THU0683 COVERAGE, PREDICTORS OF VACCINATION AND FREQUENCY OF SEVERE INFECTIONS DUE TO STREPTOCOCCUS PNEUMONIAE IN A COHORT OF PATIENTS WITH CHRONIC INFLAMMATORY ARTHRITIS WITHIN AN EIGHTEEN-YEAR PERIOD
Authors: Sebastian C Rodriguez-García, Raul Castellanos-Moreira, Victoria Hernandez, Roberto Gumucio, Anna Vilella, Carolina García-Vidal, Juan D. Cañete, Julio Ramirez, Raimón Sanmartí, Jose A. Gómez-Puerta
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Community-acquired pneumonia (CAP), the most common pneumococcal infection, is a leading cause of morbidity and mortality among immunocompromised hosts. Although vaccination against <i>Streptococcus Pneumoniae</i> is recommended by international guidelines, most studies report a sub-optimal coverage. <h3>Objectives</h3> To describe the pneumococcal vaccination coverage, predictors for vaccination uptake and frequency of severe CAP and invasive pneumococcal disease during the study period. <h3>Methods</h3> We performed a cross-sectional study using electronic medical record data from October 2000 to October 2018, including patients diagnosed with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and Ankylosing Spondylitis (AS), treated with biologic (bDMARD) and conventional synthetic DMARD (csDMARD) with or without glucocorticoids (GC), followed-up at a referral centre. Since pneumococcal vaccination guidelines have changed during the study period, patients who received at least one dose of any of the available vaccines were defined as being "ever-vaccinated" whereas those who received a complete scheme defined as one dose of conjugated vaccine and one of polysaccharide vaccine 8 weeks apart were defined as having "optimal vaccination". Predictors of vaccination were analyzed using logistic regression modelling using a set of covariates selected according to the literature. Model assessment was done using Akaike information criterion. To analyze the frequency of severe infections we defined two outcomes: Severe CAP: An episode requiring hospitalization or intravenous antibiotic treatment Invasive pneumococcal disease (IPD): an infection confirmed by the isolation of the micro–organism from a normally sterile site (i.e. blood). <h3>Results</h3> A total of 279 patients were included, their main clinical features are shown in Table 1. The vaccination coverage was 38.7% and 13.3% overall when analyzing as "ever-vaccinated" and having "optimal vaccination" respectively. A 66% of patients were vaccinated in primary care with a 7% of optimal vaccination whereas the remaining ones received vaccination in referral centres with an 85.3% of optimal vaccination. After adjustment in a multivariate model, age, presence of bronchiectasis, history of severe CAP, current use of csDMARD or GC were predictors of being ever-vaccinated against <i>Streptococcus Pneumoniae</i>. (Table 2) During the study period, 27 (10%) episodes of severe CAP and 4 of IPD were identified, 8 of the former with evidence of pneumococcal infection (either positive urine antigens or isolation in sputum). <h3>Conclusion</h3> Pneumococcal vaccination coverage remains lower than expected with most patients vaccinated in primary care and not receiving the current recommended scheme. Age, bronchiectasis, history of severe CAP and current use of csDMARD or GC were independent predictors of receiving vaccination. The frequency of severe CAP and IPD was 10% and 1,43% within this cohort. <h3>Disclosure of Interests</h3> Sebastian C Rodriguez-García: None declared, Raul Castellanos-Moreira Speakers bureau: MSD, Lilly, Victoria Hernandez: None declared, Roberto Gumucio: None declared, Anna Vilella: None declared, Carolina García-Vidal Speakers bureau: Lilly, Pfizer, Juan D. Cañete: None declared, Julio Ramirez: None declared, Raimón Sanmartí Speakers bureau: PFIZER, SANOFI, LILLY, MSD, UCB, NOVARTIS, JANSSEN, Jose A. Gómez-Puerta Consultant for: Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen, MSD, Pfizer, Roche