Investigating factors associated with respiratory syncytial virus vaccination and breakthrough infection among patients with systemic autoimmune rheumatic diseases

Objective To investigate respiratory syncytial virus (RSV) vaccine uptake, associations, and breakthrough infection among patients with systemic autoimmune rheumatic diseases (SARDs). Methods We performed a retrospective cohort study investigating RSV vaccination among patients with SARDs at Mass General Brigham (Boston, MA). We identified all patients with SARDs who were 60 years or older and thus eligible to receive the RSV vaccine between 5/2023 to 2/2025. We used multivariable logistic regression to identify factors associated with RSV vaccination. Among the vaccinated, we described documented cases of laboratory-confirmed breakthrough RSV infection. Results Among 10,587 patients with SARDs (median age 71.7 years, 72.4% female) eligible for RSV vaccination, 1,075 (10.2%) received RSV vaccination. Factors associated with higher odds of RSV vaccination included higher median census-tract household income and comorbidities such as cancer and interstitial lung disease. Associations with lower odds of RSV vaccination included Black race, lack of previous influenza or COVID-19 vaccinations, and glucocorticoid use. RSV vaccination was not associated with specific SARD types or disease-modifying antirheumatic drugs (DMARDs), including CD20 inhibitors. Among the 1,075 who were vaccinated, there were 9 (0.8%) documented cases of RSV breakthrough infection (2 hospitalizations and no deaths). Conclusion Only 10.2% of eligible SARD patients received RSV vaccination. Glucocorticoid users were less likely to receive RSV vaccination, while specific SARD types and DMARDs were not associated. While some predictors of vaccine uptake are observed in this dataset, there are many unmeasured factors that may play a role in vaccine uptake. There were few documented breakthrough infections and no deaths. Future studies are needed to optimize RSV vaccine use and establish safety and efficacy in this vulnerable population.