Patients with Inflammatory Arthritis Confused About Vaccine Recommendations
In a recent survey, people with inflammatory arthritis expressed considerable uncertainty over which vaccines were recommended and safe to receive. As a result, authors of the study, published in ACR Open Rheumatology, concluded that relevant vaccine recommendations should be communicated more consistently to this population.
The online questionnaire -- which was administered before the onset of the COVID-19 pandemic -- included questions about vaccination history, vaccine hesitancy, health literacy, education, and similar topics.
Overall, respondents expressed positive views toward vaccines in general around safety, efficacy, and access in particular. At the same time, only 43% knew which vaccines were recommended for them. Uncertainty and lack of information about recommendations were the top causes of vaccine hesitancy.
Primary care providers (89%) and rheumatologists (76%) were the most frequently used and positively viewed information sources for vaccine information. Negative perceptions of vaccinations were most often informed by internet chatrooms and social and mainstream media. Males and younger individuals were more strongly associated with lower adherence and greater uncertainty about vaccinations.
Catherine Hill, MBBS, MD, head of the rheumatology unit at The Queen Elizabeth Hospital and clinical professor at the University of Adelaide in Australia, served as a co-author of the study, which she recently discussed with the Reading Room. The exchange has been edited for length and clarity.
What was the impetus for this study?
Hill: People with inflammatory arthritis are at increased risk of vaccine-preventable infections due to both their disease and its treatment. We sought to describe vaccine rates and hesitancy in this group, and to determine predictors of vaccine hesitancy and vaccine information sources used.
This study also allowed us to identify possible targets for intervention to improve vaccine uptake and reduce the morbidity and mortality of vaccine-preventable infections.
How was the study conducted?
Hill: A survey was sent to 1,408 members of the Australian Rheumatology Association Database, a national voluntary registry of patients with inflammatory arthritis. The response rate was 994 of 1,498 (66%).
We asked about age-appropriate vaccination uptake (such as influenza and pneumococcal), vaccination hesitancy (World Health Organization vaccine hesitancy scale), patients' beliefs about medicines (and whether they think they cause harm), and the information sources used by patients regarding vaccinations.
The data were analyzed to establish vaccine rates and predictors of vaccination hesitancy and to identify common sources of both positive and negative vaccine information and perception.
Would you summarize your key findings?
Hill: Adherence to recommended annual flu vaccination was high at 83%. (The flu vaccination is free for this group of patients in Australia.) Participants generally held positive views regarding vaccinations, but fewer than half knew which vaccines were recommended for them.
Among those who expressed vaccine hesitancy, a lack of vaccine information was a key driver of that perception. Primary care clinicians and rheumatologists were the most common sources consulted for vaccine information.
Almost one-quarter of patients turned to social media (24%) and online forums (22%) to get their vaccination information. Concerningly, these were sources that most commonly yielded very strongly and strongly negative views of vaccination. Predictors of lower vaccine adherence and increased vaccination hesitancy included younger age, male gender, and having greater skepticism generally about the harms and overuse of medicines.
Did anything surprise you about the study or its findings?
Hill: Two findings surprised us.
First, rheumatology nurses were consulted for vaccine information sources by only 25% of participants; and only 48% reported that the vaccine information they received from rheumatology nurses was positive. This is out of keeping with perceptions of the information respondents received from other health professionals, such as physicians and pharmacists, who provided mainly positive views regarding vaccination.
Second, it was somewhat surprising that the level of a person's education and self-reported literacy were not predictors of vaccine hesitancy.
What are the clinical takeaways for rheumatologists and their practices?
Hill: A lack of understanding of vaccination recommendations, as well as information regarding vaccination safety and efficacy, are factors associated with increased vaccine hesitancy. Improving patient understanding about vaccines is a potential target to improve vaccination uptake.
Rheumatologists have a key role in providing education and advice to their patients and to general practitioners.
Read the study here and expert commentary on the clinical implications here.
The Australian Rheumatology Association Database is supported by unrestricted educational grants from Pfizer Australia, AbbVie Pty Ltd., Eli Lilly Australia Pty Ltd. Sanofi Australia, Celgene Australian & NZ, Bristol Myers Squibb Australia Pty Ltd. Amgen Australia Pty Ltd., Aventis, AstraZeneca, and Roche that are administered through the Australian Rheumatology Association.