AB0804 ONE YEAR FOLLOW-UP SAFETY AND EFFICACY RESULTS OF VACCINATION PROTOCOL FROM A RHEUMATOLOGY CLINIC
Authors: S. Jeria Navarro, S. P. Fernandez-Sanchez, V. Pomar, D. Lobo Prat, L. Sainz Comas, H. Park, A. García-Guillén, A. M. Millán Arciniegas, C. Díaz-Torné, P. Moya, B. Magallares, I. Castellví, A. Laiz, H. Corominas
Journal: Annals of the Rheumatic Diseases (2021)

Background: Patients with autoimmune inflammatory rheumatic diseases (AIIRD) have a higher burden of infectious diseases compared to the general population. This could be explained by the disturbances in their immune system response, comorbidities and immunosuppressive treatment.Vaccination is the most effective measure to prevent infections. Objectives: To describe a cohort of patients with AIIRD referred to the infectious disease´s unit according to the vaccination protocol. Methods: Restrospective and descriptive study of a cohort of 286 patients with AIIRD who were evaluated in the rheumatology service of a tertiary hospital in Barcelona and referred to the infectious disease´s unit according to the vaccination protocol among 1 year,between January 1 rst December 31 st , 2019. The vaccination protocol included serologies of human immunodeficiency virus,hepatitis A,B and C, varicella zoster,tuberculosis,measles,mumps and rubella virus.The recommended vaccines were H.influenzae b,S.pneumonia, influenza,hepatitis A and B(immunity absence), meningococcus c ,tetanus – diphtheria (low antigenic load),poliomyelitis and human papillomavirus (not vaccinated).The patients included were diagnosed with a rheumatologic condition under immunosuppressive therapy. Demographic variables,diagnosis,treatment,vaccines administered,infections and adverse effects were collected. Results: Of 286 patients reviewed the mean age was 61, 4 (±14.4) years. The characteristics of the cohort are shown in Table 1. Most of the patients used csDMARDs 149 (52.1%), 77(26.9%) patients used combined treatment. Measles and rubella are part of the triple virus vaccines included in the systematic Spanish vaccination schedule, in our cohort 20 (7%) patients had negative serologies for measles and 26 (9%) for rubella. 57 (20%) patients had latent TB with positive Quantiferon.Forty-one (14.3%) were vaccinated before receiving immunosuppressive treatment. The less administered vaccine was influenza with 44.9% (vaccination rate in Spain in healthy population, in 2019-2020 was 51.2%).No serious adverse effects were reported in relation to the vaccination. The infectious complications during the follow-up period were bronchopneumonia in a patient with RA treated with certolizumab (1), herpes zoster infection in RA on adalimumab(1), recurrent otitis in RA on adalimumab(1), mycobacterium avium infection in RA on etanercept(1), TB reactivation in RA with GCs and csDMARDs(1) and Papilloma virus infection in SpA on ustekinumab (1). Table 1. CHARACTERISTICS OF COHORT OF PATIENTS Sex n % (women/men) 193/93 (67,5/32,5) Age, years ± DE 61.4 ± 14.4 Diagnoses AIIRD, n (% ) Rheumatoid arthritis n (%) 164 (57.3) Systemic lupus erythematosus n (%) 6 (2.1) Sjögren´s syndrome n (%) 9 (3.1) Systemic sclerosis n (%) 1 (0.35) Inflammatory myopathie n (%) 5 (1.7) Vasculitis n (%) 36 (12.6) Polymyalgia rheumatica n (%) 4 (1.4) Spondyloarthropathy n (%) 46 (16.1) Others n (%) 15 (5.2) Treatment AIIRD GCs n (%) 116 (40.7) csDMARDs n (%) 149 (52.1) bDMARDs n (%) 80 (27.8) tsDMARDs n (%) 7 (2.4) Others 1 n (%) 12 (4.2) GCs + csDMARDs n (%) 59 (21) GCs + bDMARDs n (%) 14 (4.9) GCs + csDMARDs + bDMARDs n (%) 4 (1.4) Vaccines PCV 13 n (%) 283 (99) PPSV23 n (%) 265 (93) HiB n (%) 265 (93) NM n (%) 247 (86.7) Influenza n (%) 128 (44.9) HBV n (%) 121 (42.3) Vaccination before IS n (%) 41 (14.3) Vaccination with IS n (%) 244 (85.3) Other: Behcet,Adult Stills,Relapsing polychondritis,IGg4 related disease,Sarcoidosis Others 1 : Mycophenolic acid,cyclosporine and tacrolimus Conclusion: In our cohort, the vaccination protocol proved to be a good tool to improve the vaccination rate of rheumatological patients, despite this, the vaccination of Hepatitis B and specially of influenza, continues to have a lower prevalence to general population.The vaccines were effective since none of the preventable infections occurred during follow up, despite the use of an immunosuppressant. Vaccination showed a good safety profile, without reported serious adverse effects or worsening of the underlying disease. Disclosure of Interests: None declared