Background Severe Respiratory Infections (SRI) are relative frequent complications of biologic therapy. The vaccines can reduce these complications.
Objectives To assess the SRI in a prospective cohort of patients with rheumatic diseases who were immunized following a protocol of immunization.
Methods A protocol of immunization agreed beforehand between preventive and rheumatology service was established. In the first visit they initiated immunization for Pneumococcal, Haemophylus and Influenza vaccines. Influenza vaccine was only administered during the seasonal period (from October to April yearly in our hospital). At May 2013, pneumococcal conjugate was added to pneumococcal polysaccharide.
Cohort study of 374 patients consecutively evaluated at the first visit for the vaccine consultation from 1 October 2011 to 31 September 2013. They were followed for a minimum period of one month and a maximum of two years.
Data about episodes of SRI were collected from patients seen at emergency departments and hospitalisation.
Results The mean age of the 374 patients was 53.1±15.4 (62.2% women/37.8% men). 8 of 374 patients refused to be vaccinated and 1 died before been vaccinated.
The most frequent underlying diseases were Rheumatoid Arthritis (38.9%), Psoriatic arthritis (23.6%) and Ankylosing spondylitis (8,8%). A total of 225 (61.6%) patients were taking a biological drug (adalimumab 49,3%, etanercept 18,2%, infliximab 17,3%, tocilizumab 5,3%, Golimumab 5,%, Rituximab 3,5%, abatacept 0,4% and belimumab 0,4%) at the first visit. Combined therapy with other synthetic DMARDs was observed in 41.7% (mainly methotrexate).
The following vaccines were prescribed: Influenza (n=365 patients), Haemophylus influenzae (n=360), Pneumococcal polysaccharide (n=322), Pneumococcal conjugate (n=178). 26 of 50 patients that had been immunized previously for pneumococcal polysaccharide, did not receive another dose.
Throughout the follow-up, only 4 of 365 patients (1.1%) had a SRI. All of them required to be hospitalized, one with a tuberculous necrotizing granulomatous pneumonia, two with a bacterial pneumonia (E coli and other unidentified) and one with a lower respiratory tract infection without pulmonary condensation.
Conclusions Our immunized cohort of patients with inflammatory rheumatic diseases had a low incidence of SRI. It seems that vaccination following a protocol of immunization may be useful.
Disclosure of Interest : None declared
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