{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:32:31Z","timestamp":1785717151783,"version":"3.56.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T00:00:00Z","timestamp":1673222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005187","name":"National and Kapodistrian University of Athens","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005187","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Patients with rheumatoid arthritis (RA) are at increased risk for serious infections. Pneumococcal vaccination is among the most important preventive measures, however, vaccine uptake is suboptimal. We explored the rate and factors associated with pneumococcal vaccination in a contemporary RA cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Multi-center, prospective, RA cohort study in Greece. Patient and disease characteristics and influenza and pneumococcal vaccinations were documented at baseline and 3 years later.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One thousand six hundred and ninety-seven patients were included and 34.5% had already received at least one pneumococcal vaccine at baseline. Among 1,111 non-vaccinated patients, 40.1% received pneumococcal vaccination during follow-up, increasing the vaccine coverage to 60.8%. By multivariate analysis, positive predictors for pneumococcal vaccination included prescription of influenza vaccine (OR = 33.35, 95% CI: 18.58\u201359.85), history of cancer (OR = 2.35, 95% CI: 1.09\u20135.06), bDMARD use (OR = 1.85, 95% CI: 1.29\u20132.65), seropositivity (OR = 1.47, 95% CI: 1.05\u20132.05), and high disease activity (DAS28-ESR, OR = 1.33, 95% CI: 1.17\u20131.51). Male sex (OR = 0.65, 95% CI: 0.43\u20130.99) was a negative predictor for pneumococcal vaccination during follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Despite increasing rates of pneumococcal vaccine coverage, 40% of RA patients remain unvaccinated. Severe disease, bDMARD use, comorbidities, and more importantly flu vaccination were the most significant factors associated with pneumococcal vaccination, emphasizing the currently unmet need for cultivating a \u201cvaccination culture\u201d in RA patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.1039464","type":"journal-article","created":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T11:59:05Z","timestamp":1673265545000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Patterns and factors associated with pneumococcal vaccination in a prospective cohort of 1,697 patients with rheumatoid arthritis"],"prefix":"10.3389","volume":"9","author":[{"given":"Konstantinos","family":"Thomas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Argyro","family":"Lazarini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evripidis","family":"Kaltsonoudis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paraskevi V.","family":"Voulgari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros A.","family":"Drosos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Argyro","family":"Repa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ainour Molla Ismail","family":"Sali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prodromos","family":"Sidiropoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiota","family":"Tsatsani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sousana","family":"Gazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalliopi","family":"Fragkiadaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria G.","family":"Tektonidou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros P.","family":"Sfikakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pelagia","family":"Katsimbri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Boumpas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia","family":"Argyriou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyriaki A.","family":"Boki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantina","family":"Karagianni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Katsiari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos","family":"Evangelatos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexios","family":"Iliopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleftheria P.","family":"Grika","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis G.","family":"Vlachoyiannopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodoros","family":"Dimitroulas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Garyfallos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Melissaropoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Georgiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantinos","family":"Georganas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Periklis","family":"Vounotrypidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Ntelis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Areti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George D.","family":"Kitas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Vassilopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1136\/annrheumdis-2013-204021","article-title":"Mortality in rheumatoid arthritis: the impact of disease activity, treatment with glucocorticoids, TNF\u03b1 inhibitors and rituximab.","volume":"74","author":"Listing","year":"2015","journal-title":"Ann Rheum Dis."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-60621-2","article-title":"Mortality is increased in patients with rheumatoid arthritis or diabetes compared to the general population \u2013 the nord-tr\u00f8ndelag health study.","volume":"10","author":"Houge","year":"2020","journal-title":"Sci Rep."