Background/Purpose: Annual vaccination with inactivated influenza vaccine is recommended for adults with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). Despite this, influenza immunization coverage among those patients is suboptimal. Interventions proven to enhance immunization rates in other at-risk groups include letters to patients, physician reminders, and home visits providing vaccines. We tested the effectiveness of an intervention bundle to enhance influenza vaccination uptake among adults living with RA and JIA.

Methods: Between 10/2018 and 12/2018, an influenza vaccine intervention bundle was implemented at a large academic center in North America. This consisted of: (i) a letter from the Division of Rheumatology mailed to RA/JIA patients reminding them of the benefits of vaccination and need to plan for it; (ii) providing influenza vaccine at the rheumatology clinics; and (iii) placing posters in rheumatology clinics targeting patients and their providers. Between 01/2019 and 05/2019, a post-intervention anonymous survey was completed by RA/JIA patients at the time of a routine rheumatology appointment. Baseline influenza vaccination rates had been established in 2015 using the same survey. The effectiveness of the intervention was determined by comparing patient reported vaccination rates in 2015 and 2019. During the intervention period, there were no changes in the public health program promoting vaccination in RA/JIA. Multivariate logistical regression analyses were performed to evaluate reasons of non-vaccination.

Results: On 10/2018, 254 letters were mailed to RA/JIA patients who had a rheumatology appointment in the previous 4 months. During the intervention period in which 343 RA/JIA patients had rheumatology appointments, 116 received the influenza vaccine. Most (107/116, 92.2%) were vaccinated at the time of a previously scheduled appointment while the remainder (9/116, 7.7%) presented for vaccination in response to the mailed letter. The post-intervention survey conducted in 2019, showed that the influenza vaccination rate in RA/JIA was 62.6% (67/107) increased from 48.5% (65/136) in 2015 (p=0.03). Over a third (26/67, 38.8%) of the surveyed patients received the vaccine at the rheumatology clinic in 2019. In multivariate analysis, age (OR 1.07, 95% CI 1.03-1.11), and biologic use (OR 3.45, 95% CI 1.04-11.4) independently predicted vaccination uptake. Physician recommendation was the strongest independent predictor of vaccination (OR 6.56, 95% CI 1.54-27.97). Vaccine hesitancy and refusal were reported reasons for non-vaccination in 35.5% (38/107) of the patients that completed the 2019 post-intervention survey.

Conclusion:

An influenza vaccine bundle, with recall interventions directed at both patients and providers, and that facilitated vaccination access, was associated with an increase in vaccine coverage among adults with RA/JIA. Vaccine hesitancy and refusal remain high among RA/JIA patients. Rheumatologists have a key role in promoting vaccination in this population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/an-intervention-bundle-increases-uptake-of-influenza-vaccine-by-rheumatoid-arthritis-patients/