Coronavirus disease 2019 vaccination uptake and hesitancy among Polish patients with inborn errors of immunity, autoinflammatory syndromes, and rheumatic diseases: A multicenter survey

Abstract

Data regarding the willingness of patients affected by inborn errors of immunity to accept vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. Therefore, this study assessed SARS-CoV-2 vaccination coverage and hesitancy in immunodeficient patients by surveying adults with primary immune deficiencies and autoinflammatory and rheumatic diseases on biologic therapy. The study was conducted from September 20, 2021, to January 22, 2022, when the primary coronavirus disease 2019 (COVID-19) vaccinations were available to all adults in Poland. We included 207 participants consecutively recruited from five referral centers (57% female; median age: 42.6 [range: 18–76, standard deviation ± 14.70] years). Overall, 55% (n = 114), 17% (n = 36), and 28% (n = 57) of the patients had primary immune deficiencies, autoinflammatory diseases, and rheumatic diseases, respectively. Among the entire cohort, 168 patients (81%) were vaccinated, and 82% were willing to receive a booster dose. Patients with autoinflammatory diseases had the highest vaccination rate (94.4%). A strong conviction that it was the correct decision (72%), fear of getting COVID-19 (38%), and expert opinions (34%) influenced the decision to vaccinate. Among the unvaccinated patients, 33.3% had primary or vocational education (p <0.001). Furthermore, only 33% believed they were at risk of a severe course of COVID-19 (p = 0.014), and 10% believed in vaccine efficacy (p <0.001). They also doubted the safety of the vaccine (p <0.001) and feared a post-vaccination flare of their disease (p <0.001). Half of the unvaccinated respondents declared that they would consider changing their decision. Vaccination coverage in immunodeficient patients was higher than in the general Polish population. However, the hesitant patients doubted the vaccine’s safety, feared a post-vaccination disease flare, and had primary or vocational education. Therefore, vaccination promotion activities should stress personal safety and the low risk of disease flares due to vaccination. Furthermore, all evidence must be communicated in patient-friendly terms.

COVID-19 vaccination in patients with primary immunodeficiencies: an international survey on patient vaccine hesitancy and self-reported adverse events

“…Our data on hesitancy are similar as reported by other immunocompromised patients, i.e. systemic rheumatic disease ( 12 , 14 ). We hypothesize that advice to wait was most given awaiting further evidence on efficacy and safety of these novel vaccines in patients with PID.…”

“…This knowledge and the observations regarding patient hesitancy highlight the necessity of education of physicians and nurses about the efficacy and safety of COVID-19 vaccination to patients with PID, which is also pointed out in other studies ( 11 , 12 ; Squire, Avni, and Joshi, n.d.; 15 ).…”

“…In addition, a strong correlation was found between hesitancy and primary or vocational education. The patients that had decided to get vaccinated against COVID-19 had a fear of getting sick with COVID-19 and reported that they felt it was the correct decision and that they had been supported in their decision from experts and relatives ( 12 ).…”

Do Not Leave Your Patients in the Dark—Using American College of Rheumatology and European Alliance of Associations for Rheumatology Recommendations for Vaccination in Polish Adult Patients with Autoimmune Inflammatory Rheumatic Diseases

“…The low vaccination rate among AIIRD patients found in our study is not surprising in this context but fits into the available literature data. The vaccination rate among AIIRD patients varies between different countries and is between 1.5 and 92.4% for influenza vaccines [6,7,, 5.8 and 71.2% for the pneumococcal vaccine [13,[15][16][17][18][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]37,38,[41][42][43][44][45][46], 24.3 and 83.7% for tetanus vaccination (booster within 10 years) [26,27,29,33,41,42], and 35.8 and 98.1% for the COVID-19 vaccine (following the recommendations applicable at the time of this study) [6,[40][41][42][43][47][48][49]. An additional problem is the fact that vaccination coverage in Polish AIIRD patients is comparably low as in the general Polish population, even though AIIRD patients constitute a group of particular ...…”

“…There is a lack of epidemiological data on the vaccination status of AIIRD patients in Poland. According to a small study of 57 patients with AIIRD, vaccination coverage in this group may be higher than in the general population-78.9% of AIIRD patients were vaccinated against COVID-19 (primary schedule) and 31% against influenza [6]. However, apart from the fact that this study included a very small group of patients, it was conducted during the COVID-19 pandemic.…”