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Abstract: PO1604

Influenza Vaccination in Systemic Lupus Erythematosus (SLE): Effectiveness, Efficacy, Safety, Utilization, and Barriers

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Sim, Jackie Jia Lin, National University Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
  • Lim, Cynthia Ciwei, Singapore General Hospital, Singapore, Singapore
Background

Influenza infections increase morbidity and mortality among immunocompromised individuals with SLE and lupus nephritis. Yet, they are highly preventable through vaccination. We aimed to describe the effectiveness, efficacy, safety, utilization and barriers to influenza vaccination in SLE so that targeted strategies can be implemented to improve vaccination rates.

Methods

We conducted a systematic review and meta-analysis of all published and unpublished studies up to 19 May 2021 via PubMed, Embase, Cochrane, WHO Clinical Trials, and ClinicalTrials.gov, which reported on our desired outcomes relating to influenza vaccination in SLE and lupus nephritis.

Results

Of 726 articles screened, 44 studies (14779 patients) were included. 9 studies reported on effectiveness, 20 studies on efficacy, 24 studies on safety, 12 studies on utilization, and 4 studies on barriers to influenza vaccination. Renal involvement or lupus nephritis was present in 20.9%. The majority were female (90.8%). The mean age was 41.3 years (95% CI 36.8-45.7), mean disease duration was 10.91 years (95% CI 7.10-14.72), and mean SLEDAI score was 4.15 (95% CI 3.18-5.12).

Individuals who received influenza vaccination were less likely to develop pneumonia (relative risk, RR 0.38, 95% CI 0.08-1.86, p=0.23), acute bronchitis (RR 0.21, 95% CI 0.09-0.48, p=0.0002), and viral respiratory infections (RR 0.36, 95% CI 0.21-0.64, p=0.0005). Pooled seroconversion and seroprotection rates were 56.6% and 68.2% for H1N1, 56.7% and 73.7% for H3N2, and 46.8% and 69.9% for B influenza strains.

Mean SLEDAI scores did not change significantly after vaccination. Flares occurred in 20.3%, while local and systemic adverse events occurred in 20.5% and 26.6%, respectively.

Only 39.1% of SLE patients were currently vaccinated against influenza. Meta-regression showed that vaccination rates were significantly associated with increasing GDP of the country (p=0.002) and increasing mean years of disease duration (p=0.02). The most common barriers to vaccination were concerns over the safety or efficacy of the vaccine (37.2%), lack of doctor recommendation (23%), and having experienced side effects of other vaccines previously (13%).

Conclusion

Influenza vaccination is effective and safe in SLE and lupus nephritis. Targeted strategies are required to overcome barriers to improve influenza vaccination uptake.