Background Infections are an important factor for morbidity and mortality in patients with systemic lupus erythematosus (SLE). Vaccinations may prevent certain infections. In Germany vaccination recommendations have been released by the German Society for Rheumatology based on the recommendations of the German Standing Committee on Vaccination. Similar suggestions have been published by the European League against Rheumatism. Vaccination coverage in the general population often falls short of reaching its goal.
Objectives Our objective was to assess vaccination rates and reasons for non-vaccination in a representative sample of German SLE patients.
Methods The LuLa-Study is a longitudinal patient-reported cross-sectional survey of the German LE self-help community on a multitude of LE associated factors. It is being conducted annually by means of a self-reported questionnaire since 2001. Amongst others medication, health-related quality of life, damage and disease activity are surveyed. In 2012 we additionally inquired about vaccinations as a main topic using a compilation of questions regarding usage, monitoring, execution and physician' respectively patients' reservations against vaccinations.
Results 579 patients (94.0% female) aged 52.3 ± 13.4 years (mean ± standard deviation) and disease duration of 16.8 ± 9.1 years completed the questionnaire. Their vaccination status is primarily checked by the general practitioner (GP) (57.3%) and only occasionally by an internal specialist (7.9%), their rheumatologist (7.6%) or others (8.5%). A quarter of patients (24.9%) reported that their vaccinations status is not checked by any of their attending physicians. Ninety-three participants (16.1%) stated that at least one of their attending physicians had generally advised against the use of vaccinations. Characteristics (clinical and demographic) did not differ significantly compared to participants that had never been advised against the use of vaccinations.
37.5% of the participants stated that they rejected vaccinations before. The two main reasons expressed for rejecting a vaccination were the fear of developing a lupus flare (21.8%) or developing adverse events after vaccination (13.5%). Only accrued damage was significantly different in univariable analysis between participants that rejected vaccinations before and participants who did not with more damage being reported by the latter ('Brief Index of Lupus Damage' 2.2 ± 2.0 vs. 1.9 ± 2.1; p=0.009). There was no evidence for differences in other demographic or clinical characteristics between the two groups. We observed vaccinations rates of 65.8% for tetanus (past 10 years), 45.2% for influenza (past year), 32.2% for pneumococcal (past 5 years) and 6.1% for meningococcal (past 5 years) vaccinations.
Conclusions Standard vaccination (tetanus) as well as medically indicated vaccination (influenza, penumococcal, meningococcal) coverage in SLE patients is still low in Germany. Reasons for non-vaccination are physician-based, patient-based but also due to organizational deficits because of competing responsibilities (GP vs. rheumatologist). Patients' and physicians' education is of major importance to increase vaccination rates. The rheumatologist bears the responsibility for this process optimization.
Acknowledgement The LuLa-study is supported by unrestricted grants from GlaxoSmithKline and UCB Pharma.
Disclosure of Interest G. Chehab Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study, J. Richter Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study, R. Brinks: None declared, R. Fischer-Betz Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study, B. Winkler-Rohlfing: None declared, M. Schneider Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study