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Although annual influenza vaccination is recommended for adults taking immunosuppressant drugs,1–3 the vaccination rate is suboptimal in these patients.4–6 We undertook a study to assess the flu-vaccination uptake of patients treated for systemic inflammatory diseases and to explore the factors that influence it. The study was approved by the Paris Ile de France III Ethics Committee (“Comité de Protection des Personnes Ile de France III”) Paris, France.
We collected information about flu shots with a standardised form completed by the doctors of patients with systemic inflammatory diseases taking corticosteroids and/or immunosuppressant drugs, followed up in our internal medicine department during January 2006.
One hundred and thirty-seven consecutive patients (mean (SD) age 53.1 (17.6) years, 40 (29%) male) were included. Fifty-three patients had at least one other indication for which a flu shot was recommended: 41 were ⩾65 years old, 33 had at least one chronic disease.
Twenty-eight per cent of the patients had received inactivated flu shots in 2005, 46% of patients ⩾65 years and 21% of those aged <65 years (p<0.05); 57% of patients with rheumatoid arthritis (RA), 30% with vasculitis or systemic sclerosis, 25% with systemic lupus erythematous, 20% with inflammatory bowel disease, 24% of patients taking immunosuppressant drugs and 37% of those taking corticosteroids alone. Finally, 47.2% of patients who had an indication for a flu shot other than drug-induced immunodepression received a flu shot in 2005 compared with 16.7% of patients who did not (p<0.001). Of the 48 patients who remembered having received the letter sent by the French National Health Insurance Agency (FNHIA) to patients aged ⩾65 years and/or with chronic disease, to encourage them to benefit from a free flu shot, 49% were vaccinated compared with 18% who did not remember (p<0.001).
The principal reasons advocated for non-vaccination were no doctor recommended it (58%), fear of side effects (35%) and uncertainty about the vaccine efficacy (5%). Age over 65 years (50% vs 22%, p<0.05), and reception of the FNHIA letter (59% vs 26%, p<0.001) were significantly associated with influenza vaccination upon univariate analysis. The FNHIA letter (odds ratio (OR) = 4.2 (95% CI 1.92 to 9.19), p<0.05) was confirmed by a multivariate logistic-regression model.
The influenza-vaccine coverage in this cohort is suboptimal, at 28%, 46% for patients ⩾65 years and 21% for the others). Our results are in agreement with available data on patients with inflammatory bowel disease (28%) and RA (57%).4 5 The influenza-vaccine coverage of patients ⩾65 years was lower than the 70.1% in the general French population of the same age in 2005–6.7 The main reason for non-vaccination in our cohort was the absence of a doctor’s recommendation (58%). This rate is close to the 49% reported rate of non-vaccination because “patients didn’t know they needed it”.4 Public health campaigns should be undertaken every autumn to improve overall awareness of flu-shot recommendations. Pertinently, the FNHIA letter, sent to patients older than 65 years and/or those with selected chronic health conditions, was significantly associated with an increased influenza-vaccination rate. To improve influenza-vaccination coverage in patients receiving immunosuppressant drugs, this letter should be sent also to these patients even if they do not meet other standard criteria.
Competing interests: None declared.
Presented in part at the ACR 2006, Washington DC, poster number 212, and at IDSA 2006, Toronto, poster number 809.
Ethics approval: Approved by the Paris Ile de France III Ethics Committee.
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