Vaccination Program to Prevent Hospital Admissions Due to Serious Respiratory Infections in Rheumatoid Arthritis Patients. Prosprective Study of 294 Patients

Lucia C. Domínguez-Casas¹, Paz Rodríguez-Cundín², Vanesa Calvo-Río¹, Ricardo Blanco¹, Nuria Vegas-Revenga³, Carlos Fernández Díaz¹, Virginia Portilla³, FM Antolin², MH Rebollo-Rodrigo², Alfonso Corrales¹, Natalia Palmou-Fontana¹ and Miguel Angel Gonzalez-Gay¹, ¹Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, ²Preventive Medicine, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, ³Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Infection, rheumatoid arthritis (RA) and vaccines

Session Information

Date: Monday, November 14, 2016

Title: Rheumatoid Arthritis – Clinical Aspects - Poster II: Co-morbidities and Complications

Session Type: ACR Poster Session B

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

Background/Purpose: Patients with Rheumatoid Arthritis (RA) are at increased risk of infections, especially serious respiratory infections. Immunization is a recommended to reduce these complications. Our aim was to assess the incidence of hospitalizations due to serious respiratory infections before and after the onset a program of systematic vaccination.

Methods: Prospective study of a cohort of 294 patients diagnosed with RA who were invited to participate in a vaccination program. It included seasonal flu vaccination (from October to April), pneumococcal (combined regimen 13-valent and 23-valent vaccines) and haemophilus influenzae type B vaccine. Only 7 patients (2.94%) refused vaccination. The follow-up time of this cohort was from October 1, 2011 (starting date) to June 30, 2015. Information on serious respiratory infection episodes before and after being immunized was conducted using the hospital information system by reviewing hospital records.

Results: 287 RA patients (225 women /62 men), average age 58.1±12.7 years, were vaccinated. The main features at the time of vaccination were: Disease duration (93±95.9 months; Rheumatoid Factor positive in 154 (53.65%), erosive arthritis in 97 (33.8%), and pulmonary fibrosis in 7 cases. Also, at the timwe of vaccination 245 (85.45%) were taking disease modifying drugs, including methotrexate in 98 (34.1%) and/or anti-TNF-alpha therapy in 98 patients (34.1%). In most of the remaining patients vaccination was performed at the time of disease diagnosis. Twenty (7%) patients had required hospital admissions by serious respiratory infections, before being included in the vaccination program. After the onset of the vaccination program only 6 of the 287 patients (2.1%) required admission because of serious respiratory infections (TABLE). The reduction achieved from 7% to 2.1% was statistically significant (p = 0.0017).

Conclusion: A program that includes systematic vaccination of RA patients seems to be an effective procedure to prevent hospitalizations caused by serious respiratory infections. TABLE

Age	sex	Biologic therapy at the time of vaccination	Previous history of biologic therapy	Other drugs used at the time of vaccination	Rheumatoid Factor status	Serious Respiratory Infections
72	W	No	Yes	Prednisone 30 mg/24h	negative	Pneumonia (Escherichia Coli)
45	W	No	–	LFN	postive	LRTI (negative cultures)
66	M	No	Yes	CQ	negative	Pneumonia (negative cultures)
67	W	No	No	–	negative	LRTI (negative cultures)
48	W	No	No	MTX Prednisone 10 mg/24h	positive	LRTI (negative cultures)
63	M	No	Yes	MTX Prednisone 10mg/24h	positive	Pneumonia (Aspergillus Fumigatus)

Abbreviations:W: woman; M: man; LFN: leflunomide. CQ: chloroquine; MTX: methotrexate; LRTI: Lower Respiratory Tract Infections

Disclosure: L. C. Domínguez-Casas, None; P. Rodríguez-Cundín, None; V. Calvo-Río, None; R. Blanco, None; N. Vegas-Revenga, None; C. Fernández Díaz, None; V. Portilla, None; F. Antolin, None; M. Rebollo-Rodrigo, None; A. Corrales, None; N. Palmou-Fontana, None; M. A. Gonzalez-Gay, None.

To cite this abstract in AMA style:

Domínguez-Casas LC, Rodríguez-Cundín P, Calvo-Río V, Blanco R, Vegas-Revenga N, Fernández Díaz C, Portilla V, Antolin F, Rebollo-Rodrigo M, Corrales A, Palmou-Fontana N, Gonzalez-Gay MA. Vaccination Program to Prevent Hospital Admissions Due to Serious Respiratory Infections in Rheumatoid Arthritis Patients. Prosprective Study of 294 Patients [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/vaccination-program-to-prevent-hospital-admissions-due-to-serious-respiratory-infections-in-rheumatoid-arthritis-patients-prosprective-study-of-294-patients/. Accessed .

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