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1748","DOI":"10.1002\/acr.23548","article-title":"Causes of death in rheumatoid arthritis: how do they compare to the general population?","volume":"70","author":"Widdifield","year":"2018","journal-title":"Arthritis Care Res."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2223","DOI":"10.1093\/rheumatology\/keaa557","article-title":"Incidence, risk factors and validation of the RABBIT score for serious infections in a cohort of 1557 patients with rheumatoid arthritis.","volume":"60","author":"Thomas","year":"2021","journal-title":"Rheumatology."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1136\/thoraxjnl-2013-204282","article-title":"Risk factors for community-acquired pneumonia in adults in Europe: a literature review.","volume":"68","author":"Torres","year":"2013","journal-title":"Thorax."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-016-1207-7","article-title":"The 23-valent pneumococcal polysaccharide vaccine in patients with rheumatoid arthritis: a double-blinded, randomized, placebo-controlled trial.","volume":"19","author":"Izumi","year":"2017","journal-title":"Arthritis Res Ther."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-13-158","article-title":"Rheumatoid arthritis and the incidence of influenza and influenza-related complications: a retrospective cohort study.","volume":"13","author":"Blumentals","year":"2012","journal-title":"BMC Musculoskelet Disord."},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0201799","article-title":"Clinical characteristics and prognostic factors of pneumonia in patients with and without rheumatoid arthritis.","volume":"13","author":"Wakabayashi","year":"2018","journal-title":"PLoS One."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1056\/NEJMoa1408544","article-title":"Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults.","volume":"372","author":"Bonten","year":"2015","journal-title":"N Eng J Med."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-215174","article-title":"Effectiveness of influenza vaccine in TNF inhibitors treated patients: comment on the article by Burmester et al.","volume":"79","author":"Adami","year":"2019","journal-title":"Ann Rheumatic Dis."},{"key":"B11","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1136\/annrheumdis-2011-201244","article-title":"Adalimumab: long-term safety in 23 458 patients from global clinical trials in rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis and Crohn\u2019s disease.","volume":"72","author":"Burmester","year":"2013","journal-title":"Ann Rheum Dis."},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-29280-2","article-title":"Pneumococcal disease and the effectiveness of the PPV23 vaccine in adults: a two-stage bayesian meta-analysis of observational and RCT reports.","volume":"8","author":"Latifi-Navid","year":"2018","journal-title":"Sci Rep."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0177985","article-title":"Effectiveness of pneumococcal vaccines in preventing pneumonia in adults, a systematic review and meta-analyses of observational studies.","volume":"12","author":"Htar","year":"2017","journal-title":"PLoS One."},{"key":"B14","author":"Thomas","year":"2016","journal-title":"Greek Society of Rheumatology Vaccination Guidelines for Patients with Rheumatic Diseases on Disease-modifying Therapies."},{"key":"B15","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1136\/annrheumdis-2013-204223","article-title":"Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA).","volume":"73","author":"Dougados","year":"2013","journal-title":"Ann Rheum Dis."},{"key":"B16","doi-asserted-by":"publisher","first-page":"27","DOI":"10.31138\/mjr.29.1.27","article-title":"Multicenter cross-sectional study of patients with rheumatoid arthritis in Greece: results from a cohort of 2.491 patients.","volume":"29","author":"Thomas","year":"2018","journal-title":"Med J Rheumatol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2569","DOI":"10.1002\/art.27584","article-title":"2010 rheumatoid arthritis classification criteria: an American college of rheumatology\/European league against rheumatism collaborative initiative.","volume":"62","author":"Aletaha","year":"2010","journal-title":"Arthritis Rheum."},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1177\/1759720X20937132","article-title":"Treatment patterns and achievement of the treat-to-target goals in a real-life rheumatoid arthritis patient cohort: data from 1317 patients.","volume":"12","author":"Thomas","year":"2020","journal-title":"Ther Adv Musculoskelet Dis."},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0153848","article-title":"Influenza and pneumococcal vaccination uptake in patients with rheumatoid arthritis treated with immunosuppressive therapy in the UK: a retrospective cohort study using data from the clinical practice research datalink.","volume":"11","author":"Costello","year":"2016","journal-title":"PLoS One."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-016-1187-4","article-title":"A large two-centre study in to rates of influenza and pneumococcal vaccination and infection burden in rheumatoid arthritis in the UK.","volume":"17","author":"Subesinghe","year":"2016","journal-title":"BMC Musculoskelet Disord."