Background/Purpose:

Patients with RA have a two to four-fold increased risk of developing infections than the general population. This is due to both, the disease itself and the therapy used to treat it. For this reason, the use of influenza and pneumococcal vaccines is recommended in all patients with AR, as well as shingles vaccine in patients older than 50 years. However, several studies have demonstrated a low prevalence of immunization and adherence to current recommendations by rheumatologists.

Our objective was to determine the knowledge and adherence to the current immunization recommendations in patients with RA by members of the Mexican College of Rheumatology (MCR) and to identify barriers in the application of this recommendations in patients with RA.

Methods:

A cross-sectional study was conducted through a survey sent by email to 577 rheumatologists from Mexico through the MCR database in January 2017.

The questions of this survey were aimed at evaluating the knowledge and adherence to current recommendations on vaccination in RA and to the clinical practice of rheumatologists in relation to these.

Results:

We obtained 122 responses, representing 21.14% of the 577 rheumatologists, of which 38.2% (n=47) were private practitioners, 19.67% (n=24) public practitioners and 41.8% (n=51) were both private and public practitioners.

Of those surveyed, 14.05% considered the responsibility for the update of vaccination schedules belonged to the family or general practitioner, 4.96% to the internist and 80.99% to the rheumatologist.

Moreover, 43.44% reported they did not collect the immunization history in the clinical record.

Also, 75.86% answered they did not recommend vaccines if the patient had contraindications for it, 20.69% did not recommend them because they gave priority to other aspects of the office visit and 3.45% responded they did not recommend it because of lack of time.

In terms of influenza vaccine, 9.84% reported recommending it to 0-25% of their patients, 12.3% to 26-50%, 27.05% to 51-75% and 50.82% to 76-100%. For pneumococcal vaccine, 19.67% reported recommending it to 0-25% of their patients, 20.49% to 26-50%, 23.77% to 51-75% and 36.07% to 76-100%.

Regarding the time of administration for influenza and pneumococcal vaccine, 13.11% administered it before starting treatment with DMARD. 22.13% administered it only before starting treatment with a biologic or tofacitinib, and 54.1% administered it indistinctly, before or during treatment with DMARD, tofacitinib or biologics and 10.66% responded they did not administer it routinely.

For Herpes Zoster vaccine, 69.67% answered they did not routinely recommend it to their patients. Only 6.56% recommended it before or during treatment with conventional DMARD and 23.77% recommended it before starting treatment with tofacitinib or biologics.

Conclusion:

According to the data obtained in this study, we conclude there is not yet adequate information on the importance of vaccination in patients with RA. It also shows us that the degree of adherence to the vaccine recommendations as well as the safety knowledge and optimal timing of vaccine administration are low in Mexico, this is most notable in Herpes Zoster immunization.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/knowledge-and-adherence-to-current-immunization-recommendations-in-patients-with-rheumatoid-arthritis-in-mexico/