Background The risk of infections is increased by patients with RA. There is increasing evidence, that biological agents can contribute to risk of both non serious and serious infections. Vaccination is attractive method to prevent certain infections. Numerous studies have documented good efficacy of vaccinations treated by biologic drugs. ACR and EULAR have developed recommendations for vaccination of adult patients with rheumatic diseases (1). Nevertheless, how it is reflected in clinical practise is not known.
Objectives To evaluate, how the patients with rheumatic inflammatory diseases treated by DMARDS and biologics are vaccinated in Czech Republic.
Methods Crossectional study using special questionnaire. Study was performed in one academic tertiary centrum and two country private practices not using biologic therapy. Research was performed in second half of 2013.
Results 340 patients have been included in study. The diagnosis was RA (220) 65 %, ankylosing spondylitis (77) 22,7 %, psoriatic arthritis (39) 11,5 % and SLE (3) 0,9 %. The mean age was 51,3 ± 14,4 years, duration of disease 13 years and male to female 33,6 % vs. 66,4 %. The proportion of patients in academic centrum to private practises was 231 (108) 68 % vs. 32 %, 31 % of patients were on DMARDs only, 69 % on biologics (ADA 28 %, INF 8 %, GOL 13 %, REM 8 %, ETA 3 %, RIT 4 %, ABA 2 %).
Before initiation of immunosuppressive therapy 57 % were vaccinated for tetanus,18,8 % for flue, 9,4 % for hepatitis B, 6,5 % for hepatitis B, 2,9 % for pneunoccoc, 0,9 % for Hemophilus infl. and 0,6 % for Neisseria meningitis. During biologic / DMARD therapy were treated 35 % of patients.
The vaccination status has been assessed in initial work–up in 42 % of patients. It was actively offered to 28,5 % of patients only 33 % of patients would have agreed on offer of vaccination and 66 % not. Approximately 50 % of patients agreed of payment for preventive vaccination before biologic therapy.
Conclusions Despite EULAR and Czech Rheum Soc. recommendations vaccination status is very low and only 18 % of patients is vaccinated for flue and 3 % for pneumoccocus. Based on these results, we suggest education campaign for both doctors / patients. We also initiate discussion with authorities for better reimbursement of vaccination for patients with inflammatory rheumatic diseases treated by biologic drugs.
References Refeences: van Assen S, Agmon-Levin N, Elkayam O, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2011;3:414-422
Acknowledgements Key words: vaccination, rheumatic diseases, biologic therapy.
Supported by grant of Ministry of Health Czech Republic Nr. NT12437
Disclosure of Interest K. Pavelka Grant/research support from: Ministry of Health Czech Republic Nr. NT12437, E. Moster: None Declared, H. Ptackova: None Declared