Gaps in Patient Safety Performance in Patients with Immunosuppressive Therapy: Results of Screening for Infections and Vaccination Status in a Large Real-life Cohort

Uta Kiltz¹, Aylin Celik ², Styliani Tsiami ¹, Björn Bühring ², Xenofon Baraliakos ³ and Jürgen Braun ⁴, ¹Rheumazentrum Ruhrgebiet/Ruhr University Bochum, Herne, Germany, Herne, Germany, ²Rheumazentrum Ruhrgebiet and Ruhr-University Bochum, Herne, Germany, ³Rheumazentrum Ruhrgebiet-Ruhr-University Bochum, Herne, Germany, Herne, Germany, ⁴Rheumazentrum Ruhrgebiet/Ruhr University, Herne, Germany

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: chronic inflammatory rheumatic diseases, immunosuppression, vaccination and screening

Session Information

Date: Sunday, November 10, 2019

Title: Health Services Research Poster I – ACR/ARP

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Patients with chronic inflammatory rheumatic diseases (CIRD) are known to have an increased risk of infections compared to the general population. Therefore, prevention of infections by vaccination strategies is mandatory.
The aim of this study was to evaluate the vaccination status in patients with CIRD.

Methods: Consecutivepatients with CIRD were prospectively recruited. Disease characteristics, vaccination status and screening for latent tuberculosis infection (LTBI) and hepatitis B (hepB) were analyzed. Antibodies against measles and hepB were measured. The vaccination status was assessed by a predefined vaccination score (range 0-26): 3 points for a complete vaccination, 2 points for a basic immunization and 1 point for an incomplete vaccination status for tetanus, diphtheria, poliomyelitis or pertussis. For hepB, pneumococcal, influenza, meningococcal, measles, rubella and varicella 2 points were given for a complete vaccination status and 1 point for an incomplete vaccination status. Finally, patients were categorized into 3 immunization states: low (0-6), moderate (7-13), good (14-20) and high (21-26).

Results: A total of 975 patients with CIRD were included (table 1). All patients on bDMARDs (n=499) were screened for LTBI, and 469 also for hepB (94%). Only 16 patients with LTBI received prophylaxis with isoniazid (3.2%) and only 16 patients with hepatitis B received prophylaxis with lamivudine (3.4%). The mean anti-HBs titer was 251.1±258.1 IU/l. Protective measles specific IgG-antibodies were found in 901 patients (92.4%). No more than 30% of patients had undergone pneumococcal vaccination and less than 20% were protected against hepB and influenza. Although 629 patients had been educated about vaccination strategies (64.5%), only 540 patients could show a vaccination certificate (55.4%). The mean vaccination score was 12.8±4.9 with 5.3% of patients categorized having a low, 24.3% a moderate, 26.1% a good and 1.8% a high score.

Conclusion: Screening for tuberculosis and hepatitis is successfully implemented in clinical routine in Germany but many patients are not sufficiently vaccinated against pneumococci, hepatitis B, influenza and measles. Our vaccination strategy is based on cooperation with GPs. However, this strategy did not seem to work. The overall rate of successful vaccination was low to moderate although patients received professional information about vaccine strategies.

Table 1: Patients characteristics of our cohort

Disclosure: U. Kiltz, AbbVie, 2, 5, 8, ABBVIE, NOVARTIS, CHUGAI, JANSEN, MSD, UCB, 8, ABBVIE, NOVARTIS, LILLY,BIOCAD, GRUNENTHAL,UCB, 5, ABBVIE, NOVARTIS, PFIZER,BIOGEN, 2, Biocad, 2, 5, Biogen, 2, 5, Chugai, 2, 5, 8, Eli Lilly, 2, 5, Eli Lilly and Company, 5, Grünenthal, 2, 5, 8, Janssen, 8, Jasnssen, 2, 5, MSD, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, Roche, 2, 5, 8, UCB, 2, 5, 8; A. Celik, None; S. Tsiami, None; B. Bühring, None; X. Baraliakos, AbbVie, 2, 5, 8, Abbvie, 2, 5, 8, BMS, 2, 5, 8, 9, Bristol-Myers Squibb, 2, 5, 8, Celgene, 2, 5, 8, 9, Chugai, 2, 5, 8, 9, Janssen, 2, 5, 8, 9, Lilly, 2, 8, 9, Merck, 2, 5, 8, MSD, 2, 5, 8, 9, Novartis, 2, 5, 8, 9, Novatis, 2, 5, 8, Pfizer, 2, 5, 8, 9, UCB, 2, 5, 8, 9, UCB Pharma, 2, 5, 8, Werfen, 2, 5, 8; J. Braun, Abbott, 2, 5, AbbVie, 2, 5, 6, 8, Amgen, 2, 5, 8, Baxter, 2, 5, 8, Biogen, 2, 8, 9, BMS, 2, 5, 8, Boehringer, 2, 5, 8, Bristol-Myers Squibb, 2, 5, Celgene, 2, 3, 5, 8, Celltrion, 2, 5, 8, Centocor, 2, 5, 8, Chugai, 2, 5, 8, Eli Lilly and Company, 2, 5, 8, Hexal, 2, 5, 8, Janssen, 2, 5, 8, Johnson & Johnson, 2, 5, Medac, 2, 5, 8, MSD, 2, 5, MSD (Schering-Plough), 2, 5, 8, Mundipharma, 2, 5, 8, Mylan, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, Pfizer (Wyeth, Hospira), 2, 5, 8, Roche, 2, 5, 8, Sanofi-Aventis, 2, 5, 8, UCB Pharma, 2, 5, 8.

To cite this abstract in AMA style:

Kiltz U, Celik A, Tsiami S, Bühring B, Baraliakos X, Braun J. Gaps in Patient Safety Performance in Patients with Immunosuppressive Therapy: Results of Screening for Infections and Vaccination Status in a Large Real-life Cohort [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/gaps-in-patient-safety-performance-in-patients-with-immunosuppressive-therapy-results-of-screening-for-infections-and-vaccination-status-in-a-large-real-life-cohort/. Accessed .

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