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

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.

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Improving pneumococcal vaccination rates in pediatric acute lymphoblastic leukemia/lymphoblastic lymphoma.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18666 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18666-e18666

Author(s):

Simone Chang ◽

Alexandra Cheerva ◽

Michael Angelo Huang ◽

Kerry McGowan ◽

Esther E Knapp ◽

...

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Hematologic Malignancy ◽

Lymphoblastic Leukemia ◽

Pneumococcal Vaccination ◽

Vaccination Rate ◽

Lymphoblastic Lymphoma ◽

Pediatric Acute Lymphoblastic Leukemia ◽

Vaccination Rates ◽

Targeted Interventions ◽

Pediatric All

e18666 Background: Pediatric Acute Lymphoblastic Leukemia/ Lymphoblastic Lymphoma (ALL/LLy) is the most common pediatric cancer. Invasive pneumococcal disease (IPD) is prevalent in this population and the Centers for Disease Control and Prevention recommends pneumococcal vaccination to decrease morbidity and mortality. Despite these recommendations, vaccination rates remain low and the incidence of IPD among children with hematologic malignancy is significantly higher compared to the average pediatric population. An interventional study was designed to improve the vaccination rate and reduce the incidence of IPD in our institution. Methods: A plan-do-study-act (PDSA) model of quality improvement (QI) was used. Chart review at our institute was done for the 6-month period of January 2020 - June 2020 and baseline rates for pneumococcal polysaccharide (PPSV23) vaccination were calculated. Patients were included if they were ≥ 2 years old, diagnosed with ALL/LLy, and undergoing maintenance. A multidisciplinary team performed the root cause analysis. Immunization records were obtained and reviewed and targeted interventions were implemented. The interventions used are outlined in Table. The percentage of pediatric ALL/LLy patients per month in maintenance who received age-appropriate pneumococcal vaccinations was monitored before and after the interventions. Results: Analysis of the 6-month retrospective cohort (n=36) showed a baseline vaccination rate of 5.5%. During the subsequent 6-month phase with interventions, 40 patients were prospectively enrolled. Demographics showed a mean age of 10.2 years (range, 2-21) and a predominantly male (66.7%) cohort. B-cell ALL/LLy comprised the majority (78.9%); the rest included T-cell ALL/LLy and mixed phenotype acute leukemia. As seen in Table, the percentage receiving at least 1 pneumococcal vaccine increased from 5.5% to 84.8% over the first 3 months, this plateaued around 81%. Completion of the series mirrored this and increased to 74.2%. Pre-visit planning and cues proved to be the most helpful interventions. Conclusions: Use of a PDSA model successfully improved pneumococcal vaccination rates in the pediatric ALL/LLy population. We suggest these results can be achieved with planning and implementation of the outlined interventions. [Table: see text]

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Comparison between cohorts vaccinated and unvaccinated against influenza and pneumococcal infection

Epidemiology and Infection ◽

10.1017/s095026880200780x ◽

2002 ◽

Vol 129 (3) ◽

pp. 515-524 ◽

Cited By ~ 35

Author(s):

B. CHRISTENSON ◽

P. LUNDBERGH

Keyword(s):

Influenza Vaccination ◽

Chronic Diseases ◽

Demographic Data ◽

Pneumococcal Infection ◽

Pneumococcal Vaccination ◽

Vaccination Rate ◽

Elderly Persons ◽

Vaccination Rates ◽

Myocardial Disease ◽

Chronic Lung Diseases

This study characterizes possible confounders that might make cohorts vaccinated and unvaccinated against influenza and pneumococcal infection different at baseline, with the hypothesis that the two cohorts are comparable. The similarity between health and demographic data was analysed by a randomized, multivariant study addressed to 10 000 persons aged 65 years and older in Stockholm County and was carried out in the form of a postal inquiry during the period December 2000 to May 2001. The study-population response rate was 78%. Of these, 66% (5120 persons) had been given at least one influenza vaccination during the 3-year study period (1998–2000), 50% (3780) had received one pneumococcal vaccination and 78% had received both vaccines during the period. The vaccination rate was lower in the age group 65–69 years (60%), compared with elderly cohorts aged over 70 years (67–72%, P<0·001). Elderly persons living in nursing homes or institutions had higher vaccination rates than persons living in their own households (72 vs. 67%). Persons with underlying chronic diseases had higher vaccination rates (71%, P<0·001) than those without underlying chronic diseases. Vaccine recipients had fewer days in hospital, compared with non-recipients. Unvaccinated persons with myocardial disease had nine times more days in hospital than vaccinated persons with myocardial disease. Vaccination against pneumococcal infection had an additional effect with influenza vaccination in reducing hospitalization for chronic lung diseases; influenza vaccination alone did not have this effect. In conclusion, the influenza and pneumococcal-vaccine recipients were older and had significantly more chronic lung and heart conditions than the unvaccinated cohort.