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/5459793","article-title":"Vaccination coverage of the elderly in greece: a cross-sectional nationwide study.","volume":"2020","author":"Papagiannis","year":"2020","journal-title":"Can J Infect Dis Med Microbiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1002\/art.37716","article-title":"Increasing pneumococcal vaccination for immunosuppressed patients: a cluster quality improvement trial.","volume":"65","author":"Desai","year":"2013","journal-title":"Arthritis Rheum."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1537","DOI":"10.1007\/s10067-019-04430-7","article-title":"Interventions to improve vaccine acceptance among rheumatoid arthritis patients: a systematic review.","volume":"38","author":"Gosselin Boucher","year":"2019","journal-title":"Clin Rheumatol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"41","DOI":"10.31138\/mjr.28.1.41","article-title":"A survey to evaluate the implementation of vaccine recommendations among rheumatologists practicing in Greece.","volume":"28","author":"Papadopoulou","year":"2017","journal-title":"Med J Rheumatol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1446","DOI":"10.1016\/j.vaccine.2015.01.065","article-title":"Low rate of influenza and pneumococcal vaccine coverage in rheumatoid arthritis: data from the international COMORA cohort.","volume":"33","author":"Hmamouchi","year":"2015","journal-title":"Vaccine."},{"key":"B26","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1080\/03009742.2016.1242774","article-title":"Factors associated with influenza and pneumococcal vaccine uptake among rheumatoid arthritis patients in Denmark invited to participate in a pneumococcal vaccine trial (Immunovax_RA).","volume":"46","author":"Nguyen","year":"2017","journal-title":"Scand J Rheumatol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"770","DOI":"10.3899\/jrheum.181376","article-title":"Suboptimal immunization coverage among canadian rheumatology patients in routine clinical care.","volume":"47","author":"Qendro","year":"2020","journal-title":"J Rheumatol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1183\/09031936.04.00063504","article-title":"Additive preventive effect of influenza and pneumococcal vaccines in elderly persons.","volume":"23","author":"Christenson","year":"2004","journal-title":"Eur Respir J."},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2011.300512","article-title":"Benefits and effectiveness of administering pneumococcal polysaccharide vaccine with seasonal influenza vaccine: an approach for policymakers.","volume":"102","author":"Gilchrist","year":"2012","journal-title":"Am J Public Health."},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-09613-5","article-title":"Pneumococcal vaccine coverage among individuals aged 18 to 64?years old with underlying medical conditions in the UK: a retrospective database analysis.","volume":"20","author":"Matthews","year":"2020","journal-title":"BMC Public Health."},{"key":"B31","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1007\/s00296-021-04817-3","article-title":"Increased influenza vaccination rates in patients with autoimmune rheumatic diseases during the Covid-19 pandemic: a cross-sectional study.","volume":"41","author":"Fragoulis","year":"2021","journal-title":"Rheumatol Int."},{"key":"B32","doi-asserted-by":"publisher","first-page":"5257","DOI":"10.1093\/rheumatology\/keab471","article-title":"Barriers and facilitators to influenza and pneumococcal vaccine hesitancy in rheumatoid arthritis: a qualitative study.","volume":"60","author":"Colmegna","year":"2021","journal-title":"Rheumatology."},{"key":"B33","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1007\/s10067-020-05059-7","article-title":"Understanding factors associated with vaccine uptake and vaccine hesitancy in patients with rheumatoid arthritis: a scoping literature review.","volume":"40","author":"Boucher","year":"2021","journal-title":"Clin Rheumatol."},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiw222","article-title":"Persistent sex disparities in invasive pneumococcal diseases in the conjugate vaccine era.","volume":"214","author":"de St Maurice","year":"2016","journal-title":"J Infect Dis."},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2017.22.10.30481","article-title":"Sex differences in invasive pneumococcal disease and the impact of pneumococcal conjugate vaccination in the Netherlands, 2004 to 2015.","volume":"22","author":"Wagenvoort","year":"2017","journal-title":"Eurosurveillance."},{"key":"B36","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1080\/10810730.2020.1868630","article-title":"Hesitant or not? the association of age, gender, and education with potential acceptance of a COVID-19 vaccine: a country-level analysis.","volume":"25","author":"Lazarus","year":"2020","journal-title":"J Health Commun."},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0150816","article-title":"Frequency of lost to follow-up and associated factors for patients with rheumatic diseases.","volume":"11","author":"Tien","year":"2016","journal-title":"PLoS One."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.1039464\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T11:59:17Z","timestamp":1673265557000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.1039464\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,9]]},"references-count":37,"alternative-id":["10.3389\/fmed.2022.1039464"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.1039464","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,9]]},"article-number":"1039464"}}