Many Lupus Patients Reject Vaccinations, German Research Shows

More than one-third of German patients with systemic lupus erythematosus (SLE) did not get vaccinated, largely due to fear of developing a lupus flare or negative side effects related to the vaccines, a new study shows.

The study, “Vaccination coverage in systemic lupus erythematosus—a cross-sectional analysis of the German long-term study (LuLa cohort),” was published in the journal Rheumatology.

Infections are a significant issue for patients with SLE, contributing to more than one-third of SLE-related deaths during the past decade. One of the major reasons for the higher rate of infections is that SLE patients are administered immunosuppressive therapies, which inhibits their immune system.

While new and evolving treatments are needed to help prevent infections, one method is to avoid specific infections through the use of vaccinations. The German Society for Rheumatology has released recommendations for the use of vaccination in adults with chronic inflammatory rheumatic diseases, including SLE.

Despite these recommendations, vaccination rates are not reaching the intended targeted rate. The reasons behind this lack of vaccination coverage in patients with SLE is not known.

So, researchers set out to determine the rates of selected vaccinations in a sample of German SLE patients, as well as to identify the reasons behind non-vaccination.

Results were obtained from a self-reported survey conducted in 2013 in 579 SLE patients. The survey included information on rates of selected vaccinations, demographics, clinical parameters, and health beliefs.

Researchers found that vaccination coverage across the SLE group was low for all recorded vaccines — including tetanus, influenza, pneumococcus, and meningococcus.

Overall, 57.3 percent of patients had their vaccination status checked by their general practitioner. In some cases, however, the vaccination status was checked by an internist, rheumatologist or other specialist.

A quarter of SLE patients (24.9 percent) did not get their vaccination status checked at all. This suggests that a significant percentage of physicians are not emphasizing the benefits of vaccines to their patients.

In fact, 16.1 percent of patients had been advised against the use of vaccinations by a physician.

Importantly, 37.5 percent of patients said they had rejected vaccinations themselves. Among them, 21.8 percent did not get vaccinated due to a fear of developing lupus flare, and 13.5 percent feared that the vaccination would lead to negative side effects. Only a few patients doubted the protective effect of vaccines or thought the vaccines would lead to a weakening of the immune system.

As expected, patients who had a greater belief in the doctor’s ability to control their health and believed in the general benefit of medication were more likely to get vaccinated. Older patients also were more likely to receive the influenza and pneumococcal vaccinations.

“Vaccination coverage in SLE patients is poor and reflects insufficient implementation of national and international recommendations,” the investigators concluded. “Rheumatologists need to recognize patients’ reservations against vaccinations, to communicate their importance and safety and to give individual recommendations to patients and their healthcare providers.”