Vaccine Uptake In Patients Research Articles

Pneumococcal vaccine uptake in patients with inflammatory arthritis: a single centre cohort study.

Current guidelines recommend pneumococcal vaccination in individuals who are over the age of 65 or are immunosuppressed due to a disease or treatment. The objective of this study was to assess vaccine uptake rates in people with inflammatory arthritis for the pneumococcal, influenza and Covid-19 vaccines and factors determining uptake. We conducted a retrospective single centre cohort study in the UK of individuals with rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis between October and December 2023. Data were collected for age, gender, co-morbidities, immunosuppressive therapies, and dates of vaccines. Logistic regression was used to evaluate predictors of vaccine uptake, with adjustments for demographic and clinical factors. 906 individuals were identified. 46% were receiving treatment with csDMARD, 26% on biologic monotherapy, and 23% were on both biologic and csDMARDs. 316 individuals (35%) received a pneumococcal vaccine, lower than uptake for influenza (63%) and Covid-19 (87%) vaccines. Predictors of pneumococcal vaccine uptake included age, with older patients more likely to be vaccinated (odds ratio [OR] for age ≥ 65 years: 1.67, 95% CI 1.21-2.29). Those on biological therapy demonstrated higher likelihood of vaccination (OR for biologic therapy: 1.81, 95% CI 1.33-2.47). Additional Joint committee for immunisation and vaccination (JCVI) Green Book indicators also positively influenced vaccine uptake (OR: 1.67, 95% CI 1.19-2.33). Pneumococcal vaccine uptake in inflammatory rheumatic diseases is low, especially in younger patients and those not on biological therapy. The study highlights the need for a focused approach, distinct from strategies for other vaccines, to address this public health challenge.

COVID-19 Vaccine Information and Infertility Posts on X: Insights on a Misinformation Pandemic.

This study aimed to evaluate misinformation surrounding infertility and the COVID-19 vaccine on X (formerly known as Twitter) by analyzing the prevalence and content of this misinformation across a sample of posts on X. This study is a retrospective review of posts on X (formerly known as tweets) from the COVID-19-TweetIDs dataset from July 2021 and November 2021. Included posts were from crucial time points in the COVID-19 vaccine discourse and contained at least one word related to COVID-19 vaccination and fertility. Posts were analyzed and categorized based on factuality, common words, and hashtags. Descriptive statistics on total followers, account verification status, and engagement were obtained. Differences between posts on X classified as factual and misinformation were examined using analysis of variance or χ2 tests. Sentiment analysis determined if post content was generally positive, neutral, or negative. A total of 17,418 relevant posts on X were reviewed: 11,436 from timeframe 1 (July 2021) and 5982 from timeframe 2 (December 2021). Misinformation posts rose from 29.9% in July 2021 to 45.1% in November 2021. In both timeframes, accounts sharing factual information had more followers (p < 0.001), and verified users were more likely to share accurate posts (p ≤ 0.001). Factual and misinformation posts had similar engagement. Sentiment analysis identified that real posts were more positive and misinformation posts were more negative (p < 0.001). Misinformation about the COVID-19 vaccine and fertility is highly prevalent on X and threatens vaccine uptake in patients desiring future fertility. Accounts sharing factual information were likely to have more followers and be verified; therefore, verifying more physicians sharing accurate information is critical.

COVID-19 vaccine uptake in mental healthcare users: Czech nationwide register study

