Background/Purpose: Patients with systemic autoimmune rheumatic diseases (SARDs) benefit from getting annual inactivated influenza vaccine (IIV). However, vaccine uptake among SARDs is suboptimal.  The delay in acceptance or refusal of vaccines despite the availability of vaccine services is known as vaccine hesitancy. This constitutes one of the ten threats to global health (World Health Organization, WHO 2019). In order to promote vaccine uptake in SARDs, it is key to understand the determinants of hesitancy. We assessed the frequency and predictors of influenza vaccine hesitancy in SARDs.

Methods: Between 11/2019 and 03/2020, consecutive SARDs patients presenting to the rheumatology clinics of a large tertiary care center completed an anonymous survey. We collected demographic data, factors reported to affect vaccine uptake (e.g. education, employment), SARDs specific information (e.g. diagnosis, disease duration, treatment), and questions proposed by the WHO to assess causes of vaccine hesitancy. The likelihood of a patient to get the flu vaccine was assessed based on a 10-point scale (‘0 = I definitely will not get the flu vaccine’ to ’10 = I unquestionably will get the flu vaccine’). Patients were classified as (a) likely to refuse IIV (values 0-2); (b) likely to accept IIV (values 8-10), or (c) IIV uncertain (values 3-7). Multivariate logistic regression models were performed to determine predictors of influenza vaccine hesitancy.

Results: A total of 107 SARDs patients completed the survey. Patients’ age ranged from 18 to 89 years (mean ± SD: 51.6 ± 17.0), 69.8% were female (n=74), and disease duration was (mean ± SD) 9.8 ± 10.8. Fifty-four patients (52.4%) had a university-level education and almost half were employed (n=51, 48.1%).  Patients self-reported diagnoses were: SLE (n=57, 53.3%), vasculitis (n=27, 25.2%) myopathies (n=8, 7.5%), and others (n=15, 14.0%). Seventeen percent of SARDs had never received IIV, and 39% did not receive IIV in the previous season. Over one third of SARDs patients (38%) reported safety concerns about IIV, and 23% were uncertain if the benefits of IIV were larger than its risks. Twenty-three (23.5%) patients were likely to refuse IIV, 55 (56.1%) likely to accept IIV, and 20 (20.4%) were uncertain. Patients ‘likely to refuse IIV’ had more often rejected IIV (43.5% vs 7.5% of the likely to accept vs 15% of the uncertain). Compared to patients ‘likely to accept IIV’, those ‘likely to refuse IIV’ more often had never received IIV (OR 147.4, 95% CI 6.9 – >999). Eighty percent of those ‘likely to refuse IIV’ feel they should get IIV. Neither demographic data, employment status, disease duration or treatment predicted IIV acceptance.  Bad reactions (personal or in known contacts) to IIV predicted vaccine refusal (OR 26.4, 95% CI 2.1 – 324.6).

Conclusion: Vaccine hesitancy in SARDs contributes to reduced IIV uptake. Despite most SARDs patients feel they should receive IIV, a third of them are concerned about the safety of the IIV. Adverse reactions to IIV strongly predict its refusal in SARDs. Reassuring SARDs patients about vaccine safety may enhance IIV uptake.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/frequency-and-predictors-of-influenza-vaccine-hesitancy-in-systemic-autoimmune-rheumatic-diseases/