Prescription of Herpes Zoster Vaccine for Immunocompromised Rheumatoid Arthritis Patients in Routine Rheumatology Care
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".