Background Biologic drugs are effective for the management of chronic inflammatory diseases. But these therapies are not free of risks like infections; some of these, preventable by vaccines. In this line, EULAR presented in 2010 its recommendations for immunization of these immunosuppressed patients  (including influenza, pneumococcal and Hepatitis B vaccines mainly). However, published data indicate that immunization rates are suboptimal .
Objectives To describe the current vaccination status in patients with subcutaneous biologic treatment and initiate a project to improve the proportion of vaccinated patients.
Methods Retrospective observational study in patients with rheumatic diseases with current prescription of subcutaneos (sc) biologic in our rheumatology clinic from 2001 until October 2014. Electronic health and immunization records of all patients, were reviewed. We collected epidemiological and clinical data (diagnosis, duration of the disease, current biologic treatment, time with the biologic agent and administered vaccines). We considered complete or adequate vaccination, the one that included: Influenza, Pneumococcal and Hepatitis B, and incomplete if any of these were not given.
Results A total of 363 patients (215 women, 59.2%) were included. Average age: 53.3 years (±17.1); with main diagnoses of Rheumatoid Arthritis (44.9%), ankylosing spondylitis (25.6%), and psoriatic arthritis (16.5%). The mean duration of disease was 10 years (±8.1). The most frequently prescribed agents were etanercept 51.1%, adalimumab 24.6% and golimumab 15.2%, with median treatment duration of 40.8 months (±35.4).
An adequate vaccination was found in 153 patients (42.1%), 55.4% of the cases were undervaccinated or unvaccinated. Influenza, Pneumococcal and Hepatitis B vaccination rates were 65.6, 34.4 and 31.7%, respectively (Table shows the different registered vaccines). All pediatric patients had their vaccinations updated. In the light of the inadequate immunization coverage, we have initiated actions to increase vaccination in this vulnerable population; in coordination with the Department of Preventive Medicine, including an informative phone call (to patients with incomplete or absent vaccination) and a consultation where appropriate vaccines are given to each of them. The impact of these measures on the immunization rate of our patients will be assessed on a later analysis.
Conclusions Vaccination rates of our patients treated with sc biologics were shown to be insufficient, so we have initiated measures to address these problem; in order to improve the quality of care offered in our unit, ensuring an adequate vaccine protection.
van Assen S, et al. EULAR Recommendations for vaccination in adult patients autoimmune inflammatory rheumatic diseases With. Ann Rheum Dis. 2011 Mar; 70 (3): 414-22. Epub 2010 Dec 3.
Sowden E, Mitchell WS. An audit of influenza and pneumococcal vaccination in Rheumatology outpatients. BMC Musculoskelet Disord 2007;8:58.
Disclosure of Interest None declared
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