Background: Patients with rheumatic and musculoskeletal diseases (RMDs) are at an increased risk of herpes zoster infection. This risk is further compounded by the use of JAK inhibitors (JAKi) in conditions such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS). The recombinant zoster virus (RZV) vaccine, which has been shown to be safe and effective, is strongly advised in patients with RMDs above 18 years on immunosuppressive medications. Despite the benefits of vaccination in this population, there remains a noticeable deficiency in vaccine uptake among patients receiving JAKi. This quality improvement project aims to assess the current uptake of the RZV vaccine and identify barriers to vaccination in a single-center cohort of patient with RMDs.

Objectives:

• Measure the vaccination rate in patients with RMDs receiving JAKi

• Identify areas of improvement as well as implement interventions to optimize vaccination uptake

Methods: Retrospective analysis of electronic medical records to assess RZV vaccination rates among adult patients receiving JAKi for the management of RMDs in Farwaniya Hospital in Kuwait from January 2022 to August 2023, followed by intervention strategy implementation during August to November 2023 and repeat analysis. Fully vaccinated individuals are those who had received the two doses of the RZV vaccine.

Adult patients with RMDs prescribed a JAKi, after Jan. 2022, identified via the hospital’s electronic pharmacy dispensing records were included.

The intervention strategy, consisted of initiating a Vaccine Outreach Liaisons Program, responsible for contacting patients, scheduling appointments as well as educating patients on the importance of vaccination and addressing concerns, was implemented.

Results: A total of 100 patients received at least one JAKi between January 2022 to August 2023, 52% were > 50 years of age. 88%, 7% and 5% were diagnosed with RA, PsA and AS, respectively.

At baseline, 20% of the patients had received two doses of the RZV vaccine and 3% received the first dose of the vaccine. The rate of vaccination in the < 50 years group was 23% and 17% in the ≥50 years group.

With the short-term intervention implementation, the rate of receiving two RZV doses increased from 20% to 29% in the period between August and November 2023. A 2% increase was noted in patient groups receiving a single vaccine dose. Final results showed that 31% of the < 50 years group received the vaccine and 27% in the ≥50 years group were vaccinated after implementation of the short-term intervention plan.

• Download figure
• Open in new tab
• Download powerpoint

Graph 1.

Vaccination rate pre & post intervention

Conclusion: Enhancing HZV vaccination rates is imperative to mitigate the potentially severe consequences of herpes zoster infection. Our Short-Term intervention led to an increase in the uptake in vaccination suggesting that a vaccination outreach liaison program may have a role in improving vaccine delivery; however the sustainability of this role should be further evaluated in long term. Furthermore, employing interventions, such as educational campaigns and streamlining vaccination processes via Clinical Decision Support Systems, such as automated messages on the health information system to offer RZV vaccination to patients prescribed JAKi, may lead to enhanced sustainability of vaccine access in the hospitals in Kuwait.

Patient related factors affecting vaccinations uptake, such as patient preceptions and socioeconomic status were not evaluated during the intervention period which might be a limitation to our project

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.