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. 2023 Jan 9:9:1039464.
doi: 10.3389/fmed.2022.1039464. eCollection 2022.

Patterns and factors associated with pneumococcal vaccination in a prospective cohort of 1,697 patients with rheumatoid arthritis

Konstantinos Thomas  1 , Argyro Lazarini  1 , Evripidis Kaltsonoudis  2 , Paraskevi V Voulgari  2 , Alexandros A Drosos  2 , Argyro Repa  3 , Ainour Molla Ismail Sali  3 , Prodromos Sidiropoulos  3 , Panagiota Tsatsani  4 , Sousana Gazi  4 , Kalliopi Fragkiadaki  1 , Maria G Tektonidou  1 , Petros P Sfikakis  1 , Pelagia Katsimbri  1 , Dimitrios Boumpas  1 , Evangelia Argyriou  5 , Kyriaki A Boki  5 , Konstantina Karagianni  6 , Christina Katsiari  6 , Gerasimos Evangelatos  7 , Alexios Iliopoulos  7 , Eleftheria P Grika  1 , Panagiotis G Vlachoyiannopoulos  1 , Theodoros Dimitroulas  8 , Alexandros Garyfallos  8 , Konstantinos Melissaropoulos  9 , Panagiotis Georgiou  9 , Constantinos Georganas  10 , Periklis Vounotrypidis  11 , Konstantinos Ntelis  12 , Maria Areti  13 , George D Kitas  1   14 , Dimitrios Vassilopoulos  1
Affiliations

Patterns and factors associated with pneumococcal vaccination in a prospective cohort of 1,697 patients with rheumatoid arthritis

Konstantinos Thomas et al. Front Med (Lausanne). .

Abstract

Introduction: Patients with rheumatoid arthritis (RA) are at increased risk for serious infections. Pneumococcal vaccination is among the most important preventive measures, however, vaccine uptake is suboptimal. We explored the rate and factors associated with pneumococcal vaccination in a contemporary RA cohort.

Materials and methods: Multi-center, prospective, RA cohort study in Greece. Patient and disease characteristics and influenza and pneumococcal vaccinations were documented at baseline and 3 years later.

Results: One thousand six hundred and ninety-seven patients were included and 34.5% had already received at least one pneumococcal vaccine at baseline. Among 1,111 non-vaccinated patients, 40.1% received pneumococcal vaccination during follow-up, increasing the vaccine coverage to 60.8%. By multivariate analysis, positive predictors for pneumococcal vaccination included prescription of influenza vaccine (OR = 33.35, 95% CI: 18.58-59.85), history of cancer (OR = 2.35, 95% CI: 1.09-5.06), bDMARD use (OR = 1.85, 95% CI: 1.29-2.65), seropositivity (OR = 1.47, 95% CI: 1.05-2.05), and high disease activity (DAS28-ESR, OR = 1.33, 95% CI: 1.17-1.51). Male sex (OR = 0.65, 95% CI: 0.43-0.99) was a negative predictor for pneumococcal vaccination during follow-up.

Discussion: Despite increasing rates of pneumococcal vaccine coverage, 40% of RA patients remain unvaccinated. Severe disease, bDMARD use, comorbidities, and more importantly flu vaccination were the most significant factors associated with pneumococcal vaccination, emphasizing the currently unmet need for cultivating a "vaccination culture" in RA patients.

Keywords: biological therapy; comorbidities; infections; rheumatoid arthritis; vaccination.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of vaccination coverage.
FIGURE 2
FIGURE 2
Forest plot of multivariate logistic regression analysis of factors associated with the prescription of pneumococcal vaccine during follow-up.
FIGURE 3
FIGURE 3
Pneumococcal vaccination coverage during follow-up according to the presence of risk factors.
See this image and copyright information in PMC

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