Background/Purpose:

Vaccinations are important for patients with rheumatoid arthritis (RA) who may receive immunosuppressive therapies that increase their risk of infection.  The Advisory Committee on Immunization Practices (ACIP) recommends all adults receive annual influenza vaccination (INFVX), patients with immunocompromising conditions such as RA receive pneumococcal vaccine (PVX), and adults age 60 and older receive zoster vaccine (ZVX).  However, rates of these vaccinations among RA patients are suboptimal. Using data from electronic health record (EHR) among our RA patients in 2012, 41% of patients had ever received PVX, 19% had received INFVX during 2011-2012 season (this may be low due to incomplete EHR capture), and 2% had ever received ZVX. We conducted a telephone survey among RA patients to assess self-reported vaccination status and to understand patient vaccination behavior and attitudes.

Methods:

We recruited randomly selected RA patients in an academic practice from July to September 2013. Eligible participants were identified by EHR query with diagnosis of RA, at least one rheumatology visit in each of the previous two years, were 18+ years of age, and listed English as preferred language. Chart review confirmed diagnosis of RA. The 10 minute survey included: (1) Patient self-reported receipt of INFVX, PVX, and ZVX; (2) Attitudes about these vaccines, reasons for unvaccinated status if applicable and; (3) Provider recommendations about these vaccines. For patients that reported ever receiving INFVX, we asked if they had been vaccinated during the previous year’s flu season (2012-2013).

Results:

Participants’ (n=102) mean age was 57.8 (SD=14.5), 85.3% were female, 67.3% were white and 85.2% reported taking immunosuppressive medication. The vast majority of participants (90.2%) reported having everreceived INFVX; 79.4% reported receipt of INFVX during the 2012-2013 flu season. Approximately half of participants (53.9%) reported receipt of PVX, and only a few (7.8%) reported receipt of ZVX. When participants, regardless of vaccination status, were asked “How important do you think it is get vaccinations to prevent infections?” 78.5% felt it was at least somewhat important to get vaccinations; 14.7% thought vaccines were not important at all.  74.5% of respondents reported being told they had an increased risk of infection, but only 63.7% recalled being told the importance of vaccines by providers.  96.1% participants reported that their provider had recommended INFVX, but only 16.7% reported that ZVX had been recommended. The most common reason patients gave for not receiving PVX and ZVX was that it had not been recommended to them.

Conclusion:

Academic rheumatology patients with RA reported very high levels of INFVX, low rates of PVX, and very poor ZVX uptake. The majority of participants thought vaccinations are at least somewhat important and the most common reason for not receiving vaccination was lack of provider recommendation. Further research is needed to investigate system-level barriers to vaccination, including reasons for inadequate provider recommendations and the impact of evidence-based provider-level interventions on vaccination rates.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/understanding-vaccination-rates-among-patients-with-rheumatoid-arthritis/