Background/Purpose: Vaccine-preventable infections pose an increased risk of infection and complications in patients with rheumatic diseases. While recommendations highlight the importance of vaccination in this at-risk population, immunization coverage in this population remains largely unknown. We assessed vaccination rates and predictors of vaccination among rheumatology patients in routine clinical care.

Methods: In this cross-sectional study, consecutive patients presenting to a tertiary rheumatology clinic at the McGill University Health Center between May and September 2015 were asked to fill a survey on vaccination. Patients self-identified as having rheumatoid arthritis (RA) (RA, juvenile idiopathic arthritis), systemic autoimmune rheumatic diseases (SARD) (e.g., vasculitis, lupus, systemic sclerosis, myositis), spondyloarthropathies (SpA) (psoriatic arthritis, ankylosing spondylitis), or other non-inflammatory problems (Control). Multivariate logistical regression analyses were performed to evaluate patient and physician factors associated with vaccination (influenza, pneumococcus, hepatitis B virus [HBV], and herpes zoster [HZ]).

Results: 352 patients were included in the analysis (RA:136, SARD:113, SpA:47, Control:56). Vaccination rates were reported as: (1) influenza: RA 48.5%, SARD 42.0%, SpA 31.9%, Control 88.9%; (2) pneumococcal: RA 42.0%, SARD 37.8%, SpA 29.7%, Control 33.3%; (3) HBV: RA 33.6%, SARD 55.6%, SpA 73.5%, Control 36.8%; and (4) HZ: RA 5.6%, SARD 28.6, SpA 25.0%, Control 16.7%. In multivariate analysis, the association between age and vaccination varied by vaccine (influenza: odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01-1.05; pneumococcus: OR 1.01, 95% CI 0.97-1.04; HBV: OR 0.96, 95% CI 0.94-0.99). Moreover, physician recommendation was the strongest independent predictor of vaccination across all vaccine types (influenza: OR 8.56, 95% CI 2.80-26.2; pneumococcus: OR 314, 95% CI 73.0-1353; HBV: OR 12.8, 95% CI 5.27-31.1). Disease group, disease duration, comorbidities (cancer, diabetes, renal disease), treatment type (disease-modifying anti-rheumatic drugs and/or biologics), and access to a primary care physician were not significantly associated with vaccination.

Conclusion: Despite national guidelines and recommendations for vaccination in this at-risk population, immunization coverage against influenza, pneumococcus, HBV, and HZ is far from optimal among ambulatory rheumatology patients. An important role for both patient and physician education is highlighted from our study, especially as physician recommendation of vaccination was strongly predictive of vaccine uptake. These results can help inform strategies aimed at optimizing vaccination rates in this at-risk population.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/suboptimal-immunization-coverage-among-rheumatology-patients-in-routine-clinical-care/