Low Influenza, Pneumococcal and Diphtheria-Tetanus-Poliomyelitis Vaccine Coverage in Patients with Primary Sjögren's Syndrome: A Cross-Sectional Study.

Morel Jacques,Combe Bernard,Cédric Lukas,Mariette Xavier,Guilpain Philippe,Hind Letaief

doi:10.3390/vaccines8010003

Abstract

Objective: To evaluate vaccination coverage and reasons for non-vaccination in patients with primary Sjögren’s syndrome (pSS). Method: A total of 111 patients fulfilling American–European Consensus Group criteria for pSS were interviewed by use of a standardized questionnaire between January 2016 and November 2017 in two French tertiary referral centers for auto-immune diseases. Results: Updated immunization coverage for influenza was 31.5% (n = 35), pneumococcus was 11.7% (n = 13), and diphtheria–tetanus–poliomyelitis (DTP) was 24.3% (n = 27). The main reasons for non-vaccination were fear of side effects from the influenza vaccine (40.3%) and a lack of proposal for the pneumococcal vaccine (72.3%). In vaccinated patients, vaccination was mainly proposed by general practitioners for the influenza vaccine (42.6%) and rheumatologists for the pneumococcal vaccine (41.2%). Probability of influenza vaccination was associated with age (odds ratio/year (OR) 1.04, 95% confidence interval (CI) 1.0–1.1; p = 0.016), history of severe infection (OR 15.9, 95% CI 1.35–186; p = 0.028), low EULAR Sjögren’s syndrome disease activity index (OR 0.85, 95% CI 0.75–0.96; p = 0.013), and comorbidities (OR 3.52, 95% CI 1.22–10.2; p = 0.02). Probability of vaccination against pneumococcus was associated with lung comorbidities (OR 3.83, 95% CI 1.11–13.12; p = 0.033) and up-to-date influenza vaccination (OR 3.71, 95% CI 1.08–12.8; p = 0.038). Conclusion: Influenza, pneumococcal, and DTP vaccine coverage was low in patients with pSS included in this study. These results underline the relevance of systematically screening vaccine status in pSS patients and educating patients and physicians on the need for vaccination to improve vaccine coverage in this population.

Highlights

Sjögren’s syndrome is an autoimmune disease present in approximately one third of patients characterized by lymphoid infiltration of the exocrine glands, especially the salivary and lacrimal glands which are responsible for mouth and eye dryness, and by potential systemic disease manifestations [1]
We evaluated vaccination coverage for influenza, pneumococcus, and DTP in patients with primary Sjögren’s syndrome (pSS) and investigated the reasons for non-vaccination
In pSS patients, vaccination coverage rates were closer to the rates observed in the general population than those reported in other rheumatic diseases, especially for the pneumococcal vaccine

Summary

Introduction

Sjögren’s syndrome (pSS) is an autoimmune disease present in approximately one third of patients characterized by lymphoid infiltration of the exocrine glands, especially the salivary and lacrimal glands which are responsible for mouth and eye dryness, and by potential systemic disease manifestations [1].Even today, pSS management is based mainly on the symptomatic treatment of different mucosal disorders. Infections have been described as one of the major causes of death in pSS [2,3,4] This susceptibility to infections in autoimmune diseases, including pSS, is due to intrinsic causes related to the disease and to immunosuppressive treatments. This inherent risk of infections in autoimmune disease could be related to an intrinsic immune deficiency, which could be explained by the immunosenescence or premature aging of the immune system [5] and leukopenia, both of which are common in pSS [2,6]

Methods

Results

Discussion

Conclusion