Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
Ruhr Universität Bochum, Bochum, Germany.
RMD Open. 2021 Apr;7(1). doi: 10.1136/rmdopen-2020-001499.
To evaluate the prevalence of infections, prevalence of hospitalisation due to infections, the vaccination status and perceived screening of infections prior to the start of biologic disease modifying antirheumatic drugs (bDMARDs) of a patient cohort with chronic inflammatory rheumatic diseases (CIRD).
Consecutive CIRD patients reporting to our specialised centre were prospectively included (n=975) in this cross-sectional study. Data on comorbidities including infections, treatment, vaccination status, screening for latent tuberculosis infection (LTBI) and hepatitis B (HepB) were collected. Antibodies against measles and HepB were measured by ELISA. The vaccination status was assessed by a predefined vaccination score (0-26) categorising patients into four immunisation states: low (0-6), moderate (7-13), good (14-20), high (21-26).
All patients on bDMARDs (n=499) were screened for LTBI, and 469 for HepB (94%). All LTBI patients (n=16) received isoniazid (3.2%) and 16 chronic HepB patients received lamivudine (3.4%). Protective measles specific IgG-antibodies were found in 901 patients (92.4%). Although 629 patients were educated about vaccination strategies (64.5%), only 540 showed a vaccination card (55.4%). Only 49% of patients had undergone pneumococcal vaccination and less than 30% were protected against HepB and influenza, while 7.6% have not protective antibody titres against measles. No patient met the German national vaccination recommendations requiring a complete documentation of vaccines. The mean vaccination score was 13.3±4.2 with 5.7% of patients having a low, 43.9% a moderate, 47.0% a good and 3.3% a high score.
The majority of CIRD patients are n0t sufficiently vaccinated against pneumococci, HepB, influenza and measles. Although CIRD patients and general practitioners regularly receive professional information about the need of vaccination, vaccination rates were low to moderate. Interdisciplinary quality projects should be planned to change that inacceptable result.
评估慢性炎症性风湿病（CIRD）患者队列在开始使用生物改善病情抗风湿药物（bDMARD）前感染的流行率、因感染住院的流行率、疫苗接种状况和感染筛查感知情况。
本横断面研究前瞻性纳入连续就诊于我们专科中心的 CIRD 患者（n=975）。收集合并症数据，包括感染、治疗、疫苗接种状况、潜伏性结核感染（LTBI）和乙型肝炎（HepB）筛查情况。通过酶联免疫吸附试验（ELISA）检测麻疹和 HepB 抗体。通过预定的疫苗接种评分（0-26）评估疫苗接种状况，将患者分为四个免疫状态：低（0-6）、中（7-13）、好（14-20）、高（21-26）。
所有接受 bDMARD 治疗的患者（n=499）均接受 LTBI 筛查，469 例患者接受 HepB 筛查（94%）。所有 LTBI 患者（n=16）接受异烟肼（3.2%）治疗，16 例慢性 HepB 患者接受拉米夫定（3.4%）治疗。901 例患者（92.4%）麻疹特异性 IgG 抗体呈保护性。尽管 629 例患者接受了疫苗接种策略教育（64.5%），但只有 540 例患者出示了疫苗接种卡（55.4%）。仅 49%的患者接受了肺炎球菌疫苗接种，不到 30%的患者对 HepB 和流感有保护作用，而 7.6%的患者麻疹保护性抗体滴度不足。没有患者符合德国国家疫苗接种建议，需要完整记录疫苗接种情况。平均疫苗接种评分 13.3±4.2，5.7%的患者接种状况差，43.9%中等，47.0%良好，3.3%高。
大多数 CIRD 患者未充分接种肺炎球菌、HepB、流感和麻疹疫苗。尽管 CIRD 患者和全科医生经常收到关于接种疫苗必要性的专业信息，但接种率较低且处于中等水平。应计划开展跨学科质量项目，以改变这种不可接受的结果。
