Vaccination Rates In Patients Research Articles

SOCIALLY VULNERABLE PATIENTS WITH INFLAMMATORY BOWEL DISEASE ARE AT INCREASED RISK FOR VACCINE PREVENTABLE ILLNESS

Abstract INTRODUCTION Inflammatory bowel disease (IBD) affects patients across diverse ethnic, minority, cultural, and socioeconomic backgrounds; however, the relationship between these social determinants of health (SDOH) and IBD outcomes is not well-studied. SDOH have a known impact on disparities in vaccination, but these effects may be more salient in the IBD population where patients are at greater risk for vaccine-preventable illness from immunosuppressive therapies. The social vulnerability index (SVI) is a tool provided by Centers for Disease Control that can identify individuals at risk for health care disparities by estimating neighborhood-level social need on a 0-1 scale (higher scores indicating greater social vulnerability). Utilizing census tract-level SVI data, we aimed to identify the relationship between the SDOH and vaccination rates in patients with IBD. METHODS We used a retrospective cohort design of patients seen at a single IBD center between 01/01/2015 and 08/31/2022. Using the current address listed in the electronic medical record, we geocoded patients to individual census tracts and linked them to corresponding SVI and subscales (Figure 1). Controlling a priori for age, gender, race, ethnicity, marital status, English proficiency, electoral district, and religious affiliation, we used multivariable linear regression to examine the relationship between SVI and vaccination against influenza, Covid-19, pneumococcal pneumonia (conjugate and polysaccharide), and Zoster. RESULTS 15,245 patients with IBD were included and the percent of unvaccinated individuals was high across all vaccine types: flu (42.8%), Covid-19 (50.9%), pneumonia (62.4%), and Zoster (89.6%). High total levels of social vulnerability were associated with lower vaccination rates across all vaccine groups: flu (B -1.3, 95% CI -1.5, -1.2, p<0.001), Covid-19 (B -0.99, 95% CI -1.1, -0.88), p<0.001), pneumonia (B -0.21, 95% CI -0.27, -0.14, p<0.001), Zoster (B -0.23, 95% CI -0.27, -0.19, p<0.001). On SVI sub-scales, high scores in Socioeconomic Status, Household Composition, and Housing/Transportation were important predictors of vaccine uptake while Minority Status/Language was non-significant (Table 1). CONCLUSION Living in a socially vulnerable community is associated with lower vaccination rates across all vaccine types. Higher scores on neighborhood level Socioeconomic Status, Household Composition, and Housing/Transportation were also associated with lower vaccine uptake. Many factors may affect why socially vulnerable patients are under-vaccinated, including a lack of patient and provider knowledge of routine vaccines, lack of access to care, and poor trust in vaccines and healthcare system. Further research is needed improve IBD health maintenance in gastroenterology clinics and ensure equitable distribution of vaccines to socially vulnerable patients.

Strategy to increase vaccination coverage in diabetic patients at a public tertiary university hospital: A randomized controlled trial.

To evaluate whether there is an increase in vaccination rates of patients with diabetes mellitus who received guidance to update their vaccination schedules for influenza, hepatitis B, pneumonia, and tetanus. A randomized controlled trial was conducted between December 2018 and November 2020. The sample consisted of 139 patients from the endocrinology service outpatient clinic of Santa Maria University Hospital was randomized into an intervention group (n = 68) and a control group (n = 71). The intervention consisted of a phone call to update the vaccination schedule for the diseases evaluated. The mean age of the subjects was 59.17 ± 12.91 years and 62.6% were female. No age differences were observed between genders and randomization groups (p = 0.548, p = 0.791) and groups were homogeneous (p = 0.173, p = 0.443). The intervention group showed a significant increase in vaccination rates after the intervention. For influenza, 79.4-89.7% (p = 0.016); hepatitis B, 29.4-48.5% (p = 0.002); tetanus, 51.5-72.1% (p = 0.007); and pneumonia, 22.1-29.4% (p = 0.049). No significant increase was observed in control group. The orientation to update the vaccination schedule through telephone contact was effective in increasing vaccination rates for influenza, hepatitis B, pneumonia, and tetanus. RBR-92z99d2 https://ensaiosclinicos.gov.br/rg/RBR-92z99d2.

