Rheumatology Advance Access originally published online on April 25, 2006
Rheumatology 2006 45(7):912-913; doi:10.1093/rheumatology/kel104
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LETTER TO THE EDITOR |
Pneumococcal and influenza vaccination in patients with rheumatic conditions and receiving DMARD therapy
Rheumatology Department, Wrightington Hospital, Hall Lane, Appley Bridge, WN6 9EP, Lancashire, UK
Correspondence to: W. A. Fahy. E-mail: billy-fahy{at}doctors.org.uk
SIR, It was interesting to read your editorial ‘Vaccinate your immunocompromised patients!’ [1] and we would like to outline an audit performed at Wrightington Hospital, UK, which highlights this problem. Streptococcus pneumoniae, the most common cause of adult community-acquired pneumonia, has an annual incidence rate of between 10 and 100 cases per 100 000 population [2]. The annual incidence of influenza infection varies; however, it has the propensity to cause epidemics affecting up to 15% of the population [3]. In the UK, the Department of Health runs campaigns to encourage yearly vaccination against influenza and immunization against pneumococcus in those aged 
65 and those in ‘at risk’ groups <65 years of age [4, 5]. However, much of the promotional material available is aimed at those >65 yr of age [6]. Furthermore, funding is based on the >65 population covered by a given primary care trust.
Patients with rheumatic disease represent an ‘at risk’ group as a result of immunosuppressive disease modifying anti-rheumatic drug (DMARD) therapy that increases their susceptibility to infection. As such, they should be immunized against pneumococcal and influenza infection. We performed an audit to assess the level of pneumonia and influenza vaccine awareness and uptake in 100 patients treated with DMARDs (e.g. methotrexate, azathioprine and cyclosporine) attending our unit between October and December 2005. Amongst the study population rheumatoid arthritis was the most common diagnosis, representing 85% of the patients studied. Analysis revealed marked differences in the level of knowledge and uptake of vaccination in those <65 and those >65 (Table 1).
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Awareness of the influenza vaccine was good across both populations and health practitioners including GPs, hospital doctors and nurses were proactive in discussing immunization requirements with their patients. Influenza vaccine uptake was relatively poor in the <65 age group despite education about immunization. Similarly with respect to pneumococcal vaccination of the >65 age group, there was a good level of vaccine awareness and education from health practitioners, though this was not reflected in its uptake. This may suggest that the immunization message needs to be reinforced. Our audit highlighted a very low level of pneumococcal vaccine uptake in the <65 age group. This may have resulted from a failure of healthcare professionals to educate their patients and thus, raise awareness of the importance of pneumococcal vaccination. We have thus highlighted a need to educate patients treated for rheumatic disease with DMARDs, and under the age of 65, about vaccination. These individuals are eligible for immunization against pneumococcus and influenza though are not always targeted in promotional campaigns. Rheumatology departments can play an important role in increasing vaccine uptake in their patient population by being proactive in their education about immunization. Following this audit, we have changed our own practice such that we have highlighted the importance of vaccination on our patient education leaflets, and offer vaccination against influenza and pneumococcus routinely to our inpatients.
References
- Gluck T. Vaccinate your immunocompromised patients! Rheumatology 2006;45:9–10.
[Free Full Text] - World Health Organisation. Pneumococcal Vaccines. WHO position paper. Weekly Epidemiol Rec. 2003;78:110–19.
- World Health Organisation. Influenza Fact sheet N°211 [online] Available from the Internet: (http://www.who.int/mediacentre/factsheets/fs211); 2003.
- Department of Health. The influenza immunisation Programme [online] Available from the Internet: http://www.dh.gov.uk/AboutUs/MinistersAndDepartmentLeaders/ChiefMedicalOfficer/CMOPublications/CMOLetters/fs/en); 2005.
- Department of Health. The pneumococcal immunisation programme for older people and risk groups [online] Available from the Internet: http://www.dh.gov.uk/AboutUs/MinistersAndDepartmentLeaders/ChiefMedicalOfficer/CMOPublications/CMOLetters/fs/en; 2005.
- Department of Health. Aged 65 or over? Make sure you get your pneumo jab; 2004.
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