Patients with rheumatoid arthritis, lupus, and other rheumatic conditions are more at risk for complications and death from pneumonia, meningitis, and other bacterial infections, yet most have not been vaccinated against infection.
UT Southwestern rheumatologist Elena K. Joerns, M.D., recommends that all patients with rheumatic disorders receive a pneumococcal vaccine to protect against the Streptococcus pneumoniae bacteria, which can cause infections in the ears, sinuses, lungs, spinal fluid, or bloodstream and lead to severe symptoms and hospitalization.
“In people who take immunosuppressant drugs to treat chronic inflammatory conditions, pneumococcal infections are more likely to be severe due to the weakened immune system,” said Dr. Joerns, Instructor in Internal Medicine at UT Southwestern.
According to the Centers for Disease Control and Prevention, just 23.9% of adults ages 64 and younger with a higher risk of infection due to various conditions had received one or more vaccine doses in 2020.
At UT Southwestern, a team in the West Campus Rheumatology-Internal Medicine Subspecialties Clinic has taken steps to boost vaccination rates among its patients, offering greater flexibility to provide vaccines during the check-in process or while patients wait to be seen by a physician.
“These patients often don’t have a lot of time during their clinic visits because they’re dealing with other complex issues, and there is a lack of awareness and knowledge about these vaccines,” Dr. Joerns said.
As a result of the effort, the percentage of unvaccinated patients visiting the clinic decreased from 68.2% in 2019 to 40.5% in 2021, the team reported this month in The Journal of Rheumatology.
The Advisory Committee on Immunization Practices, which provides guidance to the CDC, updated its recommendations in 2022 to give providers and patients the option of a new, single-dose pneumococcal vaccine rather than a three-dose regimen previously recommended, making vaccination more convenient.
Dr. Joerns noted that the new protocol could be useful for administering vaccinations in other clinical settings. “Our data showed that this protocol, which shifts vaccination to be standardized and done as part of patient check-in, allows vaccination to be completed more efficiently and effectively,” she said.
This quality improvement project involving the Clinic was supported by Pfizer Inc. in partnership with the Alliance for Continuing Education.
Elena K. Joerns et al, Implementing a Nurse-Driven Protocol for Pneumococcal Vaccination in an Academic Rheumatology Clinic, The Journal of Rheumatology (2022). DOI: 10.3899/jrheum.220771
Journal of Rheumatology.
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