Abstract 10416: Influenza Vaccine Among Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Introduction: Trials evaluating the efficacy of influenza vaccine in secondary prevention among patients with prior coronary artery disease (CAD) have yielded mixed results. We sought to evaluate the efficacy of influenza vaccine in reducing cardiovascular events among patients with prior CAD. Methods: MEDLINE, EMBASE, and Cochrane databases were searched without restrictions through March 2022 for Randomized Controlled Trials (RCTs) that evaluated the outcomes of influenza vaccine versus control in patients with prior CAD. We conducted a pairwise meta-analysis comparing outcomes among the influenza vaccine. The primary outcome was all-cause mortality. Results: The final analysis included 5 trials with a total of 4,187 patients and the weighted median follow-up duration was 12 months. The influenza vaccine group was associated with 46% relative risk [RR] reduction in all-cause mortality compared with control group. (2.8% vs. 5.1%; RR 0.56; 95% confidence interval [CI] 0.41-0.76; I 2 =0%). The influenza vaccine group was also associated with lower composite of MACE (6.3% vs. 9.9%; RR 0.63; 95% CI 0.52-0.78), and cardiovascular mortality (2.5% vs. 4.7%; RR 0.54; 95% CI 0.39-0.74). There was no significant difference among both groups in acute myocardial infarction (MI) (RR 0.77; 95% CI 0.53-1.13), ischemia—driven revascularization (RR 0.89; 95% CI 0.52-1.53) and hospitalization for heart failure (RR 0.91; 95% CI 0.91 0.21-4.00). Conclusion: a meta-analysis of RCTs showed that influenza vaccine was associated with lower major adverse cardiac events (MACE), all-cause mortality, and cardiovascular mortality in patients with prior CAD. Further efforts are warranted to improve influenza vaccination rate in patients with CAD.

COVID-19 vaccination coverage among patients with psychiatric disorders in China during the pandemic: a cross-sectional study

Background:To investigate the Coronavirus Disease 2019 (COVID-19) vaccination coverage and the influential factors of vaccination among patients with mental disorders, we conducted a cross-sectional study in China.Method:The anonymous questionnaires including demographic data, vaccination status, intention to be vaccinated and its reasons were collected in the Second Xiangya Hospital, one of the biggest four psychiatric centers in China. Mental health of these participants were measured by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder-7 items (GAD-7). The influential factors associated with vaccination status were analyzed by Fisher exact tests and binary logistical analysis.Result:1328 patients and 922 family members completed the survey. The vaccination rate of patients included was 69.4%, whereas 85.5% patients were willing to be vaccinated. Being hospitalized (aOR 0.41, 95% CI:0.27–0.60), suffering from schizophrenia (aOR 0.38, 95% CI: 0.19–0.75) and secondary school educational background (aOR 0.58, 95% CI: 0.37–0.93) were significantly associated with less likelihood to get vaccinated. Uptaking vaccines could reduce depressive (aOR 0.63, 95% CI: 0.41–0.98) or anxious symptoms (aOR 0.40, 95% CI: 0.25–0.63) in these patients for a short period.Conclusion:Further COVID-19 immunization programme should prioritize hospitalized psychiatric patients and schizophrenic patients since their demands for vaccination had been partly ignored during the current inoculation.

Vaccination considerations for patients receiving cancer therapy.

Vaccination rates in patients with cancer remain low, yet these individuals are at increased risk of severe outcomes from vaccine-preventable illnesses.[1][1] Primary care providers are often uncertain about the safety of vaccines in this population and vaccine recommendations for these patients.[2

A SHORT SURVEY ABOUT AWARENESS OF INFLUENZA VACCINATION AMONG PATIENTS WITH HEART FAILURE IN A TERTIARY CARE HOSPITAL OF PAKISTAN

