Vaccinations in Inflammatory arthritis patients
Shama Khan Roberta Visivic Trevor Duffy Maurice Barry
Rheumatology Department Connolly Hospital Blanchardstown
Patients with autoimmune inflammatory rheumatic diseases (AIIRD) are at increased risk of contracting infections. This risk is further increased by immunosuppressive disease modifying agents.(
The vaccination status of patients should be assessed early in the course of work up for patients with AIIRD.Hepatitis A, B, Influenza, streptococcus pneumonia, Nisseria meningitides, Tetanus toxoid and human papilloma virus vaccinations’ history should be taken. Efficacy is reduced by immunosuppressive medications. Preferentially vaccinations should be administered during stable disease to minimise flare ups and side effects. They can be given while while patients are on biologics but ideally before B cell depletion. Live attenuated ones should be avoided.
The mortality rate of AIIRD patients dying from pulmonary infections is higher than the general population, and therefore EULAR recommends vaccinating these patients against Influenza and pneumococcal. The aim of the study was to assess how many of our inflammatory arthritis patients received vaccinations for these two agents.Hepatitis A and B vaccination is recommended in high risk groups only , and varicella zoster(VZ) for patients prior to Rituximab,as it cause reactivation of VZ.
100 patients with AIIRD patients filled in a questionnaire on the day of their outpatient appointment. The following parameters were included.
• ID number
• Oral DMARDS
• Vaccination received /not
• Name of the vaccination
• Year of vaccination
• Who recommended it? GP/rheumatologist
Results table attached .
Though nearly half of the cohort receive vaccinations, most of them didn’t receive both flue and pneumococcal vaccine and not annually either, which can be improved by better communication and advise at the outpatient visit.