvaccinal period was noted in all cases. There were no adverse reactions to vaccination in 72 (65%) patients; 38 (35%) patients were noted to have pain, skin swelling and hyperemia up to 2 cm in diameter at the site of injection, as well as low-grade fever. There were no episodes of a RD exacerbation or any new autoimmune disorders during the follow-up period.Conclusion. The findings were suggestive of the sufficient immunogenicity and good tolerability of 23-valent pneumococcal vaccine in patients with RD during the two-year follow-up period.

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