A REAUDIT ON UPTAKE OF PNEUMOCOCCAL AND INFLUENZA VACCINATION STATUS IN PATIENTS ON BIOLOGICAL DMARDS
Wan Lin Ng, Aqeel Anjum, Siobhan Morrissey, Mary Brady, Breeda McCarthy, Elaine Fitzgerald, Helen Fitzgerald, Mary Gillespie, Joe Devlin, Alexander Fraser
Department of Rheumatology, University Hospital Limerick
BDMARDs have been the panacea for rheumatic diseases but their use may increase the risk of infection.
Morbidity and mortality in patients with chronic disease can be prevented with pneumococcal and influenza vaccinations. EULAR recommended that pneumococcal and influenza vaccination should be considered in patients with autoimmune inflammatory rheumatic diseases1.
Patients on bDMARDs attending the rheumatology infusion unit were asked about their vaccination status on pneumococcal and influenza using a questionnaire. This re-audit was performed on 62 patients who did not have their pneumococcal and/or influenza vaccination the previous year. These patients were educated and were given Arthritis-UK booklet on vaccination. The patients’ current bDMARD, reasons for not having vaccination and number of hospital admissions secondary to infections were recorded.
62 patients who did not receive both vaccinations last year were recruited and 45(72.6%) were females. 16(25.8%) had received both pneumococcal and influenza vaccination, 18(29%) had receive influenza vaccination alone, 5(8.1%) had received pneumococcal vaccination alone and 23(37.1%) had neither. 6(9.7%) had hospital admissions due to infections, of which 3 had chest infections, 1 had urinary tract infection, 1 had cellulitis and 1 had necrotising fasciitis. 3 of 12 patients age ≥65 years received both vaccination. 31(50%) were on rituximab, 28(45.2%) on infliximab and 3(4.8%) on tocilizumab.
Of the 41(66.1%) patients who did not receive the pneumococcal vaccine, 12(29.3%) were not aware of the availability of this vaccine, 8(41.2%) had forgotten to vaccinate, 7(17.1%) were not aware that it was recommended, 7(17.1%) were afraid of side effects, 4(9.8%) were not interested and 2(4.9%) declined vaccination and 1(2.4%) had a life-threatening infection (necrotising fasciitis). 34(54.8%) received influenza vaccination and for those who didn’t, 9(26.5%) were afraid of side effects, 7(20.6%) had forgotten, 6(2.9%) were not interested, 3(8.8%) decline vaccination, 1(2.9%) wasn’t aware of its availability, 1(2.9%) wasn’t aware that the vaccine was recommended and 1(2.9%) had a life-threatening infection (necrotising fasciitis).
Although the re-audit showed below-satisfactory vaccination rates, it demonstrated improvement in patient awareness and vaccination uptake following education. Patients should be educated by primary care physicians and rheumatology staff to increase awareness and alleviate fears of vaccination.