35 Pneumococcal vaccination among immunosuppressed Lupus patients: who vaccinates?

Background Center for Disease control and US department of Health and Human Services recommend Pneumococcal vaccination (PV) for chronic diseases and immunosuppressed. PV is a known quality indicator for patients with Systemic Lupus Erythematosus (SLE). We aimed to study the prevalence rates and predictors of PV in a cohort of SLE patients on immunosuppressive medications (ISM). Methods Data were obtained through self-report questionnaires and medical chart review of 150 patients with SLE seen in rheumatology clinic at an academic center. Ninety four patients were eligible for PV based on ISM use (current use of any ISM other than hydroxychloroquine or current prednisone 7.5 mg daily for 3 months or age 65 years). Information on rheumatologist recommendation/receipt of PV 23 in the preceding 5 years was collected by self-report in the questionnaire and/or from chart review. Information was also collected on demographics (age, gender, race, education, insurance), physician (having a primary care physician (PCP), the volume of SLE patients seen by each rheumatologist in the past 4 months) and severity and duration of SLE (ACR classification criteria, disease activity, damage, medications). Rheumatologists SLE volume was categorized as 0–50, 50–100 and >100. Univariate and Stepwise Binary logistic regression analysis were done to study predictors and most parsimonious model for PV (dependent variable). Results Mean (SD) age of the cohort was 45.9 (15.0) years, 90% were women: 52% African-American, 26% Caucasian, 7% Hispanic, 13% Asian and 2% other. Mean (SD) SELENA-SLEDAI and SDI were 4.1 (2.3) and 1.7 (0.9), respectively. Over 90% had a PCP. SLE patient volume of rheumatologist during the previous 4 months was: 21% had 0–50, 27% had 51–75, while 52% had >76 SLE patients. Sixty-five (69.1%) patients had been either recommended or given PV 23 in the preceding 5 years. Univariate correlates were older age, higher education, Caucasian race, having a PCP, rheumatologists SLE patient volume, greater number of ACR criteria met, longer disease duration, higher SLEDAI and SDI scores, lupus nephritis class III-V, treatment with steroids (ever), current mycophenolate mofetil or biologic use. On multivariate analysis none retained independent significance. On stepwise analysis odds of being recommended/receiving PV were twice with every increase in Rheumatologists SLE patient volume by 50. Conclusions The volume of lupus patients seen by rheumatologists is independently associated with pneumococcal vaccination. Physician and patient education towards importance of preventive measures in SLE are needed to meet this important quality index. Funding Source(s): None