# Patients with immune mediated inflammatory diseases are insufficiently protected against vaccine-preventable infections

## TL;DR

Patients with immune diseases on immunosuppressive therapy are not being vaccinated as recommended, especially for measles and diphtheria/tetanus/polio.

## Contribution

This study reveals a significant gap in vaccination adherence among immunosuppressed patients with immune-mediated inflammatory diseases.

## Key findings

- Only 2% of at-risk patients were vaccinated for measles before immunosuppressive therapy.
- 4% of patients were vaccinated for diphtheria/tetanus/polio before starting therapy.
- 62% of patients received annual influenza vaccines, and 91% were fully vaccinated against COVID-19.

## Abstract

Patients with Immune Mediated Inflammatory Diseases (IMIDs) using immunosuppressive therapy are at increased risk of infections, including vaccine-preventable infections. In this study, we aimed to evaluate whether patients with IMIDs on systemic immunosuppressive therapy are vaccinated according to current guidelines.

A survey was sent out, between August 2022 and March 2023, to all patients with IMIDs that visited the departments of dermatology, rheumatology and gastroenterology at an academic and regional hospital in Rotterdam, the Netherlands. Patient-reported vaccination status was compared to the Dutch guidelines on vaccinations in patients with chronic inflammatory diseases.

A total of 1,905/5,987 patients responded to the survey (response rate 32%). After exclusion of patients without systemic immunosuppressive medication, the study population comprised 1,390 patients, median age 56 years (IQR 42–66) and 41% male. Most patients (92%) had been vaccinated according to the Dutch National Immunization Program. Before starting immunosuppressive therapy, 2% of the patients who were still considered at risk according to the Dutch guideline were vaccinated for measles, and 4% for diphtheria/tetanus/polio (DT-IPV). Additionally, 62% of patients received an annual influenza vaccine, 16% received a five-yearly pneumococcal vaccine, and 91% were fully vaccinated against COVID-19.

Patients with IMIDs on immunosuppressive therapy are not vaccinated in accordance with the guidelines. Implementation strategies to improve the vaccination rates for patients with IMIDs should specifically focus on vaccinating against measles and diphtheria/tetanus/polio, and periodic vaccination against pneumococcal and influenza infections.

The online version contains supplementary material available at 10.1007/s15010-024-02373-z.