Peer-reviewed article
Variability in vaccination practices in children with rheumatic diseases: results of a childhood arthritis and rheumatology research alliance (CARRA)-wide survey.
Randal De Souza, Beth Rutstein, Maria Schletzbaum-Bowler, Nora Singer, Melanie Kohlheim et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study surveyed North American pediatric rheumatologists about how they approach vaccination for children with autoimmune rheumatic diseases who are receiving immunosuppressive therapies. Researchers found that doctors use highly variable approaches to reviewing and recommending vaccines, with significant differences in practice patterns. Major barriers to vaccination included lack of clinic resources, vaccine hesitancy among families, and unclear communication between specialists and primary care providers. The researchers recommend standardizing vaccination review practices and improving coordination between rheumatologists and primary care doctors to increase vaccination rates in this vulnerable population.
Key points
- 64% of surveyed rheumatology providers responded; up to 90% endorsed diverse approaches to vaccine review with variations by disease and medication
- Immunosuppressive therapy changes prompted providers to assess baseline live vaccine receipt significantly more than non-live vaccines (p < 0.001)
- Provider-identified barriers included lack of clinic resources (58%), patient or parent vaccine hesitancy (27%), and family concerns about vaccines (20%)
- 26% of providers preferred vaccines be administered by primary care providers, yet providers frequently administered influenza and pneumococcal vaccines themselves
- 78% of subspecialty providers communicated vaccine recommendations to primary care providers via clinic notes
Limitations
This survey captures self-reported practices among CARRA network members in North America only, so results may not generalize to other regions or healthcare systems. The study does not measure actual vaccination rates achieved or clinical outcomes, only provider-reported approaches and identified barriers.
Abstract
BACKGROUND: Children with autoimmune and immune-mediated rheumatic diseases (AIIRD) receiving immunosuppressive therapies (IST) are at increased risk of morbidity from vaccine-preventable infections. The 2022 American College of Rheumatology (ACR) guidelines recommend vaccinating all children with AIIRD, with specific recommendations based on IST. Children with AIIRD receiving IST or who are immunocompromised are eligible to receive non-live vaccines, however vaccination rates remain low. The aim of this study was to understand the North American pediatric rheumatology provider approach to vaccine review and reconciliation and identify possible barriers to immunization. METHODS: The Childhood Arthritis and Rheumatology Research Alliance (CARRA) Vaccination Workgroup surveyed member North American pediatric rheumatologists about their vaccination practices when caring for children with AIIRD receiving IST. A 44-question electronic survey was distributed from March-May 2022 among rheumatology providers in the CARRA network. RESULTS: The survey response rate was 64% and up to 90% of rheumatology providers endorsed diverse approaches to vaccine review, with variations related to frequency of review, based on rheumatic disease and medication. Notably, IST changes prompted providers to assess baseline receipt of live vaccines over non-live vaccines (p < 0.001), while providers who endorsed not performing or deferring vaccine review did so less frequently for live compared to non-live vaccines (p < 0.05). Although 26% of surveyed providers indicated they preferred all vaccines be administered by the patient’s primary care provider (PCP), surveyed providers frequently administered influenza and pneumococcal vaccines within their practices. Provider-identified barriers to immunization included lack of clinic resources (58%), patient or parent vaccine hesitancy (27%), and family concerns regarding vaccines (20%). Most subspecialty providers (78%) communicated vaccine recommendations to PCPs using a clinic note. CONCLUSION: Our results highlighted potential modifiable factors for optimizing immunization coverage among children with AIIRD receiving IST. Standardized vaccine review practices and improved communication between rheumatologists and primary care providers can maximize clinical opportunities for improving vaccination rates and increase awareness of the importance of vaccination against vaccine-preventable infections.