# Assessing the Vaccination Status and Barriers to Influenza, Pneumococcal, and COVID-19 Vaccination Among Moroccan Patients With Chronic Inflammatory Rheumatic Disease

## TL;DR

This study finds that Moroccan patients with chronic rheumatic diseases are under-vaccinated against influenza and pneumococcus, and hesitant about the COVID-19 vaccine due to lack of doctor recommendations and fear of side effects.

## Contribution

The study provides insights into vaccination coverage and hesitancy factors specific to Moroccan patients with chronic inflammatory rheumatic diseases.

## Key findings

- Only 2.2% of patients were vaccinated against influenza and 0.4% against pneumococcus.
- Fear of vaccine side effects, especially flare-ups of rheumatic disease, was the main reason for avoiding the COVID-19 vaccine.
- Lack of doctor recommendations was the primary cause for not getting influenza and pneumococcal vaccines.

## Abstract

Objective: To evaluate the vaccination coverage of patients with chronic inflammatory rheumatic disease (CIRD) against influenza, pneumococcus, and COVID-19 and to determine, per the patients' point of view, the possible factors related to vaccination hesitation and/or refusal.

Methods: A cross-sectional study carried out by the vaccination working group of the Moroccan Society of Rheumatology, including patients with CIRD in Morocco. Information about vaccination coverage and reasons for non-vaccination against influenza, pneumococcal infection, and COVID-19 was collected.

Results: This survey included 230 patients (mean age of 46.9 +/-13.89 years; 68.7% females) affected by CIRD (rheumatoid arthritis 53%, spondyloarthritis 39.6%, psoriatic arthritis 7%). The study shows a significant lack of influenza and pneumococcal vaccination in CIRD patients, with vaccination coverage against influenza, pneumococcal infection, and COVID-19 at 2.2%, 0.4%, and 80.9%, respectively. The main reason for non-vaccination against influenza and pneumococcus was related to the absence of recommendations by their doctors (77%, 87%, p = 0.04). Additionally, the primary reason for non-vaccination against COVID-19 was the fear of the vaccine's side effects (51%, p = 0.0001), mainly a flare-up of CIRD (44%, p = 0.001).

Conclusion: This survey shows a lack of influenza, pneumococcal, and COVID-19 vaccination in CIRD patients. The principal actions to improve vaccination should aim to educate patients and encourage rheumatologists to vaccinate their patients.