Vaccination coverage of influenza and pneumococcal vaccines in patients with rheumatic diseases: a systematic review and meta-analysis.

Abstract

Current guidelines recommend influenza and pneumococcal vaccination in the majority of patients with rheumatic diseases. This study aimed to summarize the coverage of influenza and pneumococcal vaccines among these patients. A literature search was conducted in PubMed, Embase, Web of Science and Scopus for eligible studies. Vaccination rate was presented as a percentage with 95% confidence intervals (CI). Clinical characteristics of the vaccinated patients were shown as the mean difference (MD) or odds ratio (OR) with 95% CI. Sensitivity analyses, subgroup analyses and meta-regression were performed to identify sources of heterogeneity. A total of 51 studies were identified. The pooled vaccination rates of influenza vaccine in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), spondylarthritis (SpA) and psoriasis arthritis (PsA) were 50%, 42%, 43% and 53%, respectively. The corresponding rates of pneumococcal vaccination in patients were 37%, 30%, 39% and 41%, respectively. Compared with unvaccinated RA patients, vaccinated RA patients were associated with older age and an increased prevalence of comorbidities. Geographical location and use of disease-modifying antirheumatic drugs were two significant factors affecting the heterogeneity of the study results. A larger proportion of patients received vaccine education from rheumatologists rather than general practitioners, and the two major reasons for not receiving vaccination were "lack of awareness" and "not offered by doctors". Influenza and pneumococcal vaccine coverage was still suboptimal in patients with rheumatic diseases. Enhancing vaccine education from physicians and improving awareness of patients may become two important approaches to improve vaccination rates.