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Background: Patients with autoimmune inflammatory rheumatic diseases (AIIRD) are susceptible to pneumococcal infection. Despite The European Alliance of Associations for Rheumatology (EULAR) recommendations for pneumococcal vaccination for most patients with AIIRD 1, the uptake of pneumococcal vaccination remains suboptimal. COVID-19 pandemic has highlighted the importance of vaccination. Yet, its impact on pneumococcal vaccination in AIIRD patients is unknown. Objectives: 1.To describe temporal trends in PCV13 vaccination during 2017-2020 in order to explore the impact of the onset of the COVID-19 pandemic on PCV13 vaccination patterns in patients with common AIIRD, using data from Maccabi Healthcare Services MHS, the 2nd largest of state-mandated health plans in Israel. 2.To describe temporal trends in the characteristics of AIIRD patients newly vaccinated with PCV13 in 2017-2020. Methods: A retrospective study was performed using de-identified MHS electronic healthcare data, including adult patients with rheumatoid arthritis (RA; ICD-9: 714.0), psoriatic arthritis (PsA; ICD-9: 696.0), systemic lupus erythematosus (SLE; ICD-9: 710.0), or ankylosing spondylitis (AS, ICD-9: 720.0). PCV13 coverage was described by calendar year among prevalent patients at 4 time points: 31/12/2017, 31/12/2018, 31/12/2019 and 31/12/2020, overall and by demographic and clinical characteristics. Vaccine coverage rates were calculated on 31 December of each calendar year by dividing the number of vaccinated individuals by the total number of prevalent patients. The annual percentage change in vaccination coverage (VC) was calculated (VC minus VC in previous year/ VC in previous year X 100). Characteristics of patients newly-vaccinated with PCV13 were compared across calendar years using Chi-squared and Kruskal-Wallis tests. Results: The study population characteristics are presented in Table 1 (total Ns: 15898 2017, 16736 2018, 17731 2019 and 1878 2020). Among the 2020 prevalent population, the median age was 58.6 years (64.9% female) and the median AIIRD duration was approximately 10 years, with 69.0% and 56.4% having previously been treated with DMARDs ever and in the past 5 years, respectively. Across all years, vaccination coverage with PCV13 was highest in the following subgroups: men, age ≥65 years, high socioeconomic status (SES), and RA patients, followed by PsA and SLE in a sequential order (Figure 1). Overall, PCV13 vaccination coverage increased from 2.3% at the end of 2017 to 13.0% at the end of 2019, then reached 31.1% at the end of 2020. Similar trends over time were observed in subgroup analyses by diagnosis and age groups. The annual percentage increase in PCV13 vaccination coverage from 2019 to 2020 was largest among patients with PsA. PCV13 coverage among patients without prior use of anti-rheumatic treatments remained below 2% in 2017-2019, increasing to 7.8% by the end of 2020. Among 5659 patients who were newly vaccinated with PCV13 in 2017-2020, the median age at PCV13 vaccination increased over time from 57 years in 2017-2018 to 61-9 years in 2020. A significant change in SES distribution among PCV13-vaccinated patients was observed over time; while an increasing proportion of vaccinated patients resided in low SES areas (from 2.2% in 2017 to 22.6% in 2019), 2020 was characterized by a relatively higher SES. Overall, 9.7% of PCV-13 vaccinated patients were never treated with DMARDs, with no clear trend observed over time. Over time, smokers and patients with comorbidities, such as diabetes and hypertension, accounted for a relatively higher proportion of PCV13-vaccinately patients. While 2017-2019 was characterized by an increasing prevalence of immunosuppression (from 22.4% to 28.8%), patients vaccinated in 2020 were relatively less likely (26.8%) to be treated with immunosuppressants. Conclusion: The results of the real-world analysis of patients with AIIRD in a large healthcare database in Israel indicate that PCV13 vaccination coverage increased over time across major demographic and comorbidity subgroups, prior to and during 2020, the start of the COVID-19 pandemic. REFERENCES: 1 Furer V. Ann. Rheum. Dis.79, 39–52 (2020). Acknowledgements: NIL. Disclosure of Interests: Victoria Furer: None declared, Clara Weil: None declared, Sivan Gazit: None declared, Gabriel Chodik: None declared, Shera Ann Slav AbbVie Inc., AbbVie Inc., Shiran Nafterlberg Blonder AbbVie Inc., AbbVie Inc., Ori Elkayam: None declared.
Furer et al. (Sat,) studied this question.