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Counties with Lower Insurance Coverage and Housing Problems Are Associated with Both Slower Vaccine Rollout and Higher COVID-19 Incidence

Vaccines ◽

10.3390/vaccines9090973 ◽

2021 ◽

Vol 9 (9) ◽

pp. 973

Author(s):

Gregory Donadio ◽

Mayank Choudhary ◽

Emily Lindemer ◽

Colin Pawlowski ◽

Venky Soundararajan

Keyword(s):

Socioeconomic Factors ◽

Insurance Coverage ◽

Vaccination Rate ◽

Incidence Rates ◽

P Value ◽

Strongly Correlated ◽

Marginalized Communities ◽

Vaccination Rates ◽

Using Data ◽

The Impact

Equitable vaccination distribution is a priority for outcompeting the transmission of COVID-19. Here, the impact of demographic, socioeconomic, and environmental factors on county-level vaccination rates and COVID-19 incidence changes is assessed. In particular, using data from 3142 US counties with over 328 million individuals, correlations were computed between cumulative vaccination rate and change in COVID-19 incidence from 1 December 2020 to 6 June 2021, with 44 different demographic, environmental, and socioeconomic factors. This correlation analysis was also performed using multivariate linear regression to adjust for age as a potential confounding variable. These correlation analyses demonstrated that counties with high levels of uninsured individuals have significantly lower COVID-19 vaccination rates (Spearman correlation: −0.460, p-value: <0.001). In addition, severe housing problems and high housing costs were strongly correlated with increased COVID-19 incidence (Spearman correlations: 0.335, 0.314, p-values: <0.001, <0.001). This study shows that socioeconomic factors are strongly correlated to both COVID-19 vaccination rates and incidence rates, underscoring the need to improve COVID-19 vaccination campaigns in marginalized communities.

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Pneumococcal vaccination in general practice

Orvosi Hetilap ◽

10.1556/oh.2015.30054 ◽

2015 ◽

Vol 156 (5) ◽

pp. 186-191

Author(s):

Péter Vajer ◽

Ferenc Tamás ◽

Róbert Urbán ◽

Péter Torzsa ◽

László Kalabay

Keyword(s):

General Practitioners ◽

Pneumococcal Disease ◽

Pneumococcal Vaccination ◽

Daily Practice ◽

Developed Countries ◽

Vaccination Rate ◽

Prescription Rate ◽

Routine Method ◽

Vaccination Rates ◽

The Mean

Introduction: The prevalence of invasive pneumococcal disease, which is depending on risk factors and comorbidities, is increasing over the age of 50 years. Most developed countries have recommendations but vaccination rates remain low. Aim: To assess the general practitioners’ daily practice in relation to pneumococcal vaccination and analyse the effect of informing the subjects about the importance of pneumococcal vaccination on vaccination routine. Method: Subjects over 50 years of age vaccinated against influenza during the 2012/2013 campaign were informed about the importance of pneumococcal vaccination and asked to fill in a questionnaire. Results: Of the 4000 subjects, 576 asked for a prescription of pneumococcal vaccine (16.5% of females and 11.6% of males, OR 1.67 CI 95% 1.37–2.04, p<0.001) and 310 were vaccinated. The mean age of females and males was 70.95 and 69.8 years, respectively (OR 1.01; CI 95% 1.00–1.02; p<0.05). Information given by physicians resulted in 33,6% prescription rate, while in case it was 8% when nurses provided information (OR 6.33; CI 95% 5.23–7.67; p<0.001). As an effect of this study the vaccination rate was 6.3 times higher than in the previous year campaign (p<0.001). Conclusions: General practitioners are more effective in informing subjects about the importance of vaccination than nurses. Campaign can raise the vaccination rate significantly. Orv. Hetil., 2015, 156(5), 186–191.

