Friday, 19 Jan 2018

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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

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