Pneumococcal Vaccination in Patients With Rheumatic Diseases

Kevin Deane, MD


March 11, 2011

In This Article

Routinely Measuring and Reporting Pneumococcal Vaccination Among Immunosuppressed Rheumatology Outpatients: The First Step in Improving Quality

Desai SP, Turchin A, Szent-Gyorgyi LE, et al
Rheumatology (Oxford). 2011;50:366-372


Infections with Streptococcus pneumonia may be a significant cause of morbidity/mortality in patients with rheumatic diseases.[1,2,3,4] To guide the use of vaccines to prevent disease, the Centers for Disease Control and Prevention (CDC) has published guidelines for the use of vaccines, including the 23-valent polysaccharide pneumococcal vaccine.[5] These guidelines recommend that all patients 65 years of age and older receive the pneumococcal vaccine; moreover, they recommend that patients younger than 65 years receive the vaccine if they have a condition or use medications that can lower the immune system. Per the CDC, such qualifying conditions include smoking, chronic lung disease, alcoholism, diabetes, cirrhosis, HIV, organ transplant, sickle cell disease, renal failure, lymphoma or generalized malignancy, and asplenia. Of interest, however, the CDC does not specifically include rheumatic diseases in this list.

The immunosuppressive medications listed by the CDC that may qualify a patient for early pneumococcal vaccine include chronic steroid therapy (dose not specified), and radiation therapy (other immunosuppressive medications are not specified). Patients who received the pneumococcal vaccine when they were younger than age 65 should receive a second vaccine after the age of 65 or 5 years after their initial vaccine; there are no recommendations for additional vaccines beyond this. The American College of Rheumatology (ACR) recommends that patients with rheumatoid arthritis (RA) who are taking leflunomide, methotrexate, sulfasalazine, and biologics receive the pneumococcal vaccine, preferably prior to the initiation of immunosuppression, although vaccination recommendations for patients with other rheumatic diseases have not been clearly outlined by the ACR.[6]

Even with these recommendations in place, previous data have shown that many patients with rheumatic diseases who meet the indications for vaccination are not receiving the appropriate vaccines.[7] With these issues as background, Desai and coworkers used electronic medical records to determine vaccination rates in rheumatology outpatients. This was the first step towards implementing quality improvement efforts in the field of vaccinations.


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