Objectives: The objective of this survey was to highlight whether influenza vaccination was advised or not in patients with heart failure. Whether heart failure patients are aware of its significance or not, and more importantly they are getting vaccinated or not. Methodology: This descriptive short survey was conducted at heart failure clinic of a tertiary care cardiac center. Consecutive patients of heart failure with reduced ejection fraction (HFrEF) were interviewed regarding awareness and significance of influenza vaccination. Survey was conducted using a structured questionnaire with specific sections pertinent to the demographic details of the participants, clinical history of heart failure and hospitalizations, co-morbid conditions, and awareness and adherence to the influenza vaccination. Results: A total of 60 patients with HFrEF participated in this survey, 71.7% (43) of which were male, overall mean age was 56.82 ± 11.78 years, and mean duration since diagnosis of HFrEF was 3.88 ± 3.66 years. Only 15% (9) of the participants were aware of influenza vaccination, 18.3% (11) recall being advised by the medical officer, and 11.7% (7) received these vaccinations. Conclusion: Influenza vaccination rate in patients with heart failure in Pakistan population is very low. The primary reason is inadequate prescription practice by physicians and lack of adequate awareness. Need of time is to emphasis health care provider to prescribe and encourage their patients with heart failure to receive influenza vaccine and to make it accessible.

Influence of cantonal health policy frameworks & activities on the influenza vaccination rate in patients with non-communicable diseases in Switzerland

Background and objectiveSeasonal influenza may cause serious illness, especially in high-risk populations such as older adults and individuals suffering from non-communicable diseases (NCD) and may be prevented by a vaccination. However, an assessment of the impact of the Swiss legal frameworks and number of health activities on influenza vaccination coverage of the population at the cantonal level is lacking. MethodsTwo participating healthcare insurers sent out 25,000 semi-structured questionnaires to their subscribers aged 60–85 in five Swiss cantons selected according to the number of health activities and legal framework regarding influenza vaccination and linguistic region. Influenza vaccination coverage of the participants was evaluated and stratified by disease status, age, canton, and linguistic region. Results were compared by cantonal activities, legal framework, and linguistic region. Results7,617 valid questionnaires were evaluated from the cantons Aargau, Jura, St. Gallen, Schwyz, and Vaud. 47.9 % stated to have an NCD, with the most frequent being muscle/ skeletal disease (36.7%). Before 2018, 48.6% were vaccinated against influenza, and 35.9% in 2019, with the highest in canton Vaud. In all cantons and in both survey periods, NCD patients and those aged 73–85 had a higher vaccination coverage than participants without NCD, and aged 60–72. There was no difference in the odds of getting an influenza shot based on legal framework. Although a comparison of the number of activities between the German-speaking cantons did not reveal any significant differences, the odds of the participants living in a French-speaking canton getting an influenza vaccination was more likely than those living in a German-speaking canton. ConclusionThere was no association between the investigated cantonal frameworks and number of health activities and influenza vaccination coverage in NCD patients in the selected cantons. However, age, disease status and linguistic region appear to have an influence on vaccination uptake.

Low Pneumococcal Vaccination among Patients with Psoriasis in Germany: Results from Vac-Pso.

While suboptimal pneumococcal vaccination rates have been reported in immunosuppressed patients with rheumatic diseases, data for patients with psoriasis (PsO) or atopic dermatitis (AD) are scarce. Pneumococcal vaccination in Germany is recommended in patients with certain comorbidities, immunosuppression, and/or aged 60 years or above. The aim of this multicenter cross-sectional study was to investigate the pneumococcal vaccination rate in patients with PsO compared to patients with AD and to evaluate patient perceptions. All patients completed a questionnaire on vaccination status and perceptions, patient and disease characteristics, as well as comorbidity. Medical records and vaccination certificates were reviewed. Over the whole cohort (n = 327 PsO (41.9% female), n = 98 AD (42.9% female)), 83.8% and 42.9% of PsO and AD patients, respectively, had an indication for pneumococcal vaccination due to immunosuppressive treatment. The pneumococcal vaccination rate was 14.4% and 10.2% in PsO and AD patients, respectively. The vaccination rate depended significantly on age, working status and presence of psoriatic arthritis. The most common reason for nonvaccination was lacking recommendation by physicians. Higher awareness, particularly for vaccination indication due to immunosuppression among dermatologists, general physicians, and patients, is warranted.

