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Background: Patients with immune-mediated rheumatic diseases (IMRD) undergoing immunosuppressive treatment are at greater risk of infection. Infectious are one of the main causes of death in this group of patients. Although vaccination impacts in reducing the incidence of infections, the vaccine coverage of the general population in Brazil has been falling over the years.
Objectives: To present the preliminary results on influenza and pneumococcal (PCV10/13 and PPV23) vaccination coverage in patients with juvenile IMRD in Brazil.
Methods: This is a cross-sectional multicenter study designed to evaluate the vaccination coverage of patients under 18 years, from 2019 to 2022. Investigators from Pediatric Rheumatology outpatient clinics representing the five regions of Brazil were invited to participate. The clinical data were collected in medical records and in vaccination cards using a standardized protocol. Vaccination was evaluated considering the immunization schedule for the current year of inclusion based on the National Immunization Program and Reference Centers for special groups. Clinical and demographic data were sex, age, education level, diagnosis, time since diagnosis, current and previous treatments, disease activity and analysis of the vaccination card. Results were expressed using frequencies and percentages for qualitative variables, and measures of central tendency (mean or median) and measures of dispersion (standard deviation - SD) for quantitative ones. Comparisons of variables were performed using Student’s t-test or Mann-Whitney test. A significance level of 5% was considered.
Results: Two-hundred twenty-nine patients were included, 48% were diagnosed with juvenile idiopathic arthritis and 23% with systemic lupus erythematosus; 70.8% were female with mean age of 12 years (SD 4.17) and average time of diagnosis of 3.77 years (SD 3.17). Regarding treatment, 22.68% were using biological agents, 8.24% were in corticosteroids (>20mg/day or >2mg/kg/day or pulse therapy with methylprednisolone), and 2.4% in cyclophosphamide. According to specific disease activity criteria, 51.89% of patients were in remission. Of total, 178 (61.16%) patients were not vaccinated against influenza in last campaign; 130 of 188 (69.14%) patients had complete schedule for PCV10/13 but only 12.4% (31/250) received PPV23.
Conclusion: These results show the low vaccination coverage against influenza and pneumococcal vaccines among patients with juvenile IMRD. Additional studies are necessary to identify the reasons to the decline the vaccination among immunosuppressed children.
REFERENCES: [1] MAKAROVA E et al. Vaccination coverage in children with juvenile idiopathic arthritis, inflammatory bowel diseases, and healthy peers: Cross-sectional electronic survey data. World J Clin Pediatr 2023 March 9; 12(2): 45-56.
[2] Chevallard M et. al. Active vaccination campaign to increase seasonal influenza vaccination coverage: a monocenter experience in a cohort of Italian patients with systemic autoimmune diseases.
Clinical Rheumatology
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[3] Balažiová B, Kuková Z, Mišíková D, Novosedlíková K, Dallos T. Real-life vaccination coverage in Slovak children with rheumatic diseases. Front. Pediatr. 10:956136. doi: 10.3389/fped.2022.956136.
[4] Furer V, Rondaan C, Heijstek MW, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseasesAnn Rheum Dis 2020;79:39–52
Acknowledgements: NIL.
Disclosure of Interests: None declared.