Background/Purpose: Influenza infection constitutes a significant cause of morbidity and mortality in patients living with Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA). The risk of influenza-related morbidity and mortality is higher in these subsets of patients owing to impaired immune responses and the use of immunosuppressive therapy. Therefore, the Advisory committee on vaccination practices highly recommend yearly influenza vaccination to improve clinical outcomes in these patients. There is limited data on Influenza vaccination rate in patients with SLE and RA on immunosuppressive therapy.

Methods: Data was obtained from the electronic medical record (EMR) system of one of the ambulatory arms of Grady Memorial Hospital. Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis who visited the clinic during the influenza season from October 1, 2018 to May 31, 2019 were included. Patients were asked to complete a questionnaire on demographics, influenza vaccination status, use of immunosuppressive therapy, method of influenza awareness and smoking status. Data was confirmed with the EMR. MS excel and SAS 9.4 software were used for data management and analysis.

Results: A total of 83 patients were included in the study. 62.6% of the population had Rheumatoid arthritis while 37.4% had SLE. All patients were on immunosuppressive medications which included methotrexate, leflunomide, cyclosporine, mycophenolate mofetil and azathioprine. Based on demographics, 78.3% were female and 21.7% were male. Mean population age was 53.5. Our patient population was predominantly African American (91.6%) and the educational level of majority of the participants was high school (41%). The most common setting for vaccination was during a primary care doctor’s visit (66.1%; n=37/56) compared to 32.1% (n=18/56) who received vaccination at their Rheumatology clinic visit. 77% of the total population were non-smokers.
The overall flu vaccination coverage was 67.5% which is higher than the CDC reported 2018-2019 national coverage rate of 46.3% in patients with high risk conditions. 67.3% of the RA population (n=35/52) received the influenza vaccine while 67.7% of the SLE population (n=21/31) received the influenza vaccine. The 2019 flu vaccination coverage amongst SLE patients in this ambulatory arm increased by 37.7% compared to the 2017-2018 coverage rates. For the 32.5% of the total population that declined the flu shot, perceived lack of efficacy of the influenza vaccine was the most cited reason (37%), followed by aversion to all vaccines (25.9%).

Conclusion: Our data demonstrates an overall improvement in coverage rates compared to reports from our local 2017-2018 survey and the recent CDC national coverage rate generally. Given the lower rate of awareness provided by Rheumatologists about the flu shot in comparison to primary providers, we propose more patient education on the part of Rheumatologists on the need for influenza vaccination and on the perceived lack of inefficacy of the influenza vaccine. More studies should evaluate factors that contribute to the relatively high coverage rate seen in RA and SLE patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/influenza-vaccination-rates-among-patients-with-systemic-lupus-erythematosus-and-rheumatoid-arthritis-on-immunosuppressive-therapy-findings-from-a-large-public-hospital/