Variability in vaccination practices in children with rheumatic diseases: results of a childhood arthritis and rheumatology research alliance (CARRA)-wide survey

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. 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. 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. 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.