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Insufficient vaccination rates in patients with systemic lupus erythematosus in a German outpatient clinic

Unzureichende Impfraten bei Patienten mit systemischem Lupus erythematodes in einer deutschen Hochschulambulanz

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Abstract

Background

Patients with systemic lupus erythematosus (SLE) are at an increased risk of acquiring infections due to the disease itself and the immunosuppressive therapy. Furthermore, infections largely contribute to overall SLE mortality. Vaccinations against preventable diseases are therefore of particular importance for these patients.

Aims

To estimate vaccination frequencies among patients with SLE, we studied patients in a survey and calculated vaccination rates based on their vaccination documents. Patients were recruited from our outpatient clinic during one of their routine visits. For the statistical analysis, they have been stratified by age (≥60 vs. <60 years) for further subgroup analysis due to age-related recommendations for some vaccines.

Results

Among the patients studied (n = 68) we found rather low vaccination rates in particular for the strongly recommended vaccines against pneumococcus and influenza (21% and 49%, respectively). Furthermore, protection rates for important basic vaccinations were found to be low, e. g. pertussis protection for 31% of patients. Beside these findings, we saw age-dependant differences for a variety of vaccines: while the pneumococcus vaccination was more often given to patients ≥60 years, measles, pertussis, diphtheria and hepatitis B vaccinations were found significantly more often in younger patients.

Conclusions

Vaccination rates have to be improved among SLE patients, in particular for vaccines protecting from respiratory tract infections such as pneumococcus and influenza.

Zusammenfassung

Hintergrund

Patienten mit systemischem Lupus erythematodes (SLE) haben aus 2 Gründen ein erhöhtes Infektionsrisiko: durch die Krankheit selbst und durch die erforderliche immunsuppressive Therapie. Darüber hinaus tragen Infektionen wesentlich zur Gesamtmortalität von SLE-Patienten bei, daher sind Impfungen gegen vermeidbare Erkrankungen von besonderer Bedeutung.

Ziele

Die Ermittlung der Impfraten in einer ambulanten Kohorte von SLE-Patienten erfolgte anhand der bei den Patienten vorhandenen Impfdokumente. Die Patienten wurden über unsere rheumatologische Hochschulambulanz während einer ihrer Routinebesuche rekrutiert. Da einige Impfungen altersabhängig empfohlen werden, erfolgte eine statistische Auswertung auch nach dem Lebensalter (≥60 vs. <60 Jahre).

Ergebnisse

Innerhalb des untersuchten Patientenkollektivs (n = 68) fanden sich niedrige Impfraten, insbesondere für die empfohlenen Impfungen gegen Pneumokokken und Influenza (21 bzw. 49 %). Auch die Raten für Standardimpfungen waren niedrig, gegen Pertussis beispielweise lag sie bei 31 %. Altersabhängige Unterschiede zeigten sich darüber hinaus für verschiedene Impfungen: Während die Pneumokokkenimpfung häufiger bei Patienten ≥60 Jahren appliziert worden war, waren jüngere Patienten signifikant häufiger gegen Masern, Pertussis, Diphtherie und Hepatitis B geimpft worden.

Schlussfolgerungen

Die Impfraten für SLE-Patienten müssen verbessert werden, insbesondere für Impfungen gegen Erreger, die den Respirationstrakt betreffen (z. B. Pneumokokken, Influenza).

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The authors received no financial support for the research, authorship, and/or publication of this article.

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Correspondence to M. Krasselt MD.

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M. Krasselt and O. Seifert declare that they have no competing interests. C. Baerwald received lecture fees from Merck, MSD, Mundipharma and Pfizer.

The ethics committee of the University of Leipzig has approved the design of the study, and written informed consent was obtained from each patient before enrolment.

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U. Müller-Ladner, Bad Nauheim

U. Lange, Bad Nauheim

Authors’ contributions: M. Krasselt performed the statistical analysis, interpreted the data and drafted the manuscript. C. Baerwald contributed to data interpretation and was involved in manuscript drafting. O. Seifert collected the data, conceived the project and was involved in manuscript preparation. All authors read and approved the final manuscript.

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Krasselt, M., Baerwald, C. & Seifert, O. Insufficient vaccination rates in patients with systemic lupus erythematosus in a German outpatient clinic. Z Rheumatol 77, 727–734 (2018). https://doi.org/10.1007/s00393-017-0410-5

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