What question did this study set out to answer?

To assess influenza and pneumococcal vaccination uptake and evaluate the burden of infection among patients with rheumatoid arthritis in routine clinical practice.

August 4, 2016BMC Musculoskeletal DisordersOpen Access

A large two-centre study in to rates of influenza and pneumococcal vaccination and infection burden in rheumatoid arthritis in the UK

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Rheumatoid arthritis (n=929). Intervention: Pneumococcal vaccination vs. No pneumococcal vaccination. Primary outcome: Hospital admission with infection in the preceding year (OR 0.61, 95% CI 0.37-1.03).

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Key result

In a survey of 929 patients with rheumatoid arthritis, influenza vaccination uptake was 85.9% while pneumococcal vaccination uptake was only 44.3%, and pneumococcal vaccination was associated with a non-significant reduction in hospital admissions for infection (adjusted OR 0.61).

Population

929 patients with rheumatoid arthritis from 2 UK rheumatology centres

Comparison

Influenza and pneumococcal vaccination vs No vaccination

Design

Cross-sectional

Follow-up

12 months (retrospective)

Authors

SSSujith SubesingheGuy's and St Thomas' NHS Foundation Trust ARAndrew I RutherfordKing's College Hospital NHS Foundation Trust FIFowzia IbrahimJohnson & Johnson (United Kingdom)

Discussion

Member takes

Implication

Pneumococcal vaccination uptake lags in RA; cross-sectional data leave reduction in infection admissions open.

Key Points

To assess influenza and pneumococcal vaccination uptake and evaluate the burden of infection among patients with rheumatoid arthritis in routine clinical practice.
Conducted a survey across 2 UK rheumatology centres (N=929) using postal, clinic, and telephone questionnaires to evaluate past vaccination history, reasons for non-vaccination, and recent infections.
Obtained primary care vaccination records for a subset of patients to supplement self-reported data.
Over 85% of patients received influenza vaccination, whereas only 44% received pneumococcal vaccination, with most immunizations administered in primary care.
In the 12 months prior to the survey, 7.7% of patients reported at least one severe infection requiring hospital admission, and nearly 40% received at least one course of antibiotics.

Study Design

Type

Cross-Sectional (n=929)

Multicenter

Yes

Structured PICO

Population

929 patients with rheumatoid arthritis surveyed across two UK centers to evaluate influenza and pneumococcal vaccination uptake and its relationship with infection burden.

Exposure

Influenza and pneumococcal vaccination

Comparator

No vaccination

Outcome

Rates of influenza and pneumococcal vaccination uptake and burden of infection (hospital admissions and antibiotic courses)

Main Result

Odds Ratio: 0.61 (95% CI 0.37–1.03)

In UK patients with rheumatoid arthritis, influenza vaccination uptake is high but pneumococcal vaccination rates remain poor, highlighting a need for improved collaborative care to mitigate infection risks.

Limitations

Recall bias due to survey study design
Self-reported antibiotic courses not confirmed with practice data
Misclassification bias for comorbidity data
Selection bias due to lack of reminders for postal survey completion
Inability to account for intermittent or variable steroid therapy dosing
Unmeasured confounders such as severity of chronic lung disease
Recall bias (especially for pneumococcal vaccination and antibiotic courses)
Selection bias due to lack of reminders for postal survey
Misclassification bias for comorbidities
Inability to account for intermittent steroid therapy or variable dosing

Cite This Study

Subesinghe et al. (2016) conducted a cross-sectional in Rheumatoid arthritis (n=929). Pneumococcal vaccination vs. No pneumococcal vaccination was evaluated on Hospital admission with infection in the preceding year (OR 0.61, 95% CI 0.37-1.03). In a survey of 929 patients with rheumatoid arthritis, influenza vaccination uptake was 85.9% while pneumococcal vaccination uptake was only 44.3%, and pneumococcal vaccination was associated with a non-significant reduction in hospital admissions for infection (adjusted OR 0.61).

synapsesocial.com/papers/6a78eeba3b1c66cefb5ad42d https://doi.org/10.1186/s12891-016-1187-4

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A large two-centre study in to rates of influenza and pneumococcal vaccination and infection burden in rheumatoid arthritis in the UK

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

A large two-centre study in to rates of influenza and pneumococcal vaccination and infection burden in rheumatoid arthritis in the UK

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider