Background/Purpose: COVID-19 vaccine uptake in autoimmune and inflammatory rheumatic disease (AIIRD) patients is an area of concern to rheumatologists and other providers. These patients are at a greater risk of infection and COVID-19-related complications due to underlying conditions and therapies. The purpose was to ascertain COVID-19 vaccine and booster uptake, reasons for hesitancy, and self-reported flare in a large rheumatology practice-based network (PBRN).

Methods: A tablet-based survey was deployed as part of routine care in 104 rheumatology practices who were members of the Excellence Network in RheumatoloGY (ENRGY) PBRN during 12/2021- 12/2022. Patients were asked about COVID-19 vaccine status and why they might not receive a vaccine or booster. Patients reporting no vaccine receipt were asked additional questions about why they did not receive the vaccine and were categorized as vaccine-hesitant. Receipt of the primary series of vaccines and a response of “not planning to” or “not sure ”when asked about getting additional vaccine or booster doses defined booster-hesitant patients. We used descriptive statistics to explore the differences between vaccination status and vaccine/booster hesitancy, comparing AIIRD to non-AIIRD patients. We used multivariable logistic regression to estimate adjusted odds ratios (aOR) with confidence intervals (CI), examining the association between vaccine uptake and AIIRD status, and self-reported flare/disease worsening and AIIRD status.

Results: Of 61,158 respondents (99.9% completion rate), 89% reported at least one dose of vaccine; of the vaccinated, 68% reported at least one booster (Table 1). AIIRD patients were 32% less likely to receive a vaccine (aOR: 0.68; 95% CI: 0.65, 0.72) and 10% less likely to receive a booster (aOR: 0.90; 95% CI: 0.87, 0.94) versus non-AIIRD patients (Table 2). A greater proportion of AIIRD patients were vaccine-hesitant (14% vs. 10%; p< 0.0001) and booster-hesitant (21% vs. 16%; p< 0.0001) compared to non-AIIRD patients. Among those who were vaccine hesitant (n=7,341), safety concerns (28%) and side effects (23%) were the main reasons for vaccine hesitancy, while among those who were booster hesitant (n=11,058), lack of recommendation from the physician was the primary factor for booster hesitancy (23%) (Table 3). Of those who received a vaccination, 23% of patients reported experiencing symptoms consistent with reactogenicity or a flare/disease worsening following their most recent vaccination. AIIRD patients did not have increased odds of self-reported flare/worsening disease compared to non-AIIRD patients (aOR: 0.99; 95% CI: 0.94, 1.05). Among the vaccine-hesitant and booster-hesitant, 12% and 39% later reported receiving a respective dose.

Conclusion: A meaningful proportion of vaccine- and booster-hesitant patients eventually received vaccination or booster doses, suggesting that future interventions tailored to AIIRD patients to encourage vaccination or booster use may be fruitful.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/covid-19-vaccine-uptake-hesitancy-and-flare-in-a-large-rheumatology-practice-network/