Adult Patients with Celiac Disease Are Under-Vaccinated Against Pneumococcal Disease: A Quality Improvement Study.

Purpose: Patients with celiac disease (CeD) are at increased risk of pneumococcal infections, and guidelines recommend vaccination against pneumococcal disease as a safe and effective strategy at reducing the risk of infection. The rate of vaccination amongst patients with CeD is unknown. The aim of this study was to evaluate current underlying vaccination rates and to improve vaccination rates through a quality improvement initiative.

Methods: Data regarding rates of pneumococcal vaccination amongst patients with biopsy-confirmed CeD were retrospectively collected. A prospective quality improvement initiative was then performed. An educational handout was provided to patients seen during in-person clinic visits, and the pneumococcal conjugate 20 vaccine (PCV20) was offered.

Results: A total of 340 patients were initially reviewed. Only 78 patients (21%) were adequately vaccinated against pneumococcal infection. In the prospective portion, 93 CeD patients were seen in the office during the period of intervention, 33 of whom were already vaccinated (35%). The handout was given to 42/60 eligible patients, the majority of whom were vaccinated during the same clinic visit (62%). Of patients who did not receive the flier, 2/18 were vaccinated in the office. Patients were significantly more likely to get vaccinated after receiving the handout (odds ratio (OR) 13.0; 95% CI 2.6-64.2; p = 0.0016).

Discussion: Patients with CeD are under-vaccinated against pneumococcal disease. Providing educational resources and administering PCV20 during in-person GI office visits appears to be an effective strategy to increase vaccination rates.