Background Rheumatoid arthritis (RA) is characterized by an increased risk of infection, which is further enhanced by the associated treatments like corticosteroid therapy or biologicals. To diminish this risk, influenza and pneumococcal vaccinations have been recommended prior to initiating treatment with biological agents. The COMEDRA trial, conducted in France, revealed the usefulness of a nurse-led consultation in the management of RA-associated comorbidities. Despite this, however, only 40% of patients were shown to be appropriately vaccinated (1).

Objectives This study sought to better understand the obstacles encountered in RA patients as to influenza and pneumococcal vaccinations, along with their motivations.

Methods This qualitative study was conducted at the rheumatology department by means of semi-directed nurse-led interviews lasting about 45 minutes, between July and November 2015. Four topics were analyzed: obstacles and motivations to influenza vaccination, obstacles and motivations to pneumococcal vaccination, post-vaccination follow-up, and information sources. The interviews were registered and transcribed within 45 hours post-interview, and were pursued until data saturation. Transversal data analysis was carried out by the nurse in charge of the interview, then by a second nurse, with the two analyses assembled according to the traditional concept of double reading. Differences between both analyses were thoroughly discussed, with a consensus sought by a third researcher, namely a rheumatologist, as necessary.

Results Overall, 15 interviews were conducted involving 11 women and 4 men, with a mean age of 63 years (29–83). All patients were suffering from RA and undergoing at least one immunosuppressant therapy. Most (80%) were vaccinated against pneumococcus, but only 33% against influenza, with eight patients declaring having been affected by influenza and one by pneumococcus-related pulmonary disease.

The obstacles to vaccinations, revealed during the interviews, primarily concerned fears of unwanted effects in relation with the vaccinations, particularly concerning the influenza vaccination. The patients also reported anxieties in relation with the vaccines' excipients, with overdoses, or with disease reactivation. Moreover, media impact, contradictory information, the fact that vaccinations were not always proposed, and the lack of traceability may also be considered obstacles against vaccinations. Influenza is often considered a benign disease, and the vaccine poorly efficacious. Patients with prior influenza were more motivated towards vaccination. The primary motivation reported by the patients, and especially as to the pneumococcal vaccination, was the protection provided by the vaccine. The perception of frailty and increased infection risk associated with the disease and its treatments were other sources of motivation, and particularly when vaccination was highly recommended by the physicians, and when there had been no public controversy.

Conclusions The fears and motivations associated with these two vaccinations are not identical. Influenza vaccination appears to be poorer perceived, patients reporting more fears related to it. With respect to pneumococcus vaccination, we only collected a few comments, given that the vaccine is less well know, and thus better accepted.

References

1. Gossec L. Arthritis Rheumatol 2016; 68 (suppl 10).

References

Disclosure of Interest None declared