Prescription of Herpes Zoster Vaccine for Immunocompromised Rheumatoid Arthritis Patients in Routine Rheumatology Care
Notice bibliographique
Résumé
Objectives Immunocompromised patients are at higher risk of herpes zoster (HZ).[1-3] The recombinant zoster vaccine was approved in Canada in 2017 and as of May 2023 it is free for individuals ≥75 years, and for immunocompromised individuals aged ≥18 in Quebec. This study aims to determine the vaccination rate in rheumatology care and identify patient characteristics associated with vaccination. Methods A retrospective chart review of consecutive rheumatoid arthritis (RA) patients with a visit between January 2023 and October 2023 at the Hôpital Maisonneuve-Rosemont was performed. Demographics, comorbidities, current immunomodulating agents, corticosteroids use, previous HZ episode and vaccination status were documented. Patients on no immunomodulating agents or hydroxychloroquine monotherapy were excluded. Descriptive statistics were used. P-value ≤ 0.05 was considered significant. Results A total of 251 patients were included. Of those,184 (73.3%) were female, mean age was 66.6 ± 14.5 years, and 15 (6.0%) patients had a previous HZ episode. Throughout the study period, 155 (61.8%) were exposed to methotrexate, 66 (26.3%) to other csDMARDs, 75 (29.9%) to a biologic agent (48 anti-TNF, 22 other biologics and 5 rituximab) and 15 (6.0%) to a JAK inhibitor. A total of 65 (25.9%) were vaccinated either prior or throughout the study period and 186 (74.1%) patients remained unvaccinated. Among vaccinated patients, 28 (43.1%) received it after the implementation of the provincial gratuity program. Exposition to corticosteroids was present in 17.1%, with a mean cumulative dose of 990.0 ±1036.6 mg in the non-vaccinated group vs 525.6 ± 614.3 mg in the vaccinated group (p<0.01). When comparing subjects receiving vaccination to those who remained unvaccinated, a higher proportion of patients on anti-TNF (27.7% vs 16.1%; p=0.04), other biologics (16.9% vs 5.1%; p<0.01) and JAK inhibitors (15.4% vs 2.7%; p<0.01) were vaccinated. No difference was seen between other immunomodulating agents. A total of 21.9% vaccinated and 64.1% unvaccinated patients were ≥50 years old (p=0.70) and 6.8% vaccinated and 24.3% unvaccinated patients were ≥75 years old (p=0.32). No differences were observed between age and medication subgroups in vaccination timing relative to the provincial gratuity program’s implementation. Conclusion Only a quarter of eligible RA patients received HZ vaccination during routine rheumatology care. It was administered more frequently in patients on advanced therapy, but not on those with other immunomodulating drugs or traditional risk factors. Public health measures should be strengthened to promote vaccination among at-risk populations and rheumatologists should offer adequate counseling on vaccination. [1.] McKay SL. Clin Infect Dis 2020;71(7):e125-34. [2.] Adelzadeh L. Eur Acad Dermatol Venereol 2014;28(7):846-52. [3.] Sánchez González CO. Reumatol Clin (Engl Ed) 2022;18(8):453-8.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».