BackgroundThe excessive covid-related mortality of psychiatric patients was reduced by vaccination. The vaccine uptake in patients diagnosed with different mental health disorders is, however, not fully described. AimsA nationwide, record-based retrospective cross-sectional study examines the effect of substance use, psychotic, affective, anxiety, and personality disorders on COVID-19 vaccination rates in August and December 2021. Further, it quantifies the effect of receiving mental healthcare on vaccine uptake. MethodsThe COVID-19 vaccine rates of mental healthcare users in August and December 2021 were examined using logistic regression models adjusted for sex and age on a sample of 7,235,690 adult inhabitants of the Czech Republic. The probability of vaccine uptake in the week following mental healthcare appointment or hospitalization on any day in the fall 2021 was compared to the general probability of getting vaccinated during that week. ResultsThe vaccination rate in August 2021 was related to history of hospitalization due to substance use (OR = 0.71), personality (OR = 0.87), psychotic (OR = 0.92), and anxiety (OR = 1.15) disorders, while mood disorders had no effect (OR = 1.00). Compared to general population, mental healthcare users were undervaccinated in August but not in December 2021. Vaccine uptake was low in those with history of psychiatric hospitalizations but higher in those utilizing inpatient or outpatient mental healthcare recently, predominantly for affective disorders. Increased vaccine uptake was observed following utilization of mental healthcare as well as in those with repeated psychiatric hospitalizations. ConclusionsThe vaccination rates of mental healthcare users relative to general population largely differ across nosological categories and during the vaccination campaign. Psychiatrists were successful in promoting vaccination against COVID-19.

Quality improvement interventions targeting vaccine uptake in cancer patients: A systematic review.

e18734 Background: Patients with cancer are more susceptible to morbidity and mortality from preventable infection. Despite this, patients with cancer have low rates of vaccination and quality improvement interventions to improve their rates of vaccination have not been well studied. Methods: We searched PubMed and Cochrane Library for studies that evaluated quality improvement interventions that aimed to improve vaccine uptake in patients with cancer. We searched PubMed and Cochrane library using keywords that covered cancer, vaccines and quality improvement. Title and abstract screening, data extraction and categorization was conducted by two authors with any disagreements were resolved by consensus. Results: In total, 13 studies were identified as meeting our inclusion criteria. Studies were published from 2014 to 2022. Seven studies studied the influenza vaccine, five studied the pneumococcal vaccine, and one studied both. Twelve studies employed multiple interventions, and one study employed a single intervention. Most studies evaluated interventions designed to increase patients’ and families’ knowledge of the vaccines and interventions designed to identify vaccine-eligible patients before their visit. All studies showed improvement in vaccine uptake after implementation of the study’s interventions. Conclusions: We found a broad range of quality improvement interventions that improved pneumococcal and influenza vaccine uptake for patients with cancer. Future studies should test barriers to implementation of these interventions and review if these same interventions improve uptake of other vaccines.

WED-477 - Effectiveness of vaccine education on vaccine awareness and vaccine uptake in patients with cirrhosis of liver of a tertiary care center in South India

WED-477 - Effectiveness of vaccine education on vaccine awareness and vaccine uptake in patients with cirrhosis of liver of a tertiary care center in South India

Rate of COVID-19 vaccination among patients with cancer who tested positive for severe acute respiratory syndrome-coronavirus 2: Analysis of the American Society ofClinical Oncology Registry.

The availability of safe and effective COVID-19 vaccines has enabled protections against serious COVID-19 outcomes, which are particularly important for patients with cancer. The American Society of Clinical Oncology Registry enabled the study of COVID-19 vaccine uptake in patients with cancer who were positive for severe acute respiratory syndrome-coronavirus 2. Medical oncology practices entered data on patients who were in cancer treatment. The cohort included patients who had severe acute respiratory syndrome-coronavirus 2 infection in 2020 and had visits and vaccine data after December 31, 2020. The primary end point was the time to first vaccination from January 1, 2021. Cumulative incidence estimates and Cox regression with death as a competing risk were used to describe the time to vaccine uptake and factors associated with vaccine receipt. The cohort included 1155 patients from 56 practices. Among 690 patients who received the first vaccine dose, 92% received the second dose. The median time to vaccine was 99days. After adjustment, older patients were associated with a higher likelihood of vaccination compared with patients younger than 50years in January through March 2021, and age exhibited a linear effect, with older patients showing higher rates of vaccination. Metastatic solid tumors (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.73-0.98) or non-B-cell hematologic malignancies (HR, 0.71; 95% CI, 0.54-0.93) compared with nonmetastatic solid tumors, and any comorbidity (HR, 0.83; 95% CI, 0.73-0.95) compared with no comorbidity, were associated with lower vaccination rates. Area-level social determinants of health (lower education attainment and higher unemployment rates) were associated with lower vaccination rates. Patient age, cancer type, comorbidity, area-level education attainment, and unemployment rates were associated with differential vaccine uptake rates. These findings should inform strategies to communicate about vaccine safety and efficacy to patients with cancer.