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

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2723 ◽

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

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Increasing Pneumococcal Vaccination Rates Among Residents of Long-Term–Care Facilities: Provider-Based Improvement Strategies Implemented by Peer-Review Organizations in Four Western States

Infection Control and Hospital Epidemiology ◽

10.1086/501723 ◽

2000 ◽

Vol 21 (11) ◽

pp. 705-710 ◽

Cited By ~ 22

Author(s):

Kurt B. Stevenson ◽

John W. McMahon ◽

Jan Harris ◽

J. Richard Hillman ◽

Steven D. Helgerson

Keyword(s):

Long Term Care ◽

Pneumococcal Vaccination ◽

Vaccination Rate ◽

Term Care ◽

Improvement Project ◽

Vaccination Rates ◽

Standing Order ◽

Care Facilities ◽

Collaborative Efforts

AbstractObjective:To evaluate collaborative efforts and intervention strategies by peer-review organizations (PROs) and long-term-care facilities (LTCFs) for improving pneumococcal vaccination rates among residents of LTCFs.Design:Prospective, before-after quality improvement project.Setting:133 LTCFs in Alaska, Idaho, Montana, and Wyoming.Patients:All residents of participating LTCFs.Methods:Baseline pneumococcal vaccination rates were determined by medical-record review, self-reporting by patient or family members, and review of Medicare claims information. Remeasurement of vaccination rates was accomplished from documentation of vaccination of eligible residents by each LTCF.Results:133 LTCFs with 7,623 residents from Alaska, Idaho, Montana, and Wyoming participated in this quality-improvement project. This accounted for 41% (133/321) of the potential nursing homes and resident population in the participating states. Baseline overall vaccination rates were 40% (3,050/7,589). The overall vaccination rate improved to 75% (5,720/7,623, P<.001). The number of facilities meeting the Healthy People 2000 vaccination goal of 80% improved from 18% (24/133) to 62% (83/133, P<.001). Initial use of chart stickers and implementation of standing orders led to similar increases in vaccination rates, but the standing-order strategy required commitment of fewer PRO resources at a statewide level. Remeasurement of vaccination rates in a subset of participating Idaho LTCFs 1 year after initial vaccination efforts demonstrated a sustained vaccination rate of 70% in facilities enforcing a standing-order policy.Conclusions:Simple and straightforward vaccination strategies implemented in LTCFs over a short period of time can have a significant impact on vaccination rates. Collaborative efforts between state PROs and LTCFs enhance implementation of these strategies and can result in the achievement of national vaccination objectives. Standing orders appear to be one intervention effective in sustaining successful vaccination efforts. Regardless of the specific interventions employed, PROs played a significant role in facilitating vaccination program development and intervention implementation.

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

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4109 ◽

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

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Overcoming Barriers to Establishing an Inpatient Vaccination Program for Pneumococcus Using Standing Orders

Infection Control and Hospital Epidemiology ◽

10.1086/502511 ◽

2005 ◽

Vol 26 (11) ◽

pp. 874-881 ◽

Cited By ~ 17

Author(s):

Donald B. Middleton ◽

Dwight E. Fox ◽

Mary Patricia Nowalk ◽

Susan J. Skledar ◽

Denise R. Sokos ◽

...

Keyword(s):

Medical Center ◽

Tertiary Care ◽

Pneumococcal Vaccination ◽

Vaccination Rate ◽

Vaccination Program ◽

Successful Implementation ◽

Close Monitoring ◽

University Of Pittsburgh ◽

Vaccination Rates ◽

The University

AbstractObjectives:To identify and classify barriers to establishing a standing orders program (SOP) for adult pneumococcal vaccination in acute care inpatient facilities and to provide recommendations for overcoming these roadblocks. Vaccination rates in hospitals with SOPs are generally higher than those in hospitals that require individual physician orders. The array of solutions drawn from our experience in different hospital settings should permit many types of facilities to anticipate and overcome barriers, allowing a smoother transition from initiation to successful implementation of an inpatient pneumococcal vaccination SOP.Design:Descriptive study of barriers and solutions encountered during implementation of a pneumococcal vaccination SOP in three hospitals of the University of Pittsburgh Medical Center Health System (UPMC) and in the scientific literature.Setting:As of 2004, two UPMC tertiary-care hospitals and one UPMC community hospital had incorporated SOPs into existing physician order-driven programs for inpatient vaccination with pneumococcal polysaccharide vaccine.Results:Barriers were identified at each step of implementation and categorized as patient related, provider related, or institutional. Based on a process of continual review and revision of our programs in response to encountered barriers, steps were taken to overcome these impediments.Conclusions:A strong commitment by key individuals in the facility's administration including a physician champion; ongoing, persistent efforts to educate and train staff; and close monitoring of the vaccination rate were essential for successful implementation of a SOP for pneumococcal vaccination of eligible inpatients. Legal statutes and evaluations of external hospital-rating associations regarding the effectiveness of the vaccination program were major motivating factors in its success.