Status of vaccination and related influencing factors in patients with chronic obstructive pulmonary disease: a real-world cross-sectional study

Objective: To investigate the influenza and pneumonia vaccination rates in patients with chronic obstructive pulmonary disease (COPD), and analyze the factors affecting vaccination. Methods: Totally 4 016 COPD patients at the initial visit were included in the Respiratory Department of Xiangya Second Hospital of Central South University from December, 2016 to December, 2019. Each patient's vaccination status after the visit for 1 year was reviewed, and finally 3 177 patients were included in the analysis. Relevant factors affecting vaccination were analyzed with logistic regression. Results: The overall vaccination rates of COPD patients with influenza vaccine, pneumonia vaccine and influenza combined pneumonia vaccine were 2.3% (72/3 177), 1.1% (34/3 177) and 1.1% (34/3 177), respectively. The influenza vaccination rate of urban patients (3.3%, 41/1 252) was higher than that of rural patients (1.6%, 31/1 925,P=0.002). The rates of influenza vaccine, pneumonia vaccine and influenza combined pneumonia vaccine in ex-smokers with COPD were 3.3% (33/993), 2.1% (21/993), 2.1% (21/993), respectively and 1.7% (25/1 467), 0.7% (11/1 467), 0.7% (11/1 467), in current smokers with COPD, respectively (P=0.034, P=0.015, P=0.015, respectively). The influenza vaccination rate was higher in patients with COPD assessment test (CAT) scored less than 10 (4%, 27/673) than patients with CAT scored more than 10 (1.8%, 45/2 504,P=0.002). In a multifactor analysis, patients who lived in country side, were current smokers, and had more symptoms were less likely to be vaccinated, with an aOR 1.73(95%CI 1.02-2.93), 2.10(95%CI 1.18-3.76), 2.06(95%CI 1.24-3.43), respectively. 81.2% of COPD patients did not receive the vaccine because they did not know the vaccine. Conclusions: Vaccination rates for influenza vaccine, pneumonia vaccine and both of them in COPD patients were low and the patients lacked knowledge of vaccine. The residence, smoking status and symptoms were related to the vaccination of COPD patients, and these should be taken into account in the vaccination health education.

Improving the vaccination rate of patients with chronic obstructive pulmonary disease-getting started with clinicians

Infection of influenza virus or Streptococcus pneumoniae is the important causes of acute exacerbation of chronic obstructive pulmonary disease(COPD) and death, resulting in huge burden of medical costs. Although the guidelines at all levels generally recommend vaccination against influenza and pneumonia, the vaccination rate in China is not satisfactory. The main reasons include the limitations of economic, geographical and time constraints, as well as the influence of various socio-psychological factors and the fear of exacerbating the disease due to influenza vaccine and so on. We need start with clinicians, pay attention to the interaction of various influencing factors, to promote the integration of researchers in clinical medicine and preventive medicine, and make comprehensive consideration in the epidemic prevention strategy, which will help to adopt multi-mode methods to improve vaccination coverage and finally achieve a healthy life of patients with COPD.

Effects of Influenza Vaccination in Patients with Interstitial Lung Diseases: An Epidemiological Claims Data Analysis

RationaleVaccination is the most effective protection against influenza. Patients with interstitial lung diseases (ILDs) represent a high-risk group for influenza complications. Thus, yearly influenza vaccination is recommended, but evidence on its effects is sparse.ObjectivesThis study aimed to compare all-cause mortality and all-cause and respiratory-related hospitalization between vaccinated and unvaccinated patients with ILD.MethodsUsing data from the largest German statutory health insurance fund (about 27 million insurees in 2020), we analyzed four influenza seasons from 2014–2015 to 2017–2018 and compared vaccinated with unvaccinated patients with ILD. Starting from September 1 of each year, we matched vaccinated and unvaccinated patients in a 1:1 ratio using a rolling cohort design. Mortality and hospitalization were compared with Kaplan-Meier plots, and effects were calculated during the influenza season (in season) with risk ratios.ResultsBoth the vaccinated and the unvaccinated cohorts included 7,503 patients in 2014–2015, 10,318 in 2015–2016, 12,723 in 2016–2017, and 13,927 in 2017–2018. Vaccination rates were low at 43.2% in season 2014–2015 and decreased over time to 39.9% in season 2017–2018. The risk ratios for all-cause mortality were 0.79 (95% confidence interval [CI], 0.65–0.97; P = 0.02) in season 2014–2015, 0.66 (95% CI, 0.54–0.80; P < 0.001) in 2015–2016, 0.89 (95% CI, 0.76–1.04; P = 0.15) in 2016–2017, and 0.95 (95% CI, 0.81–1.12; P = 0.57) in 2017–2018. The effects on all-cause hospitalization and respiratory-related hospitalization were similar in all seasons.ConclusionsAlthough an unequivocally beneficial impact of influenza vaccination in patients with ILD could not be demonstrated, we observed promising results regarding avoidance of all-cause mortality in half of the seasons observed. Given the low vaccination rates, further efforts are necessary to improve vaccination rates in patients with ILD.

