German rheumatologists encouraged to vaccinate patients against routine infections
medwireNews: Routine vaccination rates are currently “inacceptable” among patients with chronic inflammatory rheumatic diseases (CIRDs) in Germany, researchers report in RMD Open.
“The vaccination strategy in Germany is based on cooperation with [general practitioners]. However, this strategy does not seem to work very well,” explain Uta Kiltz (Rheumazentrum Ruhrgebiet, Herne) and colleagues.
They therefore recommend: “Interdisciplinary quality projects should be planned to change current management strategies. Thus, rheumatologists should be encouraged to vaccinate CIRD patients themselves and the healthcare system should make sure that the associated efforts are compensated for.”
The findings are based on an analysis of data prospectively collected from 975 German patients with a CIRD, most commonly rheumatoid arthritis (43.5%), followed by axial spondyloarthritis (14.9%), psoriatic arthritis (12.6%), and systemic lupus erythematosus (4.2%). The mean age of the patients was 55.3 years and over half (51.2%) were taking a biologic (b)DMARD.
“Infections were rather common” in this patient population, say the researchers, with 7.6% of patients hospitalized for an infection in the 12 months prior to study enrollment. Throughout their lifetime, 8.6% of patients had experienced sepsis and 9.3% had been isolated because of an infection.
The majority (64.5%) of patients said the importance of vaccination had been explained to them, but only 55.4% were able to present a vaccination card when asked. None of the patients met the German National Vaccination recommendations that require a complete record of vaccinations received throughout the patient’s lifetime.
The researchers assigned the participants an immunization score out of a possible 26 points based on their receipt of 11 vaccines: tetanus, pneumococcal, influenza, hepatitis (Hep)B, measles, diphtheria, meningococcal, pertussis, poliomyelitis, rubella, and varicella. Three points were given for each complete vaccination, 2 points for each basic immunization, and 1 point for an incomplete vaccination. The mean vaccination score of the cohort was 13.3 points, with 3.3% of patients having a high immunization status (21–26 points), 47.0% a good status (14–20 points), 43.9% a moderate status (7–13 points), and 5.7% a low status (0–6 points).
The researchers emphasize that the majority of patients were “not sufficiently protected against vaccine preventable infections such as influenza, pneumococci and HepB,” with only 18.5%, 27.3%, and 12.5% of patients, respectively, fully vaccinated against these diseases.
They do note, however, that screening for latent tuberculosis infection and HepB, which is mandatory or highly recommended in most countries prior to starting biologics, had been “successfully implemented in clinical routine,” and rates were high, at a respective 100% and 94%.
Overall, Kiltz et al say that since vaccination rates in their study were “inacceptable,” they “are convinced that there is substantial room for improving the healthcare system and its effectivity.”
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