626 - Factors Associated with Pneumococcal Vaccination in Immunosuppressed Children with Rheumatologic Conditions

Poster Number: 626
Publication Number: 626.200

Zachary J. Pettigrew, Cone Health Children's Services, Durham, NC, United States; Feng-Chang Lin, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Lang Li, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Peyton J. Thompson, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States

Background:
The CDC recommends that children on long-term immunosuppressive therapy (IT) for rheumatologic conditions receive an extended pneumococcal vaccine series (EPVS), consisting of 1 dose of conjugate vaccine (PCV13, if not previously received) followed by 2 doses of polysaccharide vaccine (PPSV23, 5 years apart), due to increased risk of invasive pneumococcal disease. While overall EPVS rates are low for this population, little is known about factors associated with vaccination uptake.

Objective: To describe factors that impact receipt of EPVS for children on IT for rheumatologic conditions.

Design/Methods:
We performed a retrospective chart review of children 6-18 years old who received systemic, long-term IT for rheumatologic conditions within the University of North Carolina Health system from 11/2014-10/2019. Those on IT for non-rheumatologic conditions and those with a history of malignancy or hematopoietic stem cell transplant were excluded. Univariate and multivariate logistic regression analyses were performed to identify clinical and demographic factors associated with receipt of at least one EPVS vaccine, with multinomial logit regression used to analyze the categorized outcomes based on receipt of none (“non-vaccinated”), one (PCV13 or PPSV23, “partially-vaccinated”), or two (PCV13 and PPSV23, “adequately-vaccinated”) vaccines.

Results: 497 children met inclusion criteria with 68 (14%) receiving at least one EPVS vaccine (Table 1). Children with a diagnosis of lupus versus other conditions (aOR 8.13, 95%CI 3.93-16.83), those taking >3 IT drugs during their lifetime (aOR 6.38, 95%CI 2.49-16.35), and those who were older at study onset (mean age 13.8y versus 10.7y respectively, aOR 1.27, 95%CI 1.15-1.31; Table 2) were more likely to be vaccinated. The multinomial analysis found no statistically significant difference between adequately- and partially-vaccinated groups. The total number of encounters, number of specialties involved in care, and route of IT administration were not related to EPVS status.Conclusion(s):
For children on IT for rheumatologic conditions at a tertiary pediatric hospital in NC, pneumococcal vaccination rates were low, consistent with existing literature. In our small cohort, EPVS uptake was higher for certain populations—those with lupus, on more IT drugs, and of older age—but did not significantly differ between those receiving 1 and >2 vaccines, suggesting that barriers to EPVS initiation in other at-risk groups likely exist. Future efforts should focus on identifying such barriers and improving access to pneumococcal vaccination in a larger population of children on IT.

Table 1: Demographic and Clinical Characteristics of Children on IT for Rheumatologic Conditions at UNCP-values were calculated by comparing non-vaccinated, partially-vaccinated, and adequately-vaccinated groups. Abbreviations: IPD = invasive pneumococcal disease; IT = immunosuppressive therapy; SD = standard deviation
Table 2: Adjusted Odds Ratios for EPVS Uptake Among Children on IT for Rheumatologic ConditionsTable 2: Adjusted odds ratios for EPVS uptake based on a variety of demographic and clinical factors. CI = confidence interval; * denotes statistically significant differences between groups.