Uptake of influenza vaccination in rheumatology patients

S. Saravana

Department of Rheumatology, Diana Princess of Wales Hospital, Grimsby, UK

Correspondence to: S. Saravana, Department of Rheumatology, Diana Princess of Wales Hospital, Grimsby DN33 2BA, UK. E-mail: adersh555saravana{at}hotmail.com

SIR, According to the Department of Health guideline, immunosuppressed patients should be given influenza vaccination [1]. There are relatively few data about immunization in rheumatology patients. In one study it was shown that uptake of influenza vaccine in patients with RA taking methotrexate was suboptimal [2].

We undertook a study in patients who attended a rheumatology out-patient clinic to (i) identify patients who were on immunosuppressive treatment; (ii) find out whether they had influenza vaccination every year; and (iii) if they did not have influenza vaccination every year, to find the reason.

We collected data for 100 consecutive patients attending our rheumatology out-patient clinics. Before consultation, the attending doctor enquired about vaccination status using a standard questionnaire. The patient's self-report was recorded regarding influenza vaccination. The questionnaire also included information about DMARD use.

Most of the 100 patients had RA. Table 1 shows the rheumatological conditions present in the study group. Table 2 shows the DMARDs the patients were taking.


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TABLE 1. Rheumatological conditions present in the study group

 

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TABLE 2. DMARDs being taken by the patients

 
Of the 100 patients who took part in our study, 77 were receiving influenza vaccination. This is independent of what DMARD they were taking. The remaining 23 patients were not receiving influenza vaccination. Thirteen patients were unwilling to have any vaccination. Eight patients were not aware of the need for vaccination. The reason for not having vaccination in two patients was not documented.

In the report by Bridges et al. [2] the uptake of influenza vaccination in RA patients taking methotrexate was only 56%. The principal reason for this was the fact that the patients were not offered vaccination.

Our group consisted of patients with various rheumatological conditions and were taking different DMARDs. We found that only a few patients were not having influenza vaccination. The principle reason for this seems to be unwillingness.

In our hospital practice, we usually advise general practitioners about the need for influenza vaccination in patients who are taking DMARDs for various rheumatological problems. When patients see a nurse practitioner regarding diagnosis and treatment for newly diagnosed rheumatological problems, they are also given advice about the need for influenza vaccination. Perhaps this is the main reason for most patients having influenza vaccination in our set-up.

We also identified a group of patients who were not aware of the need for vaccination and advised them to contact their general practitioner in future.

We entirely agree with the suggestion of Bridges et al. that secondary care has a role in allaying patient concerns. Nurse practitioners play an important role in the education of patients. It is also worth mentioning in our letters to general practitioners the importance of the need for influenza vaccination in patients taking DMARDs.

Ethical approval and informed consent were not required for this audit and were not obtained.

The author has declared no conflicts of interest.

References

  1. Department of Health. Update on immunization issues. August 2002. London: Department of Health, 2002.
  2. Bridges MJ, Coady D, Kelly CA et al. Factors influencing uptake of influenza vaccination inpatients with rheumatoid arthritis. Ann Rheum Dis 2003;62:685.[Free Full Text]
Accepted 12 May 2004





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