Skip to main content

Advertisement

SpringerLink
Log in

Low vaccination rates among patients with rheumatoid arthritis in a German outpatient clinic

  • Public Health
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Patients with rheumatoid arthritis (RA) are at an increased risk of acquiring infections due to two reasons: the disease itself and the immunosuppressive therapy. Vaccinations against preventable diseases are therefore of utmost importance for these group of patients. To estimate vaccination frequencies among patients with rheumatoid arthritis, we studied patients in a survey and calculated vaccination rates based on their vaccination documents. Patients have been recruited from our outpatient clinic during one of their routine visits. For the statistical analysis, they have been divided by age (≥60 vs <60 years) and medication (DMARD, Biologics, TNF inhibitors) for further subgroup analysis. Among the studied patients (n = 331), we found rather low vaccination rates, in particular for the strongly recommended vaccines against Pneumococcus and Influenza (33 and 53%, respectively). Furthermore, protection rates for important basic vaccinations, e.g. against Pertussis, were found to be very low with 12% only. Beside these findings, we saw age-dependent differences for a variety of vaccines: while Pneumococcus and Influenza vaccines were more often given to patients ≥60 years, MMR, Pertussis, Diphtheria and Hepatitis were significantly more often applied to younger patients. Vaccination rates have to be improved among RA patients, in particular for vaccines protecting from respiratory tract infections such as Pneumococcus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wolfe F, Mitchell DM, Sibley JT, Fries JF, Bloch DA, Williams CA et al (1994) The mortality of rheumatoid arthritis. Arthritis Rheum 37(4):481–494

    Article  CAS  PubMed  Google Scholar 

  2. Miller RA (1996) The aging immune system: primer and prospectus. Science 273(5271):70–74

    Article  CAS  PubMed  Google Scholar 

  3. Krasselt ML, Wagner U (2014) Ageing and immunity. Osteology 23(3):195–201

    Google Scholar 

  4. Widdifield J, Bernatsky S, Paterson JM, Gunraj N, Thorne JC, Pope J et al (2013) Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis. Arthritis Care Res (Hoboken) 65(3):353–361. doi:10.1002/acr.21812

    Article  Google Scholar 

  5. Krasselt M, Baerwald C (2014) The current relevance and use of prednisone in rheumatoid arthritis. Expert Rev Clin Immunol 10(5):557–571. doi:10.1586/1744666X.2014.904746

    Article  CAS  PubMed  Google Scholar 

  6. Listing J, Strangfeld A, Kary S, Rau R, von Hinueber U, Stoyanova-Scholz M et al (2005) Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum 52(11):3403–3412. doi:10.1002/art.21386

    Article  CAS  PubMed  Google Scholar 

  7. van Assen S, Agmon-Levin N, Elkayam O, Cervera R, Doran MF, Dougados M et al (2011) EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 70(3):414–422. doi:10.1136/ard.2010.137216

    Article  PubMed  Google Scholar 

  8. Hua C, Barnetche T, Combe B, Morel J (2014) Effect of methotrexate, anti-tumor necrosis factor alpha, and rituximab on the immune response to influenza and pneumococcal vaccines in patients with rheumatoid arthritis: a systematic review and meta-analysis. Arthritis Care Res (Hoboken) 66(7):1016–1026. doi:10.1002/acr.22246

    Article  CAS  Google Scholar 

  9. Panda A, Arjona A, Sapey E, Bai F, Fikrig E, Montgomery RR et al (2009) Human innate immunosenescence: causes and consequences for immunity in old age. Trends Immunol 30(7):325–333. doi:10.1016/j.it.2009.05.004

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Shaw AC, Joshi S, Greenwood H, Panda A, Lord JM (2010) Aging of the innate immune system. Curr Opin Immunol 22(4):507–513. doi:10.1016/j.coi.2010.05.003

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Weyand CM, Fujii H, Shao L, Goronzy JJ (2009) Rejuvenating the immune system in rheumatoid arthritis. Nat Rev Rheumatol 5(10):583–588. doi:10.1038/nrrheum.2009.180

    Article  CAS  PubMed  Google Scholar 

  12. Krasselt M, Baerwald C, Wagner U, Rossol M (2013) CD56+ monocytes have a dysregulated cytokine response to lipopolysaccharide and accumulate in rheumatoid arthritis and immunosenescence. Arthritis Res Ther 15(5):R139. doi:10.1186/ar4321

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wagner UG, Koetz K, Weyand CM, Goronzy JJ (1998) Perturbation of the T cell repertoire in rheumatoid arthritis. Proc Natl Acad Sci USA 95(24):14447–14452

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Goronzy JJ, Shao L, Weyand CM (2010) Immune aging and rheumatoid arthritis. Rheum Dis Clin North Am 36(2):297–310. doi:10.1016/j.rdc.2010.03.001