COVID-19 Vaccination Rates in Patients With Chronic Medical Conditions: A Nationwide Cross-Sectional Study.

As most individuals acquire immunity to severe acute respiratory syndrome coronavirus 2, South Korea declared a return to normalcy a few months ago. However, epidemic waves continue because of endlessly emerging variants and waning immunity. Health authorities are focusing on those at high risk of severe coronavirus disease 2019 to minimize damage to public health and the economy. In this regard, we investigated the vaccination rates in patients with various chronic medical conditions by examining the national health insurance claims data and the national immunization registry. We found that patients with chronic medical conditions, especially those of higher severity, such as malignancy, had vaccination rates approximately 10-20% lower than those of the general population. Public health authorities and healthcare providers should try to vaccinate these patients to avoid preventable morbidity and mortality.

Vaccination Rates of Hospitalized Patients at High Risk of Severe COVID-19: A Single-Center Cross-Sectional Study.

We investigated coronavirus disease 2019 (COVID-19) vaccination rate in patients admitted to chronic pulmonary disease, cardiovascular disease, chronic kidney disease, and cancer wards in the third week of April 2022 to determine the immunity level of these vulnerable groups. Compared to the general population, our study subjects had lower vaccination rates, except for higher percentages of boosted individuals in patients with chronic pulmonary disease and cardiovascular disease. This tendency was most pronounced in cancer patients, less than half of whom were boosted. Patients with cancer should be encouraged to complete their COVID-19 vaccination.

Evaluation of Influenza Virus Frequency, Influenza Types, Clinical Characteristics and Vaccination Rates of Patients Admitted to the Hospital with Flu-like Complaints

Amaç: Antijenik değişiklikler ile mevsimsel salgın ve pandemiler oluşturabilen influenza virüsleri özellikle risk gruplarında hastaneye yatışı gerektiren ve ölümcül olabilen akut bir solunum yolu enfeksiyonuna yol açarlar. Moleküler testler ile hızlı tanı olanakları, erken antiviral tedavi ile hastalık süresi ve komplikasyonları azaltabilir. Bu çalışmada gribal yakınmaları nedeni ile solunum yolu viral panel gönderilen, ayaktan ve yatırılarak izlenen erişkin hastaların retrospektif olarak değerlendirilmesi amaçlanmıştır. &#x0D; Gereç-Yöntem: 30.09.2019 ile 10.03.2020 tarihleri arasında solunum yolu örneklerinden multipleks real-time polimeraz zincir reaksiyonu (mRT-PZR) yöntemiyle solunum yolu viral etkenleri çalışılan erişkin hastalar çalışmaya dahil edilmiştir. Hastaların demografik verileri, tedavileri, solunum yolu viral panel sonuçları, hemogram ve CRP değerleri hastanemiz otomasyon sisteminden elde edilmiştir. Aşılanma durumları aşı kayıt sisteminden kontrol edilmiştir. Yatan hastaların taburcu şekli (ölüm/şifa) belirlenmiştir.&#x0D; Bulgular: Çalışmaya dahil edilen 225 hastanın 126’sı (%56) kadın, 99’ı (%44) erkek olup yaş ortalaması 51.20±20.27’dir. 118 (%52.4) olguda etken saptanmazken 59 olguda (%26.2) influenza virüs pozitifliği belirlenmiştir. İnfluenza A (H1N1) %57.6, influenza B %42.4 oranında bulunmuştur. İnfluenza virüs pozitif hastaların 24’ü pnömoni tanısıyla izlenmiştir. Hastaların 150’sinde en az bir eşlik eden hastalık, 10’unda gebelik mevcuttur. Sadece iki hastanın grip aşısı ile aşılandığı saptanmış ve bu hastalarda influenza virüs tespit edilmemiştir. Yedi hastada influenza A(H1N1)’e bağlı ölüm saptanmıştır. En fazla örneğin Ocak ayında gönderildiği ve 51 (%48.1) örnekte influenza virüs pozitifliği olduğu bulunmuştur. İnfluenza virüsü saptanan hastaların %18.6’sına oseltamivir, %54.3’üne oseltamivir ve antibiyotik birlikte, %18.6’na sadece antibiyotik verilmiştir.&#x0D; Sonuç: İnfluenza virüs alt tiplerinin belirlenmesi sürveyans ve kesin tanı için önemli olmakla birlikte erken tanı ile antivirallerin erken kullanımı ölümlerin önlenmesinde önemlidir.

