Pediatric Rheumatologists Vary in Vaccine Communication Practices

Survey finds lack of standardized approaches to reviewing vaccination history and coordinating with primary care providers

Published on Feb. 23, 2026

Got story updates? Submit your updates here. ›

A survey of pediatric rheumatologists found wide variation in their practices for reviewing patients' vaccination history and communicating with primary care providers, highlighting the need for more standardized guidance to maximize immunization rates among children with rheumatic diseases.

Why it matters

Children with rheumatologic diseases who take immunosuppressive therapies have an increased risk for complications from vaccine-preventable infections, making consistent vaccine review and coordination between specialists and primary care critical. However, the lack of a national immunization registry and variable vaccine reporting requirements have contributed to incomplete vaccine data and coverage gaps for this patient population.

The details

The survey, conducted by the Childhood Arthritis and Rheumatology Research Alliance (CARRA), found that while nearly all respondents (91%) endorsed reviewing vaccines with patients, the timing varied greatly. Some only reviewed vaccines at the first visit, while others did so with every medication change or at every routine visit. About a quarter also specifically reviewed seasonal flu, COVID-19, and pneumococcal vaccines. Less than half the respondents said they reviewed vaccines based on the patient's specific disease. While most providers routinely assessed vaccination status, a third said they never contacted the child's primary care provider about vaccines. The most common form of communication was a clinic note, but only a quarter contacted PCPs for all vaccines.

  • The survey was conducted in March-May 2022, before the American College of Rheumatology published its 2022 vaccine guidance.

The players

Randal De Souza, MD

An assistant professor of pediatrics in infectious disease at the University of Kentucky in Lexington, Kentucky, and lead author of the study.

Vidya Sivaraman, MD

The senior author of the study and an associate professor of clinical pediatrics in rheumatology at Nationwide Children's Hospital and The Ohio State University in Columbus, Ohio.

Nathan Boonstra, MD

A general pediatrician based in Des Moines, Iowa, who was not involved in the research.

Aimee Hersh, MD

The division chief of pediatric rheumatology at the University of Utah School of Medicine, Salt Lake City, and Primary Children's Hospital, Lehi, Utah, and a member of CARRA.

Got photos? Submit your photos here. ›

What they’re saying

“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.”

— Randal De Souza, MD, Assistant professor of pediatrics in infectious disease (Pediatric Rheumatology)

“The overarching theme of communication is really important here, not just sending a note to communicate but how you communicate to the primary care doctors, realizing that sometimes these children are quite complicated and see multiple specialists.”

— Randal De Souza, MD, Assistant professor of pediatrics in infectious disease (Medscape Medical News)

“Pediatricians are therefore really looking to us to kind of give the blessing [about what vaccines to give] because they're worried their disease may flare or what side effects could they have. Also, in many cases, we've built that relationship with the family.”

— Vidya Sivaraman, MD, Associate professor of clinical pediatrics in rheumatology (Medscape Medical News)

“It's understandable that patients prefer that their primary care provider give all their vaccines, but there is a lot of complexity when it comes to immune compromising conditions, and some specific vaccines are indicated for some situations that are not necessarily stocked in all general clinics.”

— Nathan Boonstra, MD, General pediatrician (Medscape Medical News)

“It is critically important to ensure that, when appropriate, patients have received vaccines as recommended by the American Academy of Pediatrics or guidelines specific to the underlying rheumatic disease, since many of our patients are at higher risk for infection, either from the disease itself or because they are taking immunosuppressive therapies.”

— Aimee Hersh, MD, Division chief of pediatric rheumatology (Medscape Medical News)

What’s next

The authors noted that various quality improvement initiatives can help both small and large practices look for ways to improve their patient populations' vaccine uptake. They also said that an overarching consensus statement from a medical organization on standardized vaccine review practices and communication between rheumatologists and primary care providers could help address the wide variation found in the survey.

The takeaway

This survey highlights the need for more standardized guidance and improved communication between pediatric rheumatologists and primary care providers to ensure children with rheumatic diseases receive recommended vaccines and are protected from vaccine-preventable infections, which pose a higher risk for this patient population.