    Article  PubMed  PubMed Central  Google Scholar 

  15. Giat E, Lidar M (2015) Vaccinations in Rheumatoid Arthritis. In: Shoenfeld Y, Agmon-Levin N, Tomljenovic L (eds) Vaccines & autoimmunity, vol 1, 1st edn. Wiley, Hoboken, pp 233–246

    Chapter  Google Scholar 

  16. RKI (2015) Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut: Epidemiologisches Bulletin 34/2015. doi:10.17886/EpiBull-2015-001

  17. Goldacker S, Gause AM, Warnatz K, Kommission Pharmakotherapie der D (2013) Vaccination in adult patients with chronic inflammatory rheumatic diseases. Z Rheumatol 72 (7):690–694, 696–700, 702–694. doi:10.1007/s00393-013-1155-4

  18. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd et al (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 69(9):1580–1588. doi:10.1136/ard.2010.138461

    Article  PubMed  Google Scholar 

  19. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology 18(6):800–804. doi:10.1097/EDE.0b013e3181577654

    Article  Google Scholar 

  20. Feuchtenberger M, Kleinert S, Schwab S, Roll P, Scharbatke EC, Ostermeier E et al (2012) Vaccination survey in patients with rheumatoid arthritis: a cross-sectional study. Rheumatol Int 32(6):1533–1539. doi:10.1007/s00296-011-1808-z

    Article  PubMed  Google Scholar 

  21. Wotton CJ, Goldacre MJ (2012) Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: record linkage cohort analyses. J Epidemiol Commun Health 66(12):1177–1181. doi:10.1136/jech-2011-200168

    Article  Google Scholar 

  22. Costello R, Winthrop KL, Pye SR, Brown B, Dixon WG (2016) Influenza and pneumococcal vaccination uptake in patients with rheumatoid arthritis treated with immunosuppressive therapy in the UK: a retrospective cohort study using data from the clinical practice research datalink. PLoS ONE 11(4):e0153848. doi:10.1371/journal.pone.0153848

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bingham CO 3rd, Looney RJ, Deodhar A, Halsey N, Greenwald M, Coding C et al (2010) Immunization responses in rheumatoid arthritis patients treated with rituximab: results from a controlled clinical trial. Arthritis Rheum 62(1):64–74. doi:10.1002/art.25034

    Article  CAS  PubMed  Google Scholar 

  24. Cantini F, Boccia S, Goletti D, Iannone F, Leoncini E, Panic N et al (2014) HBV reactivation in patients treated with antitumor necrosis factor-alpha (TNF-alpha) agents for rheumatic and dermatologic conditions: a systematic review and meta-analysis. Int J Rheumatol 2014:926836. doi:10.1155/2014/926836

    Article  PubMed  PubMed Central  Google Scholar 

  25. RKI (2015) Schutzimpfung gegen Masern: Häufig gestellte Fragen und Antworten. http://www.rki.de/SharedDocs/FAQ/Impfen/MMR/FAQ04.html. Accessed 2 May 2016

  26. Brassard P, Lowe AM, Bernatsky S, Kezouh A, Suissa S (2009) Rheumatoid arthritis, its treatments, and the risk of tuberculosis in Quebec, Canada. Arthritis Rheum 61(3):300–304. doi:10.1002/art.24476

    Article  PubMed  Google Scholar 

  27. Seong SS, Choi CB, Woo JH, Bae KW, Joung CL, Uhm WS et al (2007) Incidence of tuberculosis in Korean patients with rheumatoid arthritis (RA): effects of RA itself and of tumor necrosis factor blockers. J Rheumatol 34(4):706–711

    CAS  PubMed  Google Scholar 

  28. Pai M, Zwerling A, Menzies D (2008) Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med 149(3):177–184

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Authors’ contributions

MK performed the statistical analysis, interpreted the data and drafted the manuscript. JPI interviewed the patients and collected the data. CB contributed to data interpretation and was involved in manuscript drafting. OS conceived of the project and was involved in data collection, data interpretation and manuscript preparation. All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Rheumatology Unit, Clinic for Gastroenterology and Rheumatology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany

    Marco Krasselt, Jean-Philipp Ivanov, Christoph Baerwald & Olga Seifert

Authors
  1. Marco Krasselt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean-Philipp Ivanov
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christoph Baerwald
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olga Seifert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Krasselt.

Ethics declarations

Conflict of interest

Dr. Krasselt declares no conflict of interest. Mr Ivanov declares no conflict of interest. Professor Baerwald has received lecture fees from Merck, MSD, Mundipharma and Pfizer. Dr. Seifert declares no conflict of interest.

Ethical approval

All procedures performed in this survey were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Data obtained in this study did not interfere with the course of treatment for patients included.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krasselt, M., Ivanov, JP., Baerwald, C. et al. Low vaccination rates among patients with rheumatoid arthritis in a German outpatient clinic. Rheumatol Int 37, 229–237 (2017). https://doi.org/10.1007/s00296-016-3608-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-016-3608-y

Keywords

Search

Navigation