S3316 Vaccinations in the VA - A Quality Improvement Project to Improve Vaccination Rates in Patients With Inflammatory Bowel Disease on Immunomodulating Agents at a Mid-South VA Hospital

Introduction: Many studies have shown patients with inflammatory bowel disease are at an increased risk for infections even prior to the side effects of immunomodulating agents. These agents have provided significant improvement in rates of symptom control for patient’s with IBD but have increased the risk of infections in this already vulnerable population. We attempted to assess and improve vaccination rates at a Veterans Affairs hospital in the Mid-South. Methods: We studied 254 patients at Memphis VA Medical Center with a diagnosis of Inflammatory Bowel disease. Of these 254 patients, 35 patients on TNF inhibitors as well as 20 on chronic steroids or Azathioprine/Mesalamine. Our methods included a 3-pronged approach: 1. Patients would be called to inform them of suggested vaccines 2. Flyers will be put up in the patient rooms and waiting room with information regarding Prevnar/Pneumovax/Flu/Heplisav-B/Shingrix vaccines and 3. Education material would be sent to GI providers regarding vaccination guidelines. Initial numbers were immediately prior to 1/2021 and repeat analysis would be completed on 1/2022 to allow time for completion of vaccinations requiring multiple doses as well as to accommodate for delays in the COVID vaccine. Results: Our goal was initially to increase vaccination rates for each of our vaccines (Prevnar, Pneumovax, Flu, Heplisav-B, Shingrix and COVID-19 by 15%. We have currently achieved our goal of increasing vaccination rates by 15% in all categories excluding flu as the flu season was finished by the time the project was underway. In our data analysis on 1/2022 we will include flu into our project measures. The exact increase in vaccination rates is still to be determined as patients are currently on the schedule to be vaccinated and the final percentages will be presented as data in the conference. Conclusion: Our project aimed to improve vaccination rates of patients with IBD on immunosuppression at the Memphis VA especially in the setting of the new COVID-19 immunization. The VA proved to be the optimal place for our study based on all vaccinations being available in the office as well as easily being able to track and establish follow-up as both PCP and GI follow-up were documented in one electronic medical record and the majority of patients following within the system. Our project and its successes hope to emphasize the drastic improvements a clinic can have by increasing awareness for both patients and providers regarding appropriate vaccinations.

Influenza, PCV13, and PPSV23 Vaccination Rates Among Inflammatory Bowel Disease Patients With Additional Co-Morbidities as per CDC Recommendations