Characterization of the COVID-19 Vaccine Uptake in Patients With Chronic Diseases in a Large University-based Family Medicine Clinical Practice.

To characterize COVID-19 vaccine uptake in patients with chronic conditions at the large university-based Family Medicine practice serving a population with low COVID-19 vaccine acceptance. A rolling panel of patients attributed to the practice was submitted monthly to the Chesapeake Regional Health Information Exchange (CRISP) to monitor patients' vaccination status. Chronic conditions were identified using the CMS Chronic Disease Warehouse. An outreach strategy deploying Care Managers was developed and implemented. Associations between vaccination status and patients' characteristics were examined using a multivariable Cox's proportional hazard regression modeling. Among 8469 empaneled adult (18+) patients, 6404 (75.6%) received at least 1 dose of COVID-19 vaccine in December 2020 to March 2022. Patients were relatively young (83.4% <65 years old), predominantly female (72.3%), and non-Hispanic Black (83.0%). Among chronic conditions, hypertension had the highest prevalence (35.7%), followed by diabetes (17.0%). Associations between vaccine status and the presence of chronic conditions varied by age and race. Older patients (45+ years old) with diabetes and/or hypertension showed a statistically significant delay in receiving COVID-19 vaccine, while young Black adults (18-44 years old) with diabetes complicated by hypertension were more likely to be vaccinated compared to patients of the same age and race with no chronic conditions (Hazard ratio 1.45; 95% CI 1.19,1.77; P = .0003). The practice-specific COVID-19 vaccine CRISP dashboard helped to identify and address delays in receiving COVID-19 vaccine in the most vulnerable, underserved populations. Reasons for age and race-specific delays in patients with diabetes and hypertension should be explored further.

Effectiveness of Vaccine Education on Vaccine Awareness and Vaccine Uptake in Patients with Cirrhosis of Liver of a Tertiary Care Centre in South India

Effectiveness of Vaccine Education on Vaccine Awareness and Vaccine Uptake in Patients with Cirrhosis of Liver of a Tertiary Care Centre in South India

Facilitators and barriers of vaccine uptake in patients with autoimune inflammatory rheumatic disease: a scoping review

ObjectivesPatients with autoimmune inflammatory rheumatic diseases (AIRD) often have lower vaccination coverage rates compared with the general population, despite being disproportionately affected by infectious complications. We aim to systematically review...

Seasonal influenza vaccine uptake among patients with cardiovascular disease in Denmark, 2017-2019.

Influenza vaccination protects against morbidity and mortality in patients with cardiovascular disease (CVD). We aimed to describe influenza vaccine uptake in patients with CVD in a universal-access healthcare system. Using nationwide Danish registries, we included all patients with prevalent CVD, defined as heart failure (HF), atrial fibrillation (AF), ischemic heart disease (IHD), or stroke during three consecutive influenza seasons (October-December 2017-2019). The outcome was relative frequency of influenza vaccination across strata of patient characteristics. There was an average of 397346 patients with CVD yearly during 2017-2019. Vaccine uptake was 45.6% for the whole population and ranged from 55.0% in AF to 61.8% in HF among patients aged ≥65 years. Among patients aged <65 years, uptake was 32.6% in HF, 19.0% in AF, 21.1% in IHD, and 18.3% in stroke. There was a lower uptake with decreasing age: 21.6% in HF, 5.5% in AF, 7.4% in IHD, and 6.3% in stroke among males aged <45 years, as opposed to 25.5% in HF, 11.5% in AF, 13.8% in IHD, and 12.1% in stroke for males aged 45-54 years. In the further stratified analyses, uptake ranged from a low of 2.5% for males <45 years with AF who were not vaccinated the previous season to a high of 87.0% for females ≥75 years with IHD who were vaccinated the previous season. Seasonal influenza vaccine uptake is suboptimal among patients with CVD, even in a universal-access healthcare system with free-of-charge vaccinations. Vaccine uptake was particularly low among young patients.

