Perception and awareness of vaccinations in autoimmune inflammatory rheumatic diseases

Abstract

Vaccines provide effective protection against diseases which can otherwise result in morbidity and mortality to the general population. This is even more relevant to patients suffering from autoimmune disease with a dysregulated immune system who are therefore more vulnerable, especially if on immunosuppressive therapy. The aim of the research is to provide information regarding vaccinations within immunocompromised patients suffering from autoimmune inflammatory rheumatic diseases (AIIRD). The methodology consisted of three phases. Phase 1 focused on a gap analysis to capture differences and similarities between practice guidelines in vaccination status recommendations issued by two main authorities in the field namely EULAR (European Alliance of Associations for Rheumatology) and American College of Rheumatology (ACR). Phase 2 consisted of the development, and validation of two separate questionnaires to rheumatologists and AIIRD patients respectively. Phase 3 focused on the dissemination of the questionnaires. The “Rheumatologists vaccination questionnaire” intended for rheumatologists captured the national experts practice on vaccinations in Maltese AIIRD patients. The “AIIRD vaccination perception and awareness questionnaire” aimed for AIIRD patients captured the perception and awareness of vaccination in a cohort of AIIRD patients. Study findings from Phase 1 indicate that the EULAR and ACR guidelines agree on recommendations put forward for vaccinations related to influenza, Pneumococcal vaccine, Hepatitis A and B and vaccinations against Covid-19 in AIIRD pa/ents. There is a difference in the age range recommendation for Human Papilloma Virus vaccine whilst a lack of agreement for varicella zoster vaccine where EULAR suggests avoid during immunosuppression and ACR strongly recommends the vaccine in patients over 18 years of age whilst on immunosuppressive therapy. Study findings from Phase 2 indicate that Maltese rheumatologists (n=3) follow EULAR guidelines and recommend that patients get their yearly influenza and COVID-19 vaccinations. Despite this, patients are still hesitant, fearful and not fully compliant as can be seen in Phase 3 of this study, with 10 out of the 13 who answered the questionnaire suggesting a need for more information about vaccine side effects for this cohort and are currently not satisfied with the information provided to them by health care professionals. The research highlights a gap between patient and rheumatologist views, that could indicate the need for educational informative campaigns to address pa/ent fears and concerns regarding vaccines. Pharmacist-led education can be relevant since pharmacists are highly accessible within the community and trained to bridge this gap to educate AIIRD patients by providing correct and up to date information without payment and address any queries and concerns.