BackgroundInflammatory bowel disease (IBD) and its immunosuppressive therapy alter the body's immune response, predisposing patients to higher infection risk preventable with vaccination. The CDC recommends every adult receive the annual influenza vaccine and patients with certain comorbidities receive the pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23). However, vaccination rates among IBD patients remain unacceptably low. The aim of our study is to present influenza and pneumococcal vaccinations rates of IBD patients at our center.MethodsWe hypothesized that vaccination rates will be suboptimal at our outpatient center and that patients are not being vaccinated based on comorbid conditions in accordance with guidelines. We retrieved electronic medical records from the gastroenterology clinic between December 2018 and December 2019. Data regarding influenza and pneumococcal vaccines, immunosuppressive drugs, and comorbidities were obtained. Microsoft Excel and SPSS Statistics (IBM Corp., Armonk, NY) were used for data analyses. A p-value < 0.05 was considered statistically significant.ResultsIn total, 109 IBD patients were identified, 46.8% female and 53.2% male. The majority were African American (77.06%). The mean age was 45 years. Around 26.61% of the patients were on immunosuppressive therapy. Around 28.7% received the annual influenza vaccine, 42.2% PPSV23 alone, 19.27% PCV13 alone, and 16.5% received both. Patients >50 years were more likely to receive the influenza vaccine (P = 0.0122). Patients on immunosuppressive therapy were not more likely to be vaccinated with both PCV13 and PPSV23 (P = 0.1848, P = 0.7382). Active smokers were not more likely to be vaccinated with PPSV23 (P = 0.695). Patients with human immunodeficiency virus (HIV), chronic kidney disease (CKD), and sickle-cell disease were more likely to be vaccinated with both PCV13 and PPSV23 (P = 0.02, P = 0.02). Patients with other chronic medical conditions were more likely to be vaccinated with PPSV23 (P = 0.0201).ConclusionOur study revealed suboptimal influenza and pneumococcal vaccination rates among IBD patients at our facility. We also found that patients were not consistently vaccinated based on qualifying co-morbid conditions. Age plays a role in whether patients received the influenza vaccine contrary to guidelines. We urge clinicians to examine IBD patient vaccination rates at their facilities.

Effect of Offering Pneumococcal Vaccines During Specialty Care on Vaccination Rates in Patients Receiving Immunosuppressive

Purpose: To determine whether clinician-led immunization education with immediate onsite vaccination availability will increase pneumococcal immunizations during specialty care. Methods: We designed a controlled before and after QI project quasi-experimental design to retrospectively evaluate the QI effectiveness. The QI setting included two clinics. Clinic #1 was a part of the county hospital system and offered comprehensive care. Clinic #2 was a university clinic that hosted a private practice and a dermatology resident continuity clinic. 201 patients with planned or existing immunosuppressive medication regimens attending an initial or follow-up dermatology visit participated in the study. The intervention included clinician provided verbal immunization recommendations. Patients were then given the opportunity for immediate immunization. The main measure of outcome was pneumococcal immunization status after QI intervention. Results: Our analysis included 201 patients with planned or existing immunosuppressive medication regimens attending an initial or follow-up dermatology visit (aged 0-64 years [82.1%] ,aged ≥65 years [17.9%]; male [34.3%] female [65.6%%]). Of these, 146 [72.6%] were in the QI group and 55 [27.4%] in the comparison group. Our unadjusted analyses identified no significant group differences in immunization status at initial observation (p=0.329; Table 1). Of the 102 patients in the QI group with no pneumococcal immunizations at initial observation, 80.4% (95% CI: 71.4%, 87.1%) received at least one pneumonia vaccination by the final observation. For the 27 patients in the QI group with partial immunization at project initiation, 85.2% (95% CI: 65.9%, 94.5%) received at least one pneumonia vaccination. Overall, 81.4% (95% CI: 73.6, 87.3) of patients in the QI group without full immunization at initial observation received at least one vaccination by the final observation. Conclusion: These data demonstrate that immunization coverage in patients on immunosuppressive medications can be markedly improved by clinician recommendation with immediate availability of the pneumococcal vaccine during specialty care. Wider adoption of this model and its adaptation to other immunizations and settings is an important opportunity to reduce vaccine-preventable illness, including COVID-19, and improve population health.

Increased influenza vaccination rates in patients with autoimmune rheumatic diseases during the Covid-19 pandemic: a cross-sectional study.

To assess non-compliance and potential changes in seasonal flu vaccination coverage before and during the Covid-19 pandemic in patients with autoimmune rheumatic diseases (ARDs). Consecutive patients with ARDs followed-up in 2 tertiary hospitals were telephone-interviewed (December 12–30, 2020) regarding seasonal flu vaccination during the 2019/20 and 2020/21 time periods. Self-reported disease flares that occurred after flu vaccination, as well as reasons for non-vaccination were recorded. One thousand fifteen patients were included. The rate of flu vaccination increased from 76% before to 83% during the COVID-19 pandemic (p = 0.0001). The rate of self-reported disease flares was < 1% among vaccinated patients. Reasons for not vaccination in both periods, respectively, included: ‘was not recommended by their rheumatologists’ (35.0vs.12.2%, p < 0.0001), ‘did not feel that they would have any benefit’ (36.9 vs. 32.6%), felt unsafe to do so (27.5 vs. 30.2%), or other reasons (18.9 vs. 23.8%). By multivariate analysis, age [OR = 1.03 (95% CI 1.02–1.04)] vs. [1.04 (95% CI 1.02–1.05)] and treatment with biologics [OR = 1.66 (95% CI 1.22–2.24) vs. [1.68 (95% CI 1.19–2.38)] were independent factors associated with vaccination in both periods. These findings, although are temporally encouraging, emphasize the need for continuous campaigns aiming at increasing patients’ and physicians’ awareness about the benefits of vaccination.

