AUTHOR=Thomas Konstantinos , Lazarini Argyro , Kaltsonoudis Evripidis , Voulgari Paraskevi V. , Drosos Alexandros A. , Repa Argyro , Sali Ainour Molla Ismail , Sidiropoulos Prodromos , Tsatsani Panagiota , Gazi Sousana , Fragkiadaki Kalliopi , Tektonidou Maria G. , Sfikakis Petros P. , Katsimbri Pelagia , Boumpas Dimitrios , Argyriou Evangelia , Boki Kyriaki A. , Karagianni Konstantina , Katsiari Christina , Evangelatos Gerasimos , Iliopoulos Alexios , Grika Eleftheria P. , Vlachoyiannopoulos Panagiotis G. , Dimitroulas Theodoros , Garyfallos Alexandros , Melissaropoulos Konstantinos , Georgiou Panagiotis , Georganas Constantinos , Vounotrypidis Periklis , Ntelis Konstantinos , Areti Maria , Kitas George D. , Vassilopoulos Dimitrios TITLE=Patterns and factors associated with pneumococcal vaccination in a prospective cohort of 1,697 patients with rheumatoid arthritis JOURNAL=Frontiers in Medicine VOLUME=9 YEAR=2023 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.1039464 DOI=10.3389/fmed.2022.1039464 ISSN=2296-858X 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.