P-137: COVID – 19 vaccine uptake in patients with multiple myeloma and AL amyloidosis: a crosssectional observational study from India

P-137: COVID – 19 vaccine uptake in patients with multiple myeloma and AL amyloidosis: a crosssectional observational study from India

Effectiveness of an intervention to overcome influenza vaccine hesitancy in specialty clinic patients.

Background:Individuals on immunosuppressive therapies experience greater morbidity and mortality due to vaccine-preventable illnesses, but there are low rates of adherence to immunization guidelines within this population.Objective:To determine the effectiveness of clinician-led education, patient-centered dialogue, and immediately available immunization on influenza vaccination uptake in patients taking immunosuppressive therapies.Method:We used a controlled before-and-after quasi-experimental design to evaluate our quality improvement intervention occurring from September 2019 to March 2020, with follow-up through July 2020. The study included 2 dermatology practices wherein nursing staff offered influenza vaccination during patient rooming (standard care). Within each practice, clinicians either implemented the intervention or provided only standard care. Patients received the intervention or standard care depending on the clinician they visited. Patients seen at the 2 clinics during the intervention period were included in analyses if they were taking or newly prescribed immunosuppressant medication at the time of their visit. We examined influenza immunization status for 3 flu seasons: 2017–2018 (preintervention), 2018–2019 (preintervention), and 2019–2020 (intervention).Intervention:Immunosuppressed patients initially declining an influenza vaccine were provided dermatologist-led education on the benefits of immunization. Dermatologists explored and addressed individual patients’ immunization concerns. Influenza vaccination was then offered immediately postdialogue.Results:Analyses included 201 dermatology patients who were prescribed or currently taking immunosuppressive medication (intervention group [72.6%], comparison group [27.4%]). During the intervention period, 91.1% of the intervention group received influenza vaccination compared to 56.4% of the comparison group. Vaccination trends from 2018–2019 (preintervention) to 2019–2020 (intervention) differed significantly between groups (χ2 = 22.92, P < .001), with greater improvement in the intervention group. In 2019–2020, influenza vaccination was more likely in the intervention group relative to the comparison group (odds ratio: 16.22, 95% confidence interval: 5.55–47.38). In the subset of patients that had never received an influenza vaccine, influenza immunization in 2019–2020 was more common in the intervention group (75.8%, 25/33) relative to the comparison group (13.3%, 2/15, P < .001).Conclusion:The intervention successfully addressed vaccine hesitancy and improved influenza immunization rates in an immunosuppressed population receiving care from a specialty clinic. Implementing a similar model across specialty clinics may improve vaccination rates for influenza, coronavirus disease 2019, and other vaccine-preventable illnesses in other populations.

COVID-19 vaccine uptake in patients with cancer and Sars-Cov-2 infection in 2020: Results from the ASCO registry.

e18713 Background: The availability of safe and effective COVID-19 vaccines has enabled protections against serious outcomes from SARS-CoV-2 infection. The ASCO Registry provides an opportunity to study the rate of vaccine uptake among patients (pts) with cancer who had SARS-CoV-2 infection prior to availability of vaccines. Methods: Participating US medical oncology practices identify pts eligible for inclusion: pts with a positive SARS-CoV-2 test and, at the same time, either (a) or (b) cancer-free less than 12 months (i.e., in complete remission or post-resection) and receiving adjuvant treatment. Registry data were extracted on 2/4/22. Pts in this analysis had a SARS-CoV-2 positive test between 3/1/2020 and 12/31/2020 and at least one clinical encounter on or after 1/1/21, documenting receipt or not of 1st and 2nd vaccine shots. Pts lacking data on vaccination status in their medical records were excluded from analysis. When the exact date of 1st vaccine shot was known, the primary endpoint was number of days from 1/1/21 to 1st shot date. If the exact date of 1st shot was unknown, date was categorized as within 7 days from the clinical encounter, 2-4 weeks, or more than 1 month prior. Summary statistics and 95% confidence intervals (CIs) were calculated using Kaplan-Meier methods. Results: The Registry included 1260 pts with SARS-CoV-2 infection in 2020. Time to vaccination (described using cumulative incidence) across age categories is shown in Table, with 1/1/21 as the baseline. Median time to vaccination ranged from 63 days in the oldest pts (&gt; 80 years of age) to 220 days in the youngest pts (&lt; 45 years of age). Differences in rates of vaccination uptake were most pronounced in the early months (Jan – Mar) and diminished in April and beyond. Conclusions: Older pts with cancer who were infected with SARS-CoV-2 in 2020 received COVID-19 vaccinations in 2021 at higher rates than those of younger ages. Delayed uptake by younger aged pts at outset could be related to lack of clarity on pts with cancer qualifying for early vaccine access and state policies on availability.[Table: see text]

