Pneumococcal Vaccination Rates Low Among Rheumatoid Arthritis Patients

An alarmingly low rate of patients with rheumatoid arthritis in a rural population report adherence to pneumococcal vaccination criteria, according to a new study.

In a new retrospective study from investigators at the Marshall University Joan C. Edwards School of Medicine, just 1 in 10 rheumatoid arthritis patients in the observed rural Appalachian area were found to be in compliance with the 2015 American College of Rheumatology (ACR) and Centers for Disease Control and Prevention (CDC) recommendations for pneumococcal vaccine.

The results—presented at the Congress of Clinical Rheumatology (CCR) West 2019 annual meeting in San Diego—reflect a current issue of lacking medical education among at-risk patients.

Investigators noted that disease-modifying antirheumatic drugs (DMARDs)—which are commonly lone therapy or added with biologics for rheumatoid arthritis—put patients at a greater risk of high-mortality, invasive pneumococcal disease.

As such, they stress the ACR and CDC guidelines for vaccination as a “critical component of rheumatoid arthritis management.”

“However, pneumococcal vaccination rates remain suboptimal among rheumatoid arthritis patients due to several reasons including lack of awareness among the patients and healthcare providers,” they wrote.

The team sought to determine vaccination rates among patients treated at the academic-based rheumatology clinic, and to identify any notable gaps in care. The retrospective chart review of adult rheumatoid arthritis patients’ electronic health records was conducted from January — June 2019.

Key patient demographics included age, gender, active treatment for rheumatoid arthritis, and pneumococcal immunization history.

Among the 107 identified patients, mean age was 60.6 years, with a majority (n = 67; 62.6%) being female. Mean rheumatoid arthritis duration was 6.4 years, and two-thirds (65.4%) of all patients were aged 19-64 years old. Nearly all patients (n = 102; 95.3%) were on traditional DMARDs therapy; 30.8% were on biologic agents.

Just 10 (9.3%) of all patients were compliant with the age-appropriate pneumococcal vaccination series per the ACR and CDC guidelines. Of them, 8 patients were ≥65 years old, and 2 were 19-64.

Investigators noted study limitations included the prospect of vaccines being received outside of the clinic which may not have been documented, incomplete patient records from referring physicians, and potentially undocumented patient refusal of vaccines.

That said, the overall limited rate of guided pneumococcal vaccine adherence among rheumatoid arthritis patients—especially among those younger than 65 years—was significantly concerning.

“Future steps to increase adherence rates include educating healthcare providers and patients on the importance of adhering to current immunization standards, ensuring adequate supply of vaccines in the clinic, and integrating outside medical information into our EHR,” investigators concluded.

The study, “Identifying Prevalence of Pneumococcal Vaccinations Among Rheumatoid Arthritis Patients of the Rural Appalachian Population in an Academic Rheumatology Clinic,” was presented at CCR West.