Background: Rheumatoid arthritis (RA) patients are at increased risk of pneumococcal and influenza disease secondary to a deficient immune system and immunosuppressive medications.¹ Despite the possible reduction in vaccine efficacy in RA, prophylactic vaccination for preventing pneumococcal pneumonia and influenza in RA patients should be routinely advised and practised.² EULAR guidelines recommend that influenza and pneumoccocal vaccinations should be strongly considered for all patients with RA.³

Objectives: To study pneumococcal and influenza vaccination rates in a cohort of RA patients on biologic medications.

Methods: We undertook a prospective audit of RA patients on biologics attending routine rheumatology clinics in a DGH over a 6 week period. A proforma was given to patients, and data was collected on medications, comorbidities, Disease Activity Score (DAS) and vaccination status for influenza and pneumoccocus.

Results: Of the 25 patients audited, 17 (68%) were female and 8 (32%) were male. The average age of patients included was 59 years (range 37–75). 18 (72%) patients were seropositive, and 7 (28%) were seronegative. The patients included had the following comorbidities; 14 (56%) none, 6 (24%) thyroid disease, 1 (4%) osteoporosis, 1 (4%) hypertension, 1 (4%) type 2 diabetes, 1 (4%) interstitial lung disease.

On reviewing their medications, 7 (28%) patients were on an Etanercept biosimilar (Benpali), 2 (8%) on Tociliumab, 2 (8%) on Rituximab, 9 (36%) on Adalimumab, 2 (8%) on an Infliximab biosimilar (Remsima), 2 (8%) on Etanercept, and 1 (4%) on Certolizumab. In addition to their biologic agent, all 25 patients were on Methotrexate. 2 patients (8%) were also on Sulphasalazine, and 2 (8%) were on Hydroxychloroquine additionally. The average DAS CRP score was 2.7.

8 (32%) patients had received both influenza and pneumococcal vaccinations, and 9 (36%) patients had neither. On analysing the vaccination rates individually, 16 (64%) patients were up to date with influenza and 7 (28%) were up to date with pneumococcal. Of the 9 patients that had neither vaccination, 5 (20%) patients were unaware of their requirement, and 3 (12%) felt they were too unwell to receive them. 1 (4%) patient was unsure whether they could have the vaccinations as they had been recruited into a research trial.

Conclusions: Only 32% patients had received both influenza and pneumoccocal vaccinations. The uptake rate for influenza vaccination was reasonable at 64%, however the rate for pneumococcal vaccination was only 28%.

Vaccination assessment should be performed routinely for all RA patients in clinic, and in particular those on biologic medications to reduce the risk of developing these infections in this high risk cohort.

References:

1. Blumentals W, et al. Rheumatoid arthritis and the incidence of influenza and influenza-related complications: a retrospective cohort study. BMC Musculoskeletal Disorders 2012;13:158.
2. Malemud C. Pneumonia and influenza vaccination in rheumatoid arthritis patients. Glob Vaccines Immunol 2016;1(3):60–62.
3. van Assen S, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2011;70:414–422.

Disclosure of Interest: None declared

DOI: 10.1136/annrheumdis-2018-eular.2851