2052: Vaccine Uptake in Women with Systemic Lupus Erythematosus (SLE) in a Large Urban Teaching Hospital Serving a High-Risk Population

J. Patricia Dhar¹, Forsythe Hannah², Louis Saravolatz³ and Susanna Szpunar⁴, ¹Ascension St. John Hospital and Wayne State University School of Medicine, Bloomfield Hills, MI, ²Michigan Department of Human and Health Services, Lansing, MI, ³Ascension St John Hospital and Medical Center, Wayne State University School of Medicine (affiliate), Grosse Pointe Woods, MI, ⁴Ascension St. John Hospital, Grosse Pointe Woods, MI

Background/Purpose: Infections are a major cause of morbidity & mortality in patients with systemic lupus erythematosus (SLE), including vaccine-preventable infections. SLE patients are considered to be immunocompromised & thus fall into the Advisory Committee on Immunization Practice's (ACIP) immunosuppressed category. Vaccines for influenza, pneumococcus, pertussis, varicella, & HPV are safe & immunogenic in patients with SLE. Despite the availability of vaccines, vaccine uptake has been generally low in this population, with one reason being that physicians fail to recommend them. We sought to assess vaccine update in SLE patients seen in our large Detroit area community hospital compared to that of the adult Michigan Care Improvement Registry (MCIR) population. MCIR is an immunization database that documents immunizations given to Michigan residents.

Methods: We performed a retrospective chart review of adult patients ages 18-70 with SLE who received care at Ascension St. John Hospital to obtain clinical information on SLE and vaccine uptake. Confirmation of diagnosis of SLE was made using ACR, SLICC, and updated 2019 EULAR/ACR criteria for the diagnosis of SLE. Comparison of vaccine rates of the Ascension St. John SLE cohort recorded in MCIR & the overall adult MCIR population were performed. Vaccine target goals for the SLE & adult MCIR populations were as per the CDC/AICP recommended vaccine schedule for immunosuppressed and immunocompetent persons, respectively with the addition of Shingrix® at least once for SLE and any COVID vaccine for both groups. Deceased SLE patients and males were excluded from the analysis for both groups since there were very few male SLE patients to allow for comparison. Data were analyzed using the chi-squared test.

Results: The study groups included 178 SLE women & 3.410,328 Michigan females in MCIR. The mean age was slightly older for SLE (50 yrs.) vs. MCIR females (43.7 yrs.), with Black women ages 45-49 yrs. over-represented in the SLE group (Table 1). The SLE group characteristics are seen in table 2 based on where documentation was available.: most were on immunosuppressive medications, about 1/3 had history of lupus nephritis, nearly 1/2 had history of smoking & sexually transmitted disease, & 1/4 had abnormal pap smears. Vaccine uptake in the SLE group was statistically lower than the MCIR population for HPV, Prevnar13, Shingrix®, the COVID primary series completion (#1&2) and for the booster shot (#3). Similar uptake rates were seen for both groups with respect to Pneumovax23, influenza, Tdap & and the first dose of COVID vaccination (Table 3).

Conclusion: Vaccine uptake in women with SLE was similar to the adult female MCIR population for about half of recommended adult vaccines recommended for immunosuppressed persons. A gap exists with respect to vaccination for HPV, Prevnar13, Shingrix®, the COVID series & booster completion where uptake was lower for SLE women. Women with SLE are at higher risk for HPV infection and cervical cancer, shingles, & infection with COVID & pneumococcus. Increased awareness of the importance of these vaccinations for women with SLE is needed, along with advocacy for Shingrix® vaccination coverage for SLE women < 50 yrs. of age.

Table 1: Demographic characteristics of female patients with systemic lupus erythematosus (SLE) at Ascension St. John’s, compared to female Michigan residents age 18-70, as of the 2020 census. Black women and women age 45-49 are over-represented in the SLE group.

Table 2: Characteristics of SLE women

Table 3: Uptake of 7 different vaccines by female SLE patients and MI residents found in the Michigan Care Improvement Registry (MCIR). Uptake is defined as the proportion of persons eligible for each vaccine that have received that vaccine as recommended by ACIP.
Disclosures: J. Dhar, None; F. Hannah, None; L. Saravolatz, None; S. Szpunar, None.