3 Questions About Improving Vaccination Rates in SLE

The risk of developing invasive pneumococcal infection is exceedingly higher among patients with systemic lupus erythematosus (SLE) compared with the general population. However, the rate of vaccination is less than 25% among individuals with SLE.

Shivani Garg, MD, assistant professor in the Division of Rheumatology at University of Wisconsin School of Medicine and Public Health, is the lead author of a study¹ that focused on improving the rate of combination pneumococcal vaccination—pneumococcal polysaccharide vaccine 23 and pneumococcal conjugate vaccine 13—among individuals with SLE in an adult academic rheumatology practice. 

In the study, Garg and colleagues used physician- and staff-based surveys to evaluate underlying barriers in providing vaccination. The researchers then created a multifaceted intervention that included pre-visit planning, day-of-visit planning, weekly review, and monthly feedback.

Rheumatology Consultant caught up with Dr Garg about her research. 

Rheumatology Consultant: What prompted you to conduct your study?

Shivani Garg: Individuals with lupus are at 13 times higher risk of developing invasive pneumococcal infections and at 8 times higher risk of developing pneumonia, which leads to increased hospitalization rates. Individuals with lupus have genetic polymorphism, making them susceptible to pneumococcal infections. With the new vaccine guidelines, the combination pneumococcal vaccination is considered to have boarder coverage, better immunogenicity, and better ability to prevent pneumococcal pneumonia, as well as invasive pneumococcal infections. Despite the evidence of good immunogenicity, the rate of vaccination is less than 25%. Hence, we designed this study to understand barriers to vaccination and overcome those barriers.

RHEUM CON: How can the findings from your study help rheumatology practices increase vaccination rates?

SG: The Centers for Disease Control and Prevention and the European League Against Rheumatism recommend the combination vaccination to all individuals with lupus. Understanding barriers to vaccinations at clinical practice can help plan better strategies to improve low vaccination rates. Simple strategies, as used in our study, as well as frequent reminders to physicians, enrolling with state immunization records, overcoming gaps regarding motivation, and understanding vaccination can help improve vaccination rates in busy clinical practice. Fatigability is a limitation for quality improvement steps, but this can be targeted by involving staff and physicians with monthly graphs and setting monthly achievable targets.

RHEUM CON: What is the clinical significance of your study?

SG: A targeted multidimensional approach can help in effectively overcoming barriers to vaccination in a busy clinical setting. Integrated workflow and sharing performance data can dramatically increase the rates of combination pneumococcal vaccination in adult patients with SLE. Our quality project design can serve as a model that can be adapted by other specialty clinics to achieve higher vaccination standards.

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Reference: 
1)    Garg S, Tsagaris K, Cozmuta R, Lipson A. Improving the combination pneumococcal vaccination rate in systemic lupus erythematosus patients at an adult rheumatology practice. J Rheumatol. 2018;45(12):1656-1662. doi:10.3899/jrheum.171377.