Poster (15A113)

Vaccination uptake in patients with inflammatory arthritis in a single rheumatology department in the South East of Ireland

Author(s)

E Fitzpatrick, L Bell, S Khan, P Dreelan, B Peelo, U Martin, C Sheehy.

Department(s)/Institutions

Dept. of Rheumatology, University Hospital Waterford

Introduction

Patients with inflammatory arthritis have a higher risk of infection than the general population. The national immunisations office recommends an annual influenza vaccine1 and also at least one pneumococcal vaccine2 in all patients taking immunosuppressants. EULAR also recommend these vaccines for patients with inflammatory arthritis.3 Our aim was to establish vaccination uptake rates in different treatment groups and to determine where patients are educated about vaccines.

Aims/Background

A patient questionnaire was designed, and distributed to patients attending rheumatology OPD and day ward in October 2014. The results were pooled and analysed.

Method

A total of 71 were included for analysis. There were 31 (43.7%) males and 40 (56.3%) females; the age range was from 17 to 80 years with a mean of 55.9 years. 48 (67.6%) patients had rheumatoid arthritis, 19 (26.8%) had psoriatic arthritis, 2 (2.8%) each had ankylosing spondylitis and Still’s disease. 74.6% of patients (n=53) had an influenza vaccine in the previous 12 months.

Results

32.4% (n=23) had previously had a pneumococcal vaccine, whereas 67.7% (n=48) had never it. The majority of patients (88.7%) had previously had a varicella infection. Of the 8 that had not, only 3 were certain they had been vaccinated. There was no statistical significance in vaccination uptake between patients receiving DMARDs only compared to those receiving subcutaneous and intravenous biologic therapy. The patients were asked who advised them about vaccinations; 55% were advised by the GPs, 28% were advised by hospital healthcare professionals and a further 14% were advised by both GPs and hospital staff.

Conclusions

We found a greater uptake of influenza vaccine than pneumococcal vaccine, this has been previously noted in the literature.4,5 This may be a reflection of the lack of a formal pneumococcal immunisation program in Ireland. Patients on anti-TNF therapy were not more likely to be vaccinated than those on DMARDs only. We propose establishing vaccination status prior to starting immunosuppressant therapy. This may page 33 involve checking varicella titres in those where previous infection is uncertain and making pneumococcal vaccination mandatory before starting biologic therapy.

References

Influenza [Internet] 1998 [updated Aug 2014; cited 2015 April 24]. Available from: http://www.hse.ie/eng/health/immunisation/hcpinfo/guidelines/c hapter11.pdf

Pneumococcal Infection [Internet] 2010 [updated June 2014; cited 2015 April 24]. Available from: http://www.hse.ie/eng/health/immunisation/hcpinfo/guidelines/c hapter16.pdf

van Assen S et al. EULAR recommendations for vaccination in adults with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2010.137

Sowden E, Mitchell WM. An audit of influenza and pneumococcal vaccination in rheumatology outpatients. BMC Musculoskeletal Disorders 2007, 8:5.

McCarthy E, de Barra E ,Bergin C, Cunnane G, Doran M. Influenza and Pneumococcal Vaccination and Varicella Status in Inflammatory Arthritis Patients. Ir Med J. 2011 Jul- Aug;104(7):208-11