Vaccination completeness in children with rheumatic diseases: A longitudinal, observational multicenter cohort study in Switzerland

Tatjana Welzel; Jasmin Kuemmerle-Deschner; Constantin Sluka; Raffaella Carlomagno; Elvira Cannizzaro Schneider; Daniela Kaiser; Michael Hofer; Veronique Hentgen; Andreas Woerner

doi:10.3389/fped.2022.993811

Vaccination completeness in children with rheumatic diseases: A longitudinal, observational multicenter cohort study in Switzerland

Front Pediatr. 2022 Sep 8:10:993811. doi: 10.3389/fped.2022.993811. eCollection 2022.

Authors

Affiliations

¹ Pediatric Rheumatology, University Children's Hospital Basel, University of Basel, Basel, Switzerland.
² Department of Pediatrics, Division of Pediatric Rheumatology, Autoinflammation Reference Center Tuebingen (arcT), University Hospital Tuebingen, Tuebingen, Germany.
³ European Reference Network for Rare and Low Prevalence Complex Diseases, Network Immunodeficiency, Autoinflammatory and Autoimmune Diseases (ERN RITA), Tuebingen, Germany.
⁴ Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland.
⁵ Pediatric Rheumatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
⁶ Pediatric Rheumatology, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
⁷ Pediatric Rheumatology, University Children's Hospital Zurich, Zurich, Switzerland.
⁸ Pediatric Rheumatology, Children's Hospital Lucerne, Lucerne, Switzerland.
⁹ Reference Center for Autoinflammatory Diseases CeRéMAIA, Versailles Hospital, Versailles, France.

Abstract

Introduction: Children with pediatric inflammatory rheumatic diseases (PRD) have an increased infection risk. Vaccinations are effective to avoid vaccine-preventable diseases. This study aimed to assess the vaccination completeness in Swiss PRD patients stratified by immunosuppressive treatment (IST).

Materials and methods: This multicenter observational cohort study of PRD patients was performed in Basel, Geneva, Lucerne, Lausanne, and Zurich in PRD patients aged < 18 years included in the Juvenile Inflammatory Rheumatism Cohort. Completeness was assessed for i) the overall vaccination status (Swiss national immunization program (NIP) and specific additional PRD-recommended vaccinations), ii) for all and each vaccination of the NIP at PRD diagnosis and reference date (RefD) and iii) all and each specific additional PRD-recommended vaccination at RefD. Completeness was assessed over the disease course and stratified by IST.

Results: Of 616 eligible patients, 234 children were analyzed. Of these, 147 (63%) were girls. Median age at PRD diagnosis was 6.5 years (IQR 2.9-10.3) and 10.9 years at RefD (6.9-14.3). The median follow-up since PRD diagnosis was 3 years (1.1-5.5). 120/234 children received IST. At RefD, overall vaccination completeness was 3.8% (9/234 children), completeness for the NIP vaccinations was 70.1% (164/234 children; IST 65%, no IST: 75.4%) and for all specific additional PRD-recommended vaccinations was 3.8% (9/234 children; IST 2.5%; no IST 5.3%). Vaccination completeness against pneumococcal disease, hepatitis B virus, and human papilloma virus (HPV) was 50.4, 20, 37.9%, respectively. In 25/35 children with negative varicella zoster virus history vaccination status was complete (IST: 94.4%, no IST: 47%). Annual non-live influenza vaccination was complete in 24.2% of children during IST; adherence decreased over the disease course.

Discussion: This study identified a low overall vaccination completeness in children with PRD. Particularly, the completeness of specific additional PRD-recommended vaccinations was low. If not performed early after PRD diagnosis, vaccination status remained frequently incomplete. Close collaboration between pediatrician and rheumatologist to improve vaccination completeness is essential. Exchange of vaccination records, standardized assessment of specific PRD-recommended vaccinations and those of the NIP, and annual reminder for influenza vaccination are crucial to improve vaccination completeness in this vulnerable pediatric population.

Keywords: immunosuppression; infection risk; vaccination; vaccination adherence; vaccination recommendations.