Background/Purpose: Patients with inflammatory rheumatic diseases are at increased risk of infections when compared to healthy controls. Despite the fact that part of these infections could easily be prevented by available vaccines, vaccination coverage remains very low in France. The aim of this study was to evaluate the reasons why rheumatoid arthritis (RA) and spondyloarthritis (Sp) patients had not been vaccinated against influenza and streptococcus infections.

Methods: In this French observational multicenter study, questionnaires were completed by RA and Sp patients referred to rheumatology departments from December 2012 to November 2013. The questionnaires consisted of questions about pneumococcal or influenza vaccinations, about the prescribing physician and, if applicable, about the reasons of non-vaccination. Clinical and demographic data were also collected.

Results: 268 RA patients and 189 Sp patients from 4 centers were included. Vaccination coverage was respectively 53% and 54.5% for pneumococcal vaccine and 59.7% and 47.1% for influenza vaccine. Lack of proposal was the main reason for non vaccination for pneumococcal (78.2% for RA and 78.9% for Sp patients- Figure 1) and influenza vaccine (48.1% and 61.1%- Figure 2). For pneumococcal vaccine, predictive factors for proposal were: history of RTX treatment (p= 0,0001) for RA patients and treatment with anti-TNFα (p=0.006) for Sp patients. For influenza vaccine, predictive factors for proposal were: increased age (p= 0.01) and current biologic treatment (p=0.002) in RA patients and presence of co-morbidities (p=0.004) in Sp patients.

Conclusion: Despite the recognized usefulness of vaccination among patients with inflammatory rheumatic diseases and the current international recommendations, we found that the vaccination coverage of patients from 4 French centers is low, mainly due to the lack of vaccine proposal by the practitioners. These findings are consistent with data from other countries and highlight the need of pursuing information of the patients and their doctors.