Predictors and temporal trend of flu vaccination in auto-immune rheumatic diseases in the UK: a nationwide prospective cohort study

Abstract

Objectives: To examine temporal trend in uptake of seasonal influenza vaccine (SIV) in the UK and explore disease and demographic factors associated with vaccination.

Methods: From the Clinical Practice Research Datalink, 32 751 people with auto-immune rheumatic diseases prescribed DMARDs between 2006 and 2016 were identified. The proportion vaccinated between 1 September of one year and 31 March of the next year was calculated and stratified by age, other indications for vaccination, auto-immune rheumatic diseases type and number of DMARDs prescribed. Stata and Joinpoint regression programs were used.

Results: SIV uptake was high in those aged ⩾65 years (82.3 and 80.7% in 2006-07 and 2015-16, respectively). It was significantly lower in other age groups, but improved over time with 51.9 and 61.9% in the 45-64 year age group, and 32.3 and 50.1% in the <45 year age group being vaccinated in 2006-07 and 2015-16, respectively. While 64.9% of the vaccinations in those ⩾65 years old occurred by 3 November, in time to mount a protective immune response before the influenza activity becomes substantial in the UK, only 38.9% in the 45-64 year and 26.2% in the <45 year age group without any other reason for vaccination received SIV by this date. Women, those with additional indications for vaccination, on multiple DMARDs and with SLE were more likely to be vaccinated.

Conclusion: SIV uptake is low in the under 65s, and the majority of them are not vaccinated in time. Additional effort is required to promote timely uptake of SIV in this population.

Fig. 1

Uptake of seasonal influenza vaccine in immunosuppressed AIRD patients (2006–16) Percentage of people with autoimmune rheumatic diseases on DMARD vaccinated in each flu season from 2006 to 2016. AIRD: autoimmune rheumatic diseases.

Fig. 2

Cumulative seasonal influenza vaccine uptake between the September and March in all influenza seasons Weekly cumulative seasonal influenza vaccine uptake between 1 September and 31 March in all influenza seasons. Overall vaccine uptake was significantly higher in the over 65s (P < 0.001) and 45–64 year (P < 0.001) age group with another at-risk condition for vaccination than the 45–64 year age group without another at-risk condition for vaccination (reference group). The latter had statistically similar vaccination rates to people <45 years in age with another at-risk condition for vaccination (P = 0.267), while those <45 years without another at-risk condition for vaccination had significantly lower vaccination uptake than the reference group (P < 0.001).

Fig. 3

Uptake of seasonal influenza vaccine in immunosuppressed AIRD patients by disease type (2006–16) Percentage of people with AIRD on disease modifying anti-rheumatic drugs vaccinated in each flu season from 2006 to 2016 according to individual AIRD. AIRD: autoimmune rheumatic diseases.

Fig. 4

Uptake of seasonal influenza vaccine in immunosuppressed AIRD patients by number of DMARDs (2006–16) Percentage of people with AIRD on disease modifying anti-rheumatic drugs vaccinated in each flu season from 2006 to 2016 according to number of different types of DMARDs at the start of flu season. AIRD: autoimmune rheumatic diseases.