Evidence map›Paper›PMID 41620617›Full record

ArticlePediatric rheumatology online journal2026

Variability in vaccination practices in children with rheumatic diseases: results of a childhood arthritis and rheumatology research alliance (CARRA)-wide survey.

Randal De Souza, Beth Rutstein, Maria Schletzbaum-Bowler, Nora Singer, Melanie Kohlheim, Vincent Del Gaizo, Kelly Wise, Melica Nikahd, Guy N Brock, Rebecca Sadun and 4 more

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Article in Pediatric rheumatology online journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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No citing paper in PubMed yet.

4 · The record

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5 · Who and what money

Authors and funding

14 authors.

Randal De SouzaDivision of Infectious Diseases, Department of Pediatrics, University of Kentucky HealthCare, Lexington, KY, USA. rde280@uky.edu.
Beth RutsteinDivision of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Maria Schletzbaum-BowlerDivision of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.
Nora SingerDivision of Rheumatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Melanie KohlheimChildhood Arthritis and Rheumatology Research Alliance, Washington, D.C, USA.
Vincent Del GaizoChildhood Arthritis and Rheumatology Research Alliance, Washington, D.C, USA.
Kelly WiseDepartment of Specialty Pharmacy, Division of Rheumatology, Nationwide Children's Hospital, Columbus, OH, USA.
Melica NikahdCenter for Biostatistics, The Ohio State University, Columbus, OH, USA.
Guy N BrockDepartment of Biomedical Informatics and Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Rebecca SadunDivision of Rheumatology, Duke University, Durham, NC, USA.
Monica I ArduraDepartment of Pediatrics, Division of Infectious Diseases, Host Defense Program, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Merav Heshin Bekenstein *Pediatric Rheumatology Service, Grey Faculty of Medical and Health Sciences, Dana Children's Hospital of Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
Vidya Sivaraman *Division of Rheumatology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA. vidya.sivaraman@nationwidechildrens.org.
For the CARRA Investigators and the CARRA Vaccination Workgroup (WG)

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundChildren with autoimmune and immune-mediated rheumatic diseases (AIIRD) receiving immunosuppressive therapies (IST) are at increased risk of morbidity from vaccine-preventable infections. The 2022 American College of Rheumatology (ACR) guidelines recommend vaccinating all children with AIIRD, with specific recommendations based on IST. Children with AIIRD receiving IST or who are immunocompromised are eligible to receive non-live vaccines, however vaccination rates remain low. The aim of this study was to understand the North American pediatric rheumatology provider approach to vaccine review and reconciliation and identify possible barriers to immunization.

methodsThe Childhood Arthritis and Rheumatology Research Alliance (CARRA) Vaccination Workgroup surveyed member North American pediatric rheumatologists about their vaccination practices when caring for children with AIIRD receiving IST. A 44-question electronic survey was distributed from March-May 2022 among rheumatology providers in the CARRA network.

resultsThe survey response rate was 64% and up to 90% of rheumatology providers endorsed diverse approaches to vaccine review, with variations related to frequency of review, based on rheumatic disease and medication. Notably, IST changes prompted providers to assess baseline receipt of live vaccines over non-live vaccines (p < 0.001), while providers who endorsed not performing or deferring vaccine review did so less frequently for live compared to non-live vaccines (p < 0.05). Although 26% of surveyed providers indicated they preferred all vaccines be administered by the patient’s primary care provider (PCP), surveyed providers frequently administered influenza and pneumococcal vaccines within their practices. Provider-identified barriers to immunization included lack of clinic resources (58%), patient or parent vaccine hesitancy (27%), and family concerns regarding vaccines (20%). Most subspecialty providers (78%) communicated vaccine recommendations to PCPs using a clinic note.

conclusionOur results highlighted potential modifiable factors for optimizing immunization coverage among children with AIIRD receiving IST. Standardized vaccine review practices and improved communication between rheumatologists and primary care providers can maximize clinical opportunities for improving vaccination rates and increase awareness of the importance of vaccination against vaccine-preventable infections.

Indexed as

Practice Patterns, Physicians'Rheumatic DiseasesVaccinationChildFemaleHumansImmunocompromised HostImmunosuppressive AgentsRheumatologistsRheumatologySurveys and QuestionnairesUnited StatesVaccine-Preventable DiseasesImmunosuppressive AgentsHealth care surveys, vaccine hesitancyImmunizationImmunocompromised hostRheumatic diseasesVaccines

Identifiers

PMID41620617
PMCPMC13032494

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LicenceCC BY-NC-ND
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.