An audit to review the uptake of recommended vaccinations in patients with psoriasis prescribed immunosuppressing medications

ABSTRACT

Previous reports of vaccination uptake rates in dermatology patients are variable. The aim of this audit was to get an upto-date assessment from those attending our service. Future vaccination uptake rates and awareness are likely to be affected by the COVID-19 pandemic. This is one of the last and largest studies of this topic in the pre-COVID-19 era. Patients with psoriasis receiving immunosuppressants are at increased risk of developing infections, primarily respiratory tract infections. Published guidelines recommend that this cohort of patients receive both the influenza and pneumococcal (PPV23) vaccines. We conducted a survey of patients on systemic immunosuppressive medication for their skin disease attending our dermatology department. An audit was completed in August 2019 with a subsequent reaudit in February 2020. An intervention of advertising, staff education and vaccine promotion to patients during consultations was implemented between audits. The study was approved by the hospital audit review board. A total of 104 patients were recorded in August, with 98 recorded in February. Overall, the uptake of the influenza vaccine was 77% and 78% in the respective audits. There was an increase from 63% to 72% in the uptake of the PPV23 vaccine. Those receiving biological medications had a higher uptake of vaccinations than those receiving traditional systemic agents such as methotrexate (approximately 80% vs. 70% for influenza and 62% vs. 70% PPV23 in the respective audits). Over 95% of patients self-reported that they had been advised to acquire vaccinations by the dermatology team. This audit shows that vaccination rates are already high in this cohort of patients, supporting best practice in our centre. There is a tendency to be more compliant with recommendations if receiving a biological agent. There was a small but noticeable increase in uptake after our interventions. A similar French study showed a much lower uptake rate of 3- 25% {Bonhomme A, Freling E, Reigneau M et al. [Vaccination status in psoriasis patients on immunosuppressant therapy (including biologics)]. Ann Dermatol Venereol 2017;144 92-9 (in French)}. This audit represents one of the largest studies of this topic in dermatology patients.