# Impact of the 2023/24 Influenza Vaccination on Patients with Inflammatory Rheumatic Disease in Germany: Insights from a Nationwide, Longitudinal, Self-Reported Study

## TL;DR

This study found that the 2023/24 flu vaccine was safe and well-tolerated by most patients with inflammatory rheumatic diseases in Germany, with few side effects and no severe complications.

## Contribution

The study provides real-world evidence on the safety and effectiveness of the 2023/24 influenza vaccine in a large cohort of inflammatory rheumatic disease patients.

## Key findings

- 50% of patients experienced injection site pain, but 41% reported no side effects.
- Only 5% of patients experienced IRD flares, with 1% needing changes to immunomodulation.
- Spondyloarthritis patients had higher susceptibility to influenza, and prior flare-ups predicted infections.

## Abstract

Background: Patients with inflammatory rheumatic diseases (IRD) are susceptible to influenza infections and their complications. However, they may avoid vaccination for fear of exacerbating their IRD. This study evaluates the 2023/24 influenza vaccine in IRD patients, aiming to provide recommendations for this group in the upcoming season. Methods: In this prospective, longitudinal study, we assessed the self-reported impact of influenza vaccination on patients with IRD. Participants were recruited nationwide between October and December 2023 and completed an online questionnaire after vaccination as well as at three and six months of follow-up. Results: Among 633 patients, 87.5% were female, with a median age of 50.4 (18–84) years. Post-vaccination, 50% experienced injection site pain; 41% reported no side effects. IRD flares occurred in 5%, with 1% requiring changes to immunomodulation. Among 428 patients with follow-up, influenza infections were reported in 38 patients (8.9%), including 10 (2.3%) with reinfections. No severe cases requiring hospitalization were reported. Spondyloarthritis patients had higher susceptibility to influenza (p = 0.002), accounting for 55.3% of infections. IRD flare-ups in the 12 months before vaccination predicted infections (p = 0.002). Conclusions: The 2023/24 vaccine was well tolerated by IRD patients, with no impact on the course of the disease in 95% of cases. Only 9% of patients reported influenza infections, none of which were severe. In light of these findings, physicians are advised to recommend vaccination to eligible IRD patients prior to or in the respective season.