P075 COVID-19 vaccination uptake in patients with cystic fibrosis

P075 COVID-19 vaccination uptake in patients with cystic fibrosis

COVID-19 Vaccine Hesitancy in Patients with Inflammatory Bowel Disease.

Background and AimsCOVID-19 vaccine hesitancy varies across the USA. Data on COVID-19 vaccine hesitancy in patients with inflammatory bowel disease (IBD) are lacking. We assessed COVID-19 vaccine hesitancy and its associated variables in patients with IBD.MethodsWe evaluated voluntary patient survey responses during routine clinical visits to our IBD center. Data collected included demographic and clinical characteristics. Descriptive statistics, univariate and multivariate analyses were performed to evaluate significant associations with COVID-19 vaccine hesitancy.ResultsA total of 239 individuals completed the survey. Over a third of respondents (35.6%) expressed hesitancy toward receiving the COVID-19 vaccine due to vaccine safety concerns (49.4%) and efficacy (23.5%), while others reported non-specific concerns (34.1%). On univariate analysis, Crohn’s disease (OR 2.33 CI 1.28–4.25 p = 0.0056), use of biologic medications (OR 1.93 CI 1.16–3.23, p = 0.012), previous self-reported vaccine refusal (OR 8.13 CI 2.90–22.82 p = 0.0001), earlier date of survey administration (OR 2.01 CI 1.17–3.44 p = 0.011), and self-reported COVID infection (OR 2.55 CI 1.16–5.61 p = 0.0056) were more likely to be associated with COVID-19 vaccine hesitancy. On multivariate analysis, patient age, previous vaccine refusal and date of survey administration were more likely to be associated with COVID-19 vaccine hesitancy.ConclusionsOver one-third of patients with IBD expressed COVID-19 vaccine hesitancy. Vaccine safety and efficacy were the most common reasons. Younger age, previous vaccine refusal and earlier date of survey were more likely to be associated with hesitancy. Our findings suggest that there is room for targeted education to improve COVID-19 vaccine uptake in patients with IBD.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10620-021-07377-5.

P695 Attitudes and predictors of COVID-19 vaccine uptake in patients with Inflammatory Bowel Disease

BackgroundVaccination has proven to be an effective public health measure to combat the SARS-CoV-2 pandemic. However, vaccine “hesitancy” has limited uptake in some populations. We surveyed individuals with IBD to explore factors associated with vaccine uptake, concerns, and which sources of information were considered trustworthy surrounding vaccination.MethodsPatients with IBD were recruited from a specialist IBD clinic at a tertiary hospital in Australia, and through a national IBD patient society (Crohn’s & Colitis Australia). Patients were invited to complete an anonymous survey between 31 October – 17 November 2021. Logistic regression was used to identify variables associated with vaccine uptake. Data was analysed using SPSS (Chicago, IL).ResultsThere were a total of 441 respondents. Demographic and IBD characteristics are presented in Table 1. Most respondents 411 (93.2%) had received at least 1 dose of COVID-19 vaccination. Among 30 (6.8%) respondents who had not been vaccinated, concern about experiencing an IBD flare with vaccination and vaccine safety were most commonly identified. Of those who had not yet been vaccinated, the possibility of getting vaccinated in the future was likely in 3 (10.7%), unlikely in 12 (42.8%), whilst 13 (45.4%) were unsure about future vaccination. Multivariate analysis [Table 2] demonstrated past influenza vaccination (OR 3.28, 95% CI 1.34–8.9, p = 0.009) and self-perceived risk of being more unwell with COVID-19 infection due to IBD was positively associated with COVID-19 vaccine uptake (OR 5.25, 95% CI 1.96–14.04, p <0.001). Most agreed that that vaccination in general was safe 306 (90.1%). The perceived risk of COVID-19 vaccination causing an IBD flare, and concern that vaccination is unsafe in pregnancy were both negatively associated with vaccine uptake (OR 0.28, 95% CI 0.10–0.77, p = 0.01 and OR 0.22, 95% CI 0.08–0.65, p = 0.006) respectively. Trust in healthcare workers was high with 282 (73.7%) responders ranking them the most trusted source to obtain information surrounding vaccination [Figure 1]. Social media was ranked the least trusted source of information by 225 (58.6%). ConclusionPast influenza vaccination and self-perceived risk of being more unwell with COVID-19 due to IBD, were positive predictors of COVID-19 vaccine uptake in IBD patients. Concerns about an IBD flare with vaccination is a unique consideration in those vaccine hesitant and is a negative predictor of vaccine uptake. Among those not yet vaccinated, 45% were uncertain about future vaccination. Given healthcare providers were ranked the most trusted source surrounding this domain, this survey highlights the key role they have in exploring vaccination concerns and misconceptions in IBD patients

