title: An audit of influenza and pneumococcal vaccination in rheumatology outpatients.
abstract: BACKGROUND
  Influenza and pneumococcal vaccination are recommended for a number of clinical risk groups including patients treated with major immunosuppressant disease modifying anti-rheumatic drugs. Such immunisation is not only safe but immunogenic in patients with rheumatic diseases. We sought to establish dual vaccination rates and significant influencing factors amongst our hospital rheumatology outpatients.
  
  
  METHODS
  We audited a sample of 101 patients attending hospital rheumatology outpatient clinics on any form of disease modifying treatment by clinical questionnaire and medical record perusal. Further data were collected from the local immunisation coordinating agency and analysed by logistic regression modelling.
  
  
  RESULTS
  Although there was a high rate of awareness with regard to immunisation, fewer patients on major immunosuppressants were vaccinated than patients with additional clinical risk factors against influenza (53% vs 93%, p < 0.001) or streptococcus pneumoniae (28% vs 64%, p = 0.001). The presence of additional risk factors was confirmed as significant in determining vaccination status by logistic regression for both influenza (OR 10.89, p < 0.001) and streptococcus pneumoniae (OR 4.55, p = 0.002). The diagnosis of rheumatoid arthritis was also found to be a significant factor for pneumococcal vaccination (OR 5.1, p = 0.002). There was a negative trend suggesting that patients on major immunosuppressants are less likely to be immunised against pneumococcal antigen (OR 0.35, p = 0.067).
  
  
  CONCLUSIONS
  Influenza and pneumococcal immunisation is suboptimal amongst patients on current immunosuppressant treatments attending rheumatology outpatient clinics. Raising awareness amongst patients may not be sufficient to improve vaccination rates and alternative strategies such as obligatory pneumococcal vaccination prior to treatment initiation and primary care provider education need to be explored.
authors.affiliation: Department of Rheumatology, Furness General Hospital, Barrow-in-Furness, UK. evinsowden@hotmail.com
authors.forename: Evin
authors.initials: E
authors.lastname: Sowden
authors.forename: William S
authors.initials: WS
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000917:Antibody Formation / Q000187:drug effects; D015535:Arthritis, Psoriatic / Q000188:drug therapy / Q000453:epidemiology; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology; D004198:Disease Susceptibility; D004739:England; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007252:Influenza Vaccines; D019359:Knowledge; D008297:Male; D008485:Medical Audit; D008499:Medical Records; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010045:Outpatients / Q000706:statistics & numerical data*; D022242:Pneumococcal Vaccines; D012219:Rheumatology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007166:Immunosuppressive Agents; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines