P003 An audit of the uptake of vaccinations against influenza, pneumonia and varicella zoster among rheumatology outpatients
Authors: Kazi Khalid , Low Audrey 
Published: April 2021

Background/Aims 

Patients with autoimmune inflammatory rheumatic disease (AIIRD) requiring disease modifying anti rheumatic drugs (DMARDs) are at risk from influenza, pneumonia and shingles but vaccination rates have been low (∼70%). This audit aimed to evaluate vaccination uptake (aim 90% uptake) amongst those eligible and to assess whether the departmental vaccination advice was included in the standard letter template irrespective of the timing of the vaccination programmes.

Methods 

213 rheumatology outpatient clinic appointments were identified between 3 to 7 February 2020. Exclusions were 56 new patients or non-attenders, 31 patients who were neither treated with DMARDs nor had a diagnosis of AIIRD and 17 patients with AIIRD who did not need vaccination. The remaining 109 patients were eligible for vaccination according to Public Health England, British Society for Rheumatology and the European Alliance of Associations for Rheumatology (EULAR) guidelines. Electronic patient records (hospital and GP) were accessed for demographics, clinical data, vaccination status for influenza for the winter of 2019/20, pneumococcus and varicella zoster. Additionally clinic letters from the week of the audit were audited as a snapshot to identify whether the departmental vaccination advice was included within the standard letter template.

Results 

The majority of the patients were female (65%) with rheumatoid arthritis (37%); a third was ≥65 years old (Table 1). 22 of the 109 patients in whom influenza and pneumococcal vaccination were indicated did not have a vaccination status available in their GP records. 63 and 61 of the remaining 87 patients were appropriately vaccinated against influenza and pneumococcus respectively (72% and 70%). Vaccination data were available for all 12 patients in whom Zostavax was indicated; 7 patients were appropriately vaccinated (64%). Only 24 out of 126 (19%) clinic letters included the departmental vaccination advice. P003 Table 1:Demographic data of patients eligible for vaccinationDemographic dataN = 109Female, N (%)71 (65)Median age (IQR), yrs57 (47-70)Age categories (%), yrs- 18-4933 (3)- 50-6441 (38)- ≥6535 (32)Rheumatological Diagnosis, N (%)Rheumatoid Arthritis40 (37)Psoriatic Arthritis15 (14)Ankylosing Spondylitis10 (9)Myositis3 (3)Systemic Sclerosis11 (10)Vasculitis9 (8)Systemic lupus erythematosus2 (2)Other Inflammatory Arthritis14 (13)Other Inflammatory Rheumatological Condition5 (5)Significant Co-Morbidities, N (%)Respiratory23 (21)Cardiovascular19 (17)Renal9 (8)Hepatic10 (9)Neurological1 (1)Diabetes Mellitus11 (10)Immunological5 (5)Obesity BMI &gt;402 (2)Rheumatological Medication prescribed as the time of clinic visit, N (%)Any Biologic or Non Biologic DMARD85 (78)Any Biological DMARD38 (35)Any Non Biological DMARD67 (62)- Methotrexate34 (31)- Hydroxychloroquine20 (18)- Sulfasalazine14 (13)- Leflunomide2 (2)- Other Non Biological DMARD10 (9)Oral Corticosteroids27 (24)

Conclusion 

Rates of vaccination were low and in line with previous studies. For the 2020/21 winter, the department is writing directly to patients to advise influenza vaccination. The standard letter template will be changed to include the vaccination advice in all letters. The department will re-audit vaccination uptake after these interventions.

Disclosure 

K. Kazi: None. A. Low: None.