Vaccination survey in patients with rheumatoid arthritis: a cross-sectional study

Rheumatol Int. 2012 Jun;32(6):1533-9. doi: 10.1007/s00296-011-1808-z. Epub 2011 Feb 15.


The objective of this study is to evaluate the vaccination status in rheumatoid arthritis (RA) patients during routine clinical practice, data from a German non-interventional cross-sectional study. In this prospective study, patients with rheumatoid arthritis were interviewed using a standardized questionnaire focusing on vaccination. Available vaccination documents were evaluated, and titers for common vaccination antigens (hepatitis B, rubella, mumps, measles, diphtheria, tetanus) were analyzed with special regard to the underlying treatment and age of patients. A total of 301 RA patients treated with conventional DMARDs alone (cohort I, n = 125), TNF-blocking agents (cohort II, n = 117), or B-cell depletion with rituximab (cohort III, n = 59) have been studied. Significantly more patients in the biologic cohorts II and III were aware of an increased risk of infections (I: 67.7%, II: 83.8%*, III: 89.9%*, P < 0.05). Pneumococcal vaccination rate was significantly higher (I: 20.2%, II 36.8%* and III: 39.0%*, P < 0.05) compared with cohort I. Differences were less evident for influenza. Significantly more patients ≥60 years of age have been vaccinated against Streptococcus pneumoniae and influenza. An obvious discrepancy existed between vaccination awareness and actual vaccination rates for all cohorts. No significant differences in vaccination titers could be seen between the three cohorts. Awareness of infectious complications was more present in patients treated with biologicals, and also, the rate of patients vaccinated against Streptococcus pneumoniae increased significantly depending on the underlying treatment. Nevertheless, there was a discrepancy between vaccination awareness and actual vaccination rates for all cohorts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analysis of Variance
  • Antirheumatic Agents / adverse effects
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / immunology
  • Awareness
  • Bacterial Infections / immunology
  • Bacterial Infections / microbiology
  • Bacterial Infections / prevention & control*
  • Bacterial Vaccines / administration & dosage*
  • Bacterial Vaccines / adverse effects
  • Communicable Disease Control / methods*
  • Cross-Sectional Studies
  • Diphtheria-Tetanus Vaccine
  • Germany
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice
  • Hepatitis B Vaccines
  • Humans
  • Influenza Vaccines
  • Measles-Mumps-Rubella Vaccine
  • Middle Aged
  • Pneumococcal Vaccines
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Surveys and Questionnaires
  • Vaccination* / adverse effects
  • Viral Vaccines / administration & dosage*
  • Viral Vaccines / adverse effects
  • Virus Diseases / immunology
  • Virus Diseases / microbiology
  • Virus Diseases / prevention & control*


  • Antirheumatic Agents
  • Bacterial Vaccines
  • Diphtheria-Tetanus Vaccine
  • Hepatitis B Vaccines
  • Influenza Vaccines
  • Measles-Mumps-Rubella Vaccine
  • Pneumococcal Vaccines
  • Viral Vaccines