A clinical audit of pneumococcal vaccination among patients with autoimmune rheumatic diseases living in Greece: The power of awareness

IntroductionPatients with autoimmune rheumatic diseases (ARDs) are at increased risk for pneumococcal infections and should be vaccinated against Streptococcus pneumoniae. Data on the rates of pneumococcal vaccination among patients with ARDs in Southern Europe are scarce. Here, we estimate the pneumococcal vaccination rate in patients living in Greece with ARDs, explore the patients’ awareness regarding vaccination, and try to recognize factors that influence the vaccine uptake. MethodsBetween October 2015 and September 2016, a structured questionnaire was provided to all consecutive patients with ARDs attending one outpatient clinic of our department. The survey included parameters concerning patients’ demographics, underlying ARD and immunosuppressive medications, other comorbidities, vaccine type, knowledge about infection risk and necessity of vaccination. Univariate and multivariate analyses were performed to study any association of these factors with the vaccination uptake. ResultsOverall, 395 patients with ARDs (30.13% aged >65 years and 78.99% female) participated in our survey. The most frequent ARD was rheumatoid arthritis (43.04%); 40.51% of patients were receiving biologic agents and 44.56% steroids. Pneumococcal vaccination rate was 49.37%, while 45.06% of patients have been vaccinated during the last five years and only 8.21% of them had a second pneumococcal vaccine, as per national guidelines. The decision of vaccination was significantly influenced by the patient’s age (>65 years) (p < 0.001) and the complete awareness of reasons for being vaccinated (p < 0.001), but not by presence of comorbidities, the type of ARD or administration of a biologic agent. The main reason for no vaccination was that it was not suggested by the caring physician (82.50%). ConclusionsIn our cohort of patients with ARDs the pneumococcal vaccination was suboptimal. Better understanding of the significance of vaccination by the patient and suggestion for vaccination by the caring physician will improve vaccination uptake and optimize the clinical benefits among patients with ARDs.

EASL position paper on the use of COVID-19 vaccines in patients with chronic liver diseases, hepatobiliary cancer and liver transplant recipients

According to a recent World Health Organization estimate, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which originated in China in 2019, has spread globally, infecting nearly 100 million people worldwide by January 2021. Patients with chronic liver diseases (CLD), particularly cirrhosis, hepatobiliary malignancies, candidates for liver transplantation, and immunosuppressed individuals after liver transplantation appear to be at increased risk of infections in general, which in turn translates into increased mortality. This is also the case for SARS-CoV-2 infection, where patients with cirrhosis, in particular, are at high risk of a severe COVID-19 course. Therefore, vaccination against various pathogens including SARS-CoV-2, administered as early as possible in patients with CLD, is an important protective measure. However, due to impaired immune responses in these patients, the immediate and long-term protective response through immunisation may be incomplete. The current SARS-CoV-2 pandemic has led to the exceptionally fast development of several vaccine candidates. A small number of these SARS-CoV-2 vaccine candidates have already undergone phase III, placebo-controlled, clinical trials in healthy individuals with proof of short-term safety, immunogenicity and efficacy. However, although regulatory agencies in the US and Europe have already approved some of these vaccines for clinical use, information on immunogenicity, duration of protection and long-term safety in patients with CLD, cirrhosis, hepatobiliary cancer and liver transplant recipients has yet to be generated. This review summarises the data on vaccine safety, immunogenicity, and efficacy in this patient population in general and discusses the implications of this knowledge on the introduction of the new SARS-CoV-2 vaccines.