Systemic Sclerosis and Vaccinations: A Register-Based Cohort Study about Seasonal Influenza and Streptococcus pneumoniae Vaccination Rate and Uptake from Liguria Regional Center, Northwest Italy

Abstract

Systemic sclerosis (SSc) is the connective tissue disease with the highest mortality and patients with chronic inflammatory immune-mediated diseases are at high risk of acquiring infections as they are often treated with immunosuppressive or biological drugs. This study, conducted among the patients followed by our clinical immunology, part of the Internal Medicine Department in the Ospedale Policlinico San Martino, Genoa, northwest Italy, has set itself the primary objective of analyzing the vaccine uptake and the vaccination coverage against both seasonal influenza and S. pneumoniae in a cohort of patients with SSc. We evaluated the influenza and pneumococcal vaccination rate among various subgroups of patients and the source of the recommendation for vaccination. We evaluated the vaccination rate changes between the two years considered in our study. We also calculated a binomial logistic regression between vaccination acceptance and clinical and demographics characteristics of the patients to evaluate the adjusted odds ratio (OR) of each factor on vaccination. The vaccination coverage that resulted was significantly higher than in other similar studies. Age over 65 years old, interstitial lung disease, and ongoing immunosuppressive therapy were significantly related with acceptance to both vaccinations using univariate analyses, but the multivariate logistic regression found a significant correlation only with the age and therapy factors.

The Mechanism behind Influenza Virus Cytokine Storm

“…Among hospitalized patients with influenza, those younger than 5 years old and older than 65 years old are more likely to develop acute pneumonia [ 119 , 120 , 121 , 122 ]. Therefore, it is more important for people younger than 5 years old and older than 65 years old to be vaccinated against influenza [ 123 ]. The immune response of young individuals may be more vigorous, and it is easy to trigger a stronger cytokine storm.…”

Flu and Pneumococcal Vaccine Coverage in Scleroderma Patients Still Need to Be Prompted: A Systematic Review

“…A few of these studies investigated the rate of vaccination also in relation to gender [14,26,[28][29][30][31]34,37], age [14,[26][27][28]30,31,34,37], concomitant medical therapies [14,[28][29][30]37], disease duration and comorbidities [26,30,31,37], referral by a physician, indication for vaccination, educational levels [14,37] and knowledge attitude towards vaccination [14,27,29,31,34], vaccination settings such as rural vs. urban [14] and concomitant vaccination campaigns aimed to improve the vaccination rate [26,32,33,35], however these outcomes were variably reported.…”

“…Some of the studies found through the systematic review on the vaccine coverage also investigated reasons for low rates and possible improvement strategies. For what concern the factors mainly affecting the vaccination uptake, there were the older age, the recommendation by physicians, and biological therapy [14,[26][27][28][29][30][31]34,37]. Also, awareness and favorable attitude toward vaccination was a positive predictor for vaccination, but not the level of education [14,27,29,31,34].…”

“…Also, awareness and favorable attitude toward vaccination was a positive predictor for vaccination, but not the level of education [14,27,29,31,34]. Gender was generally not associated to vaccination rate [14,26,[28][29][30][31]34,37]. Sheikh [35] tested a multimodal education activity for clinician to improve the immunization rate [35], significantly increasing awareness on the matter [32,33] developed programs to improve pneumococcal vaccination coverage in pediatric and adult patients with autoimmune inflammatory disorders.…”

Integrative genomic expression analysis reveals stable differences between lung cancer and systemic sclerosis

“…Pulmonary manifestations are known to occur in all autoimmune diseases that have standardized incidence ratios greater than 2.0, indicating that autoimmune process can lead to lung cancer susceptibility [ 8 ]. Systemic sclerosis is one of the connective tissue diseases with the highest mortality rate [ 11 , 22 ], and it has recently been reported that patients with systemic sclerosis have an increased risk of lung cancer [ 23 , 24 ], but the intrinsic gene connection is unclear. Our results reveal that genes related to innate immune response and response to virus were co-upregulated significantly in patients with systemic sclerosis and lung cancer.…”