Reasons for failure to receive pneumococcal and influenza vaccinations among immunosuppressed patients with systemic lupus erythematosus

https://doi.org/10.1016/j.semarthrit.2015.01.002Get rights and content

Abstract

Objective

To better understand why immunosuppressed individuals with systemic lupus erythematosus (SLE) fail to receive influenza and pneumococcal vaccines.

Methods

These cross-sectional data were derived from the 2009 cycle of the Lupus Outcomes Study (LOS), an annual longitudinal telephone survey of individuals with confirmed SLE. Respondents were included in the analysis if they had taken immunosuppressive medications in the past year. We assessed any prior receipt of pneumococcal vaccine and influenza vaccine in the past year, and then elicited reasons for not receiving vaccination. We used bivariate statistics and multivariate logistic regression to assess frequency and predictors of reported reasons for not obtaining influenza or pneumococcal vaccines.

Results

Among 508 respondents who received immunosuppressants, 485 reported whether they had received vaccines. Among the 175 respondents who did not receive an influenza vaccine, the most common reason was lack of doctor recommendation (55%), followed by efficacy or safety concerns (21%), and lack of time (19%). Reasons for not receiving pneumococcal vaccine (N = 159) were similar: lack of recommendation (87%), lack of time (7%), and efficacy or safety concerns (4%). Younger, less-educated, non-white patients with shorter disease duration, as well as those immunosuppressed with steroids alone, were at the greatest risk for not receiving indicated vaccine recommendations.

Conclusions

The most common reason why individuals with SLE did not receive pneumococcal and influenza vaccines was that physicians failed to recommend them. Data suggest that increasing vaccination rates in SLE will require improved process quality at the provider level, as well as addressing patient concerns and barriers.

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

References (22)

  • J. Yazdany et al.

    Provision of preventive health care in systemic lupus erythematosus: data from a large observational cohort study

    Arthritis Res Ther

    (2010)
  • Cited by (0)

    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.

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