Patients with systemic lupus erythematosus who received immunosuppressants and did not receive influenza or pneumococcal vaccines were most likely to cite a lack of recommendation from their physician as the reason for non-vaccination, according to researchers from the University of California, San Francisco.
The researchers surveyed 485 patients with systemic lupus erythematosus (SLE) recruited from the UCSF Lupus Genetics Project who participated in annual, structured telephone interviews about SLE characteristics, health care coverage and demographics. Mean patient age was 50 years. Patients’ mean disease duration was 18 years, and all were treated with immunosuppressants.
Patients were immunosuppressed with either steroids alone, disease-modifying anti-rheumatic drugs (DMARDs) with or without steroids, or a biologic with or without a DMARD or steroids.
Among other questions, patients were asked if they received either influenza or pneumococcal vaccines in the previous year. Participants who did not receive vaccinations (n=175 for influenza, 159 for pneumococcal vaccines) were asked if their physician had recommended it. Patients who were recommended but did not receive vaccinations were asked by the interviewers about reasons that prompted the choice to not vaccinate.
The most common reason reported for choosing not to obtain either an influenza or pneumococcal vaccination was a lack of recommendation by the health care provider. Influenza vaccines were not recommended to 55% of patients and pneumococcal vaccines were not recommended to 87% of patients.
Concerns about the safety or efficacy of influenza vaccines were cited by 21% of respondents, and 19% said a lack of time or motivation was behind the choice to not vaccinate, according to the researchers.
Pneumococcal vaccines were declined by 7% of patients who cited lack of time or motivation, and by 4% of patients due to concerns about efficacy or safety.
Patients who were recommended influenza vaccines by their health care providers were more likely to have longer disease duration and more likely to have visited a rheumatologist in the prior year, but few other variables reached statistical significance in multivariate analysis, according to the researchers. – by Shirley Pulawski
Disclosure: The research was supported by the Arthritis Foundation and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a division of the NIH.