Reasons for failure to receive pneumococcal and influenza vaccinations among immunosuppressed patients with systemic lupus erythematosus

Semin Arthritis Rheum. 2015 Jun;44(6):666-71. doi: 10.1016/j.semarthrit.2015.01.002. Epub 2015 Jan 22.


Objective: To better understand why immunosuppressed individuals with systemic lupus erythematosus (SLE) fail to receive influenza and pneumococcal vaccines.

Methods: These cross-sectional data were derived from the 2009 cycle of the Lupus Outcomes Study (LOS), an annual longitudinal telephone survey of individuals with confirmed SLE. Respondents were included in the analysis if they had taken immunosuppressive medications in the past year. We assessed any prior receipt of pneumococcal vaccine and influenza vaccine in the past year, and then elicited reasons for not receiving vaccination. We used bivariate statistics and multivariate logistic regression to assess frequency and predictors of reported reasons for not obtaining influenza or pneumococcal vaccines.

Results: Among 508 respondents who received immunosuppressants, 485 reported whether they had received vaccines. Among the 175 respondents who did not receive an influenza vaccine, the most common reason was lack of doctor recommendation (55%), followed by efficacy or safety concerns (21%), and lack of time (19%). Reasons for not receiving pneumococcal vaccine (N = 159) were similar: lack of recommendation (87%), lack of time (7%), and efficacy or safety concerns (4%). Younger, less-educated, non-white patients with shorter disease duration, as well as those immunosuppressed with steroids alone, were at the greatest risk for not receiving indicated vaccine recommendations.

Conclusions: The most common reason why individuals with SLE did not receive pneumococcal and influenza vaccines was that physicians failed to recommend them. Data suggest that increasing vaccination rates in SLE will require improved process quality at the provider level, as well as addressing patient concerns and barriers.

Keywords: Preventive care; Quality of care; Systemic lupus erythematosus; Vaccine.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age Factors
  • Cross-Sectional Studies
  • Female
  • Guideline Adherence
  • Humans
  • Immunocompromised Host*
  • Immunosuppressive Agents / adverse effects*
  • Influenza Vaccines / therapeutic use*
  • Influenza, Human / etiology
  • Influenza, Human / prevention & control*
  • Logistic Models
  • Lupus Erythematosus, Systemic / drug therapy*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pneumococcal Infections / etiology
  • Pneumococcal Infections / prevention & control*
  • Pneumococcal Vaccines / therapeutic use*
  • Practice Guidelines as Topic
  • Quality of Health Care
  • Secondary Prevention / standards*
  • Surveys and Questionnaires
  • Time Factors


  • Immunosuppressive Agents
  • Influenza Vaccines
  • Pneumococcal Vaccines