Background Infection is one of the main causes of increased mortality in rheumatoid arthritis (RA). This may be due to disease itself or drug therapies commonly used.
Objectives To assess the uptake of influenza and pneumoccal vaccination amongst RA patients attending rheumatology outpatients clinics at the University Hospitals of Leicester NHS Trust.
Methods An audit was undertaken over a two-month period between October and November 2011. Standards used were from the National Rheumatoid Arthritis Society (NRAS): RA patients should receive regular influenza and pneumococcal vaccination, ideally prior to starting methotrexate treatment, although this is not essential. A simple questionnaire in English was designed and distributed after comments from the 10 patients involved in the pilot stage. The questionnaire was distributed at a regional NRAS meeting held in Leicester as well as RA patients attending rheumatology outpatient (OP) clinics within our NHS Trust. Patients attending the daycase unit for infliximab infusions were also invited to participate. Data was processed and analysed using Microsoft Excel.
Results Of the ninety-one responders (23 NRAS meeting, 62 OP and 6 infliximab clinics), 21 were female and 66 male. The median age was 58.2 years and the average disease duration was 10.3 years. Fifty-three patients (58%) had previously had a flu vaccine whilst only twenty-seven (30%) had had the pneumococcal vaccine. Taking into account the number of patients and disease duration, a total of 743 vaccinations were expected yet only 221 were recorded (30% compliance). Of the 91 possible pneumococcal vaccinations only 25 (27%) patients had been vaccinated. Fifty-four patients (59%) were aware of the need to have an influenza vaccine yet 27 (30%) had been informed of the requirement of pneumococcal vaccination. Also of concern was that only 40 (43%) of all participants were aware of the existence of the pneumovax.
Conclusions From our audit, compliance with standards was only 30% thus highlighting the great need for an increased uptake of both vaccines. In comparison to pneumococcal vaccinations, there was an increased uptake of annual influenza vaccines, likely due to a greater public awareness of the availability of the annual flu vaccination following recent concerns about flu pandemics. General practitioners should continue to offer the annual flu vaccine to high risk individuals as studies have shown marked implications of not having this, such as a ten-times increased risk of pneumonia. Furthermore a recent case controlled study showed that immunisation against influenza did not modify the clinical picture of RA. Medical and nursing staff must address patients’ concerns to improve uptake of vaccinations, although this audit suggests that the majority who are aware of the need actually do receive the vaccine. There is a need to improve vaccination coverage among patients with RA. Practical methods include health professional led patient education sessions, educational seminars for primary care health professionals and provision of written materials in outpatient departments and via patient support groups such as NRAS.
Coulson E, et al. Pneumococcal antibody levels after pneumovax in patients with rheumatoid arthritis on methotrexate. Ann Rheum Dis 2011;70:1289-91.
Fomin I, et al. Vaccination against influenza in rheumatoid arthritis: the effect of disease modifying drugs, including TNFα blockers. Ann Rheum Dis 2006;65:191-4.
Disclosure of Interest None Declared