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Flu and Pneumococcal Vaccine Coverage in Scleroderma Patients Still Need to Be Prompted: A Systematic Review

Vaccines ◽

10.3390/vaccines9111330 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1330

Author(s):

Francesca Rosamilia ◽

Giovanni Noberasco ◽

Dario Olobardi ◽

Andrea Orsi ◽

Giancarlo Icardi ◽

...

Keyword(s):

Systematic Review ◽

Vaccine Coverage ◽

Pneumococcal Vaccination ◽

Vaccination Rate ◽

Vaccination Rates ◽

Increased Risk ◽

Flu Vaccine ◽

Vaccination Campaigns ◽

Low Coverage ◽

Current Guidelines

Systemic sclerosis (scleroderma, SSc) is an autoimmune connective tissue disease characterized by excessive production of collagen and multiorgan involvement. Scleroderma patients are at increased risk of influenza complications and pneumonia; thus, vaccinations are recommended. This systematic review evaluated the influenza and pneumococcus vaccination coverage for SSc patients. We included all studies from Pubmed reporting on influenza and pneumococcal vaccination rate in Scleroderma patients up to May 2021. The 14 studies thus selected identified a suboptimal vaccination rate in autoimmune and SSc patients, ranging from 28 to 59% for the flu vaccine, and from 11 to 58% for the pneumo vaccine in absence of specific vaccination campaigns, variously considering also other variables such as age, gender, vaccination settings, and possible vaccination campaigns. We also considered the reasons for low coverage and the approaches that might increase the vaccination rates. A lack of knowledge about the importance of vaccination in these patients and their doctors underlined the need to increase the awareness for vaccination in this patients’ category. Current guidelines recommend vaccination in elderly people and people affected by particular conditions that widely overlap with SSc, yet autoimmune diseases are not always clearly mentioned. Improving this suboptimal vaccination rate with clear guidelines is crucial for SSc patients and for clinicians to immunize these categories based principally on the pathology, prior to the age. Recommendations by the immunologist and the direct link to the vaccine providers can highly improve the vaccine coverage.

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Improving the Combination Pneumococcal Vaccination Rate in Systemic Lupus Erythematosus Patients at an Adult Rheumatology Practice

The Journal of Rheumatology ◽

10.3899/jrheum.171377 ◽

2018 ◽

Vol 45 (12) ◽

pp. 1656-1662 ◽

Cited By ~ 2

Author(s):

Shivani Garg ◽

Katina Tsagaris ◽

Raluca Cozmuta ◽

Aliza Lipson

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Pneumococcal Infection ◽

Pneumococcal Vaccination ◽

Vaccination Rate ◽

Practice Change ◽

Systemic Lupus ◽

Team Members ◽

Vaccination Rates ◽

Rheumatology Practice

Objective.The risk of developing invasive pneumococcal infection is 13 times higher in patients with systemic lupus erythematosus (SLE) in comparison with the general population. The US Centers for Disease Control and Prevention anticipates a US$7.6 million medical cost reduction by providing pneumococcal vaccination. The objective of this study was to improve the rate of combination pneumococcal vaccination (pneumococcal polysaccharide vaccine 23 + pneumococcal conjugate vaccine 13) in patients with SLE in our adult academic rheumatology practice.Methods.With the use of physician- and staff-based surveys, we analyzed the underlying barriers in providing vaccination. We then planned a multifaceted intervention including pre-visit planning, day-of-visit planning, weekly review, and monthly feedback.Results.Our project is one of the few studies planned to improve combination pneumococcal vaccination rates in adult patients with SLE and we report an impressive improvement from 10% baseline rate to 59% vaccination rate by the end of the study period. This highlights the role of planning an intervention with an integrated workflow and the importance of sharing performance data, which leads to high compliance among team members.Conclusion.The significant improvement in combination vaccination rate in eligible patients with SLE and the additional rise of vaccine rates seen in other eligible patients in the practice draws attention to the high adaptiveness of the intervention resulting in a true practice change. Our quality project design can serve as a model that can be adapted by other specialty clinics to achieve higher vaccination standards.

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