Reasons for failure to receive pneumococcal and influenza vaccinations among immunosuppressed patients with systemic lupus erythematosus
Section snippets
Background
Vaccine-preventable diseases remain common causes of morbidity and mortality in the United States. Nevertheless, in 2011–2012, only 50% of children and 40% of adults received an influenza vaccine [1]. Therefore, improving vaccination rates in the general population has become a national health care priority, targeted by initiatives such as Healthy People 2020 and performance measurement programs such as the Physician Quality Reporting System and Meaningful Use.
As estimated five-year survival in
Data source
The study cohort consisted of 814 individuals participating in the 2009 Lupus Outcomes Study (LOS) survey, an ongoing longitudinal study of persons with SLE from the United States. Details regarding eligibility and enrollment of participants have been described elsewhere [9]. Briefly, respondents were recruited from an existing cohort, the UCSF Lupus Genetics Project [10], developed from a combination of academic rheumatology clinics, community rheumatologists, and various non-clinical sources
Study sample
Respondents were included in the analyses if they had taken any immunosuppressive medications in the past year (N = 508) and were therefore qualified for receipt of both influenza and pneumococcal vaccinations. We excluded those who failed to report whether they had received influenza and pneumococcal vaccines. Survey questions used to assess vaccination status and vaccine recommendation are displayed in Figure 2. Reasons for not receiving a vaccination were assessed among all individuals who
Demographics and immunosuppression
The study included 485 respondents with SLE who had taken immunosuppressive medications in the past year. The mean age was 50 years, 93% were female, 60% were Caucasian, and the mean disease duration was 18 years (Table 1). Oral or IV steroids had been taken by 88% of respondents in the past year (86% receiving oral steroids and 14% receiving IV steroids). Median current oral prednisone dose was 5 mg (range: 0.5–100 mg). Only 2% had received IV steroids without any oral steroids. DMARDs had been
Conclusion
Among immunosuppressed individuals with SLE who did not receive recommended influenza and pneumococcal vaccines, the most common reason was lack of health care provider recommendation. While some patients cited concerns about vaccine efficacy and safety, or lacked time to obtain vaccination, these were far less common causes. Difficulty accessing vaccines was also not a common obstacle. Previous work done by our group assessing vaccine receipt in the LOS as compared to the general population
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Influenza Vaccination in Systemic Lupus Erythematosus: Efficacy, Effectiveness, Safety, Utilization, and Barriers
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2020, Rheumatic Disease Clinics of North AmericaCitation Excerpt :Having a primary care provider increases the likelihood of getting preventive services, including measures related to bone health34 and vaccinations against influenza and pneumococcal infections.40 Younger women, nonwhite patients, and those with shorter disease duration get these recommendations less often.35,41 Study of reproductive health measures, another important issue in SLE, has shown that rates of contraceptive counseling are low: 30% to 60% across studies (see Table 2).
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Financial support for E.F.L. was received from Arthritis Foundation, USA, PDF 6111 and NICHD, USA, T32-HD044331; for L.T., from NIAMS, USA, P60-AR053308; for E.H.Y., from NIAMS, USA, P60-AR053308; and for J.Y., from NIAMS, USA, K23 AR060259.