Background/Purpose: In rheumatoid arthritis (RA), influenza infection and its complications are important causes of hospitalization and death. Although routine annual inactivated influenza vaccine (IIV) is recommended in RA, a significant proportion of patients delay the acceptance or refuse vaccines despite the availability of vaccine services (i.e. vaccine hesitancy). Understanding the causes of vaccine hesitancy in RA is key to improve vaccination coverage and thus reduce the burden of influenza.

Methods: Between November and March 2020, we conducted a cross-sectional study of consecutive RA patients presenting to a rheumatology clinic at a large Canadian tertiary hospital. Patients completed a survey on determinants of influenza vaccine hesitancy developed by the WHO-Strategic Advisory Group of Experts (SAGE) on immunization. Questions addressed individual, group, and contextual influences, as well as vaccine-specific issues involved in vaccine acceptance. Patients were classified into 3 groups based on how likely it was for them to get the IIV: ‘unlikely’ (refused IIV), ‘likely’ (accepted IIV) or ‘uncertain’. Multivariate logistic regression was performed to evaluate factors associated with vaccine refusal.

Results: We studied 101 patients with a mean age (±SD) of 54±19 years, and RA duration 10±8.8 years; 74% were females. Over a third (38%) of the patients did not receive IIV the previous year, and 47% reported not having received the IIV on a yearly basis since RA onset. In total, 58% accepted IIV, 28% refused IIV, and 14% were uncertain. Among the contextual influences of vaccine acceptance: (a) 73% of RA patients trust that the government was making decisions in their best interest with respect to IIV, (b) 29% considered that the IIV should be compulsory, and (c) 42% trust pharmaceutical companies to provide safe and effective flu vaccines. Individual and group experiences identified to influence vaccine acceptance in RA included: (a) previous bad reactions (27%), (b) not enough information about IIV and its safety (37%), (c) concerns about IIV safety (46%), and (d) uncertainty about IIV benefits (39%). Almost half (42%) were willing to pay for IIV, and the same percent (42%) were willing to take time off from work to get the IIV. In multivariate analysis, RA patients who refused IIV were less likely to trust pharmaceutical companies to provide safe and effective vaccines (odds ratio-OR, 95% confidence interval-CI) 43.46 (1.41, >999); and were less likely to consider that IIV should be compulsory 50.89 (1.51, >999).

Conclusion: Over 40% of RA patients living in a universal, publicly funded health-care system have some degree of IIV hesitancy. Contextual and individual influences contribute to this complex and context-specific phenomenon. Actionable hesitancy determinants include those that relate to education on the benefits and safety of the IIV.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/determinants-of-influenza-vaccine-hesitancy-in-rheumatoid-arthritis-according-to-the-who-sage-matrix/