Background Infection is one of the main causes of morbidity and increased mortality in patients with rheumatic diseases. Vaccination history and updating of recommended vaccinations are useful economical way to avoid complication of infections. Influenza, pneumococcal and tetanus vaccines are safe and do not lead to disease flares, however, the majority of patients develop protective antibodies. Recommendations for hepatitis B are not yet validated in patients with rheumatic diseases.
Objectives To assess the vaccination rates for recommended vaccines and to determine the incidence of hepatitis B infections in patients with rheumatoid arthritis (RA) and systemic lupus erythematodes (SLE) attending a rheumatology outpatient clinic.
Methods Vaccination rates were assessed according to the recommendations form EULAR as well as the German Robert Koch Institute for Infection Control. Data collected included age, disease duration, treatment, vaccination history (MMR: measles, mumps and rubella; poliomyelitis, pertussis, diphtheria, influenza, human papillomavirus (HPV), hepatitis A, hepatitis B, tetanus, meningococcal and pneumococcal vaccines). 331 RA and 68 SLE outpatientswere included and the certificates of vaccinations were registered. Patients were also tested for hepatitis B (anti-HBc, anti-HBs).
Results 71.5 % of all patients presented with a WHO certificate of vaccination. About 25 % RA and SLE patients received the influenza vaccine the year prior to the appointment. Within the last 5 years 23.6 % of RA and 17.6 % of SLE patients received a pneumococcal vaccine; in older patients (> 60 years) about 26 % received a pneumococcal vaccination. Stratifying the patients for COPD revealed that in RA patients 37 % received the influenza vaccine and only 14.8 % got a pneumococcal vaccination compared to 40 % influenza as well as pneumococcal vaccination in SLE patients. 53.8 % of RA and 51.5 % of SLE patients were protected against tetanus due to vaccination. Vaccination rates for diphtheria were 61.3 % (RA) and 52.9 % (SLE), for poliomyelitis 43.5% (RA) and 38.2 % (SLE) and for pertussis about 24 % of RA and SLE-patients. About 11 % of the RA- and SLE-patients got a Hepatitis-A vaccination. Only 1.5 % RA-patients (none of SLE patients) were protected against meningococcal infection. Vaccination rate against HPV was very low, probably due to the age of the studied patient populations (1.6 % of female SLE patients, none in RA). There were no serological indications for active hepatitis-B infection in the patients studied, however, 5.3 % of RA patients and 3.6 % with SLE showed serological signs of past hepatitis-B infection (increase of Anti-HBc + Anti-HBs-Titer, or Anti-HBc). Only 5 of these 15 infections were known before. Overall, only 8.2 % RA-patients and 14.7 % patients with SLE presented with a protective vaccinination against hepatitis-B.
Conclusions In patients with RA and SLE visiting the outpatient clinic the registered vaccination rate was very low. Careful monitoring of vaccination in patients with rheumatic diseases is necessary to improve the outcome. National and international recommendations for vaccination in patients with rheumatic diseases should be followed as soon as the diagnosis is confirmed. In particular before an immunosuppressive therapy is initiated the vaccination status should be updated.
Disclosure of Interest None Declared