Friday, 17 Nov 2017

You are here

Why Rheumatologists Should Do Better Vaccinating this Flu Season

It is well known that influenza infection is more common in patients with rheumatologic diseases. Blumentals et al. showed that patients with rheumatoid arthritis are at increased risk for influenza regardless of DMARD/biologic use and may have a 2.75-fold increased incidence of related complications (https://buff.ly/2gYNTSz).

Despite these facts, vaccine uptake is lower in this population compared to patients without autoimmune diseases. Reasons for this are many, but one big issue is that it’s often unclear who’s in charge of administering and keeping track of patient’s vaccinations – the rheumatologist or the PCP? It often happens that the rheumatologist assumes the PCP will administer vaccines and vice versa. Meanwhile PCPs may be hesitant to vaccinate our patients due to their immunosuppressive medications.

I think its best that we as rheumatologist take ownership, as we are the ones prescribing the immunosuppressive medications that increase risk of flu (and other infections) and thus we should be responsible for helping prevent it. 

This deficit extends beyond flu vaccine uptake, in particular to pneumonia vaccine and the reasons again is likely multifactorial. In our clinic, for example, we do not carry the Prevnar 13 (conjugate pneumococcal vaccine) and rely on patient’s PCPs to take responsibility, and often times our patients do not even have a primary care doctor. 

 In 2006, Pradeep et al. published a study in ARD that examined vaccine uptake of influenza and pneumococcal vaccination in their UK rheumatology clinic. They found that out of 155 patients only 43% received both vaccines, 19% received influenza vaccine alone and 19% received neither. (https://buff.ly/2f03La7).

I’m sure this still is a theme in our clinics today and suggests that we need better strategies for vaccinating our immunocompromised patients. If rheumatologists are not going to be administering the vaccine, it may be wise for them to at least provide PCPs with specific advice about appropriate vaccinations. 

This flu season the CDC continues to recommend against the live-attenuated intranasal flu vaccine. All recommended vaccine formulations contain inactivated influenza and thus are safe to give to our rheumatologic patients regardless of immunosuppression. High dose vaccine (Fluzone) is still recommended for adults ≥ 65 years.

Flu season is here to stay and while its best to vaccinate in September or early October, it’s never too late to vaccinate. Flu season usually peaks in January and February but can last as late as May.

 

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

The RheumNow Week in Review - 17 November 2017

Dr. Jack Cush reviews the news and highlights from the past week on RheumNow.com. This week he covers FDA warnings on gout drugs, steroid use in Australia, biosimilars lost savings and methotrexate hepatotoxicity in psoriatic arthritis (PsA).

Podcast of ACR17 - Day 4

Care to learn what you missed at last weeks ACR 2017 meeting in San Diego?  Here are 4 one hour audio podcasts - each with a compliation of 2-4 minute reports from Drs. Cush, Kavanaugh, the RheumNow Faculty and other rheumatology thought leaders and researchers.  Another good way to learn from RheumNow.

The ACR17 RheumNow Week in Review - 10 November 2017

This special edition of the RheumNow Week in Review covers highlights of selected sessions from the 2017 ACR annual meeting in San Diego. Dr. Jack Cush reviews lupus and the microbiome, daily podcasts, pregnancy and lactation, osteoporosis drug holidays and screening for pulmonary hypertension.

Many thanks to the RheumNow Faculty for their work and expertise!

Podcast of ACR 17 - Day 3

Check out this compilation of our ACR17 Day 3 broadcasts, merged into a single one hour podcast !

ACR 2017 - Day 3 and 4 Highlights

Day 3 at the annual meeting was rich with information. Yet the most anticipated and best attended session was the Late Breaking Abstracts and the session revealing the new ACR/NPF Guidelines for Psoriatic Arthritis (more on the latter in another report).  Day 4 was full of review sessions and a modicum of original content and for me, the 7:30AM Rheumatology Roundup.