The Current Status of Vaccine Uptake and the Impact of COVID-19 on Intention to Vaccination in Patients with COPD in Beijing.

BackgroundSARS-CoV-2 tends to cause more severe disease in patients with COPD once they are infected. We aimed to investigate the rates of influenza, pneumococcal and COVID-19 vaccination uptake in patients with COPD and to determine whether the COVID-19 pandemic and widespread vaccination against COVID-19 had any impact on the intention to accept influenza vaccines in these patients.MethodsWe conducted a multi-center and cross-sectional survey in seven tertiary hospitals in Beijing and consecutively recruited outpatients with COPD from June 1st to July 30th, 2021. The survey included patient’s clinical characteristics, uptake of influenza, pneumococcal and COVID-19 vaccination, vaccine knowledge, attitude towards vaccines, and the change of intention to receive influenza vaccination after COVID-19 epidemic and COVID-19 vaccination in Beijing.ResultsA total of 264 patients were enrolled. The rate of COVID-19 vaccination during the study period was 39.0%. The rates of influenza vaccination in the past season and pneumococcal vaccination in the past year were 22.7% and 5.7%, respectively. Of the patients who had not received COVID-19 vaccination (n = 161), only 16.2% reported that COVID-19 vaccination was recommended by clinicians, while 23.5% had no knowledge regarding COVID-19 vaccination. About 51.1% of the patients reported that their intention to receive influenza vaccination was influenced by the COVID-19 pandemic. COVID-19 vaccination was independently associated with a positive change in intention to receive influenza vaccination.ConclusionThe coverage rate of COVID-19 vaccination among patients with COPD in Beijing was 39.0%, and that of influenza and pneumococcal vaccination was very low. The COVID-19 pandemic and the COVID-19 vaccination campaign showed a significant, positive impact on patients with COPD in terms of influenza vaccination. Improving awareness of the effectiveness and safety of vaccines among both healthcare professionals and patients could increase vaccination coverage in patients with COPD.

Determinants of Influenza Vaccine Uptake in Patients With Cardiovascular Disease and Strategies for Improvement.

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Influenza infection is associated with an increased risk of cardiovascular events (myocardial infarction, stroke, and heart failure exacerbation) and mortality, and all‐cause mortality in patients with CVD. Infection with influenza leads to a systemic inflammatory and thrombogenic response in the host body, which further causes destabilization of atherosclerotic plaques. Influenza vaccination has been shown to be protective against cardiovascular and cerebrovascular events in several observational and prospective studies of at‐risk populations. Hence, many international guidelines recommend influenza vaccination for adults of all ages, especially for individuals with high‐risk conditions such as CVD. Despite these long‐standing recommendations, influenza vaccine uptake among US adults with CVD remains suboptimal. Specifically, vaccination uptake is strikingly low among patients aged <65 years, non‐Hispanic Black individuals, those without health insurance, and those with diminished access to healthcare services. Behavioral factors such as perceived vaccine efficacy, vaccine safety, and attitudes towards vaccination play an important role in vaccine acceptance at the individual and community levels. With the ongoing COVID‐19 pandemic, there is a potential threat of a concurrent epidemic with influenza. This would be devastating for vulnerable populations such as adults with CVD, further stressing the need for ensuring adequate influenza vaccination coverage. In this review, we describe a variety of strategies to improve the uptake of influenza vaccination in patients with CVD through improved understanding of key sociodemographic determinants and behaviors that are associated with vaccination, or the lack thereof. We further discuss the potential use of relevant strategies for COVID‐19 vaccine uptake among those with CVD.

