Background It is well known that there is an increased risk of infection in autoimmune inflammatory rheumatic diseases (AIIRD). Influenza vaccine is thus recommended for patients with AIIRD in EULAR guidelines 20111.
An audit was carried out in 2008 assessing the uptake and awareness of flu vaccine in patients attending our hospital's outpatient Rheumatology department. Recommendations were made to make patients aware of the need for immunization at diagnosis and at follow up appointment between September and November, and also to encourage GPs in clinic letters to offer immunization to these patients. The audit cycle was then completed in February 2013.
Objectives To assess if other measures need to be considered for patients with AIIRD to have an influenza vaccine if they are not willing to have it even after the importance of having it has been stressed.
Methods 117 and 102 questionnaires were collected in 2008 and 2013 respectively from patients attending Rheumatology outpatients
73% were under 65 years old in 2008 and 72% under 70 years old in 2013.
Rheumatoid arthritis was present in 68% and 65% in 2008 and 2013 respectively. The rest of the patients had either Seronegative Inflammatory arthritis, connective tissue disease, vasculitis or Polymyalgia Rheumatica.
44% were on Methotrexate in 2008 and 22% in 2013. Steroids were being received by 24% and 26% in 2008 and 2013 respectively. 20% were on Leflunomide in 2008 while 27% were on Sulfasalazine in 2013. 9% were on biologics each year and the rest were on other Disease Modifying Anti rheumatic Drugs.
79% had been informed of the need for flu jab each year.
20% more patients had been offered a flu jab by the GP surgery in 2013.
Although 75% were aware that they are at increased risk of catching infections in 2013, only 72% actually had a flu vaccine and this was a rise of only 2% comparing with 2008.
Results– Reasons for not having vaccine were fear, allergy, unawareness of eligibility and information not being provided
The following points were audited in 2013 only:
74% of those who haven't had a vaccine would consider having if given more information, but only 65% of these actually wanted to have it next season.
In total, 81% wanted to have the vaccine next season.
Interestingly, 24% of patients had flu this season and 33% out of these had it before and a similar percentage after the vaccine.
35% of those who had flu this season had to miss work or studies, some of them up to more than 10 days.
8% had a flare of their rheumatologic condition 1 to 10 days after the vaccine.
Conclusions Our results show that still 25% of patients were not even aware of the need for immunization. The immunization uptake would still remain suboptimal in those in whom awareness can be raised, which reflects that alternative methods may be required and the question arises whether Influenza vaccination should be made mandatory2.
S van Assen et al. EULAR recommendations for vaccination in adult patients with autoimmunne inflammatory rheumatic diseases. Ann Rheum Dis 2011 70: 414-422
Snowdon E et al. An audit of influenza and pneumococcal vaccination in rheumatology outpatients. BMC Musculoskelet Disord. 2007 Jul 4;8:58
Disclosure of Interest None declared