Interventions to improve vaccine acceptance among rheumatoid arthritis patients: a systematic review

Introduction/objectiveNational guidelines emphasize the importance of annual immunization for patients living with rheumatoid arthritis (RA), but vaccination rates remain suboptimal in this population. Evaluating the efficacy of patient and/or provider-targeted interventions to improve vaccination uptake among RA patients could inform practice.MethodsWe conducted a systematic review (SR) to examine the efficacy of interventions (exposure) aiming to improve vaccination uptake in patients with RA (outcome). English and French language, peer-reviewed interventional studies to improve vaccination rates in RA patients published between 2009 and 2018 were included.ResultsThe search yielded a total of 450 records. Five articles met inclusion criteria. All interventions focused on changing provider behavior using some form of vaccination reminder as the primary intervention strategy, though only two studies reported provider prescribing behavior as an outcome (which was 4% and 58%). Overall, studies varied greatly regarding intervention delivery mode (e.g., educational sessions, e-mail reminders, best practice alerts), and behavior change techniques used to encourage providers to prescribe vaccination (e.g., feedback and monitoring, shaping knowledge, self-regulation). For influenza, pneumococcal and herpes zoster, post-intervention (mean 12–16 months follow-up) vaccination rates increased by a mean of 16.6% (± 15.4%).ConclusionsInterventions to enhance vaccine uptake in RA focused almost exclusively on improving provider prescription of vaccines using reminder-type interventions. Although effective in improving vaccination rates, those studies used heterogeneous interventions and behavior change techniques. Few studies measured provider prescribing behavior as an outcome. Future studies targeting providers should measure relevant provided-related outcomes and their impact on patient outcomes, to determine overall efficacy.

Effect of dementia on receipt of influenza vaccine: a cohort study in French older adults using administrative data: 2007–2012

Despite guidelines stating the vaccine benefit in this population, older adults with dementia may be less likely to receive influenza vaccine than cognitively intact older adults. But no study has yet reported on vaccine uptake in patients newly diagnosed with dementia or whether years since dementia diagnosis influences vaccine uptake. We conducted a cohort study in the French Health Insurance database (Echantillon Généraliste de Bénéficiaires) which contains hospital data and claims for a 1/97th random sample of the French population. Diseased subjects were ≥65years and had a new record of dementia diagnosis between September 1, 2007, and August 31, 2008. Vaccine receipt was measured via influenza vaccine dispensing in community pharmacies. We described influenza vaccination rates up to 2011-2012 and estimated adjusted relative risks (aRR) for vaccine receipt each year using multivariate modified Poisson models controlling for sociodemographics, comorbidities, and health resources use. Four hundred and seven subjects with dementia (mean age 81.8years, 69.3% females) and 4862 subjects (mean age 75.2years, 61.3% females) without dementia were included. In 2008-2009, influenza vaccination prevalence was 70.0% (95% CI=[65.3-74.4]) and 70.2% (95% CI=[68.9-71.4]) in subjects with and without dementia, respectively (aRR=0.93; 95% CI=[0.87-1.00]). In 2009-2010, the aRR was of the same magnitude (aRR=0.96, 95% CI=[0.90-1.03]), but in 2010-2011 and 2011-2012, the aRR was 1.02 (95% CI=[0.94-1.11]) and 1.05 (95% CI=[0.96-1.14]), respectively. Subjects with dementia had a slightly nonsignificant lower receipt of influenza vaccine in the year following dementia diagnosis than subjects without dementia. In subsequent years, divergent trends were observed in vaccine uptake according to dementia status.