We have had many calls for advice about influnza risk and vaccination, so we have added the following advice as a guide:

1. Many rheumatic diseases may slightly lower your immunity to infection eg rheumatoid arthritis, SLE.

2. Drugs which may reduce your ability to fight infection include (this is not an exhaustive list)

• Steroids,
• Methotrexate,
• Leflunomide,
• Azathioprine,
• Biologic therapies (eg humira / adalimumab, enbrel / etanercept, remicade / infliximab, symponi / golimumab)

3. If you fall in to these groups vaccination is usually recommended. Your family doctor is best placed to discuss this with you.

4. If you have not been vaccinated and develop flu-like symptoms, early treatment with "Tamiflu" may be appropriate for some patients and we would suggest you present in less than 48 hours to your doctor to discuss this. Please do not contact the rheumatology office regarding Tamiflu.

5. Health Canada recommend the H1N1 vaccine; LINK to news release

6. Several patients have raised concerns over both efficacy (effectiveness) of vaccination, and safety.

• Data currently available suggest that patients on the therapies listed above are still able to develop an adequate response to vaccination
• Occasionally patients report a flare of their arthritis following vaccination but whether there is a true association in this small number of patients is not clear. This would not currently be a reason to avoid vaccination.
• In two reviews of efficacy (see Bandolier) The number needed to treat was 9.2 (7.8 to 11.1). This means that for every nine people given influenza vaccine, one avoided having influenza who would have had it if they had not been vaccinated. This is NOT the same vaccine as for H1N1 as data on efficacy do not currently exist, but it gives you an idea of efficacy.
• Vaccination does not guarantee that you will NOT get the 'flu, but reduces the risk to what is considered a worthwhile degree. Like many areas of medicine controversy exists regarding the potential reduction in mortality, but data support the view that if uptake of the vaccine is good there would be expected to be a reduction in mortality associated with H1N1.

7. Handwashing, cough / sneeze etiquette, and avoiding contact probably all play a role in prevention of infection, but the magnitude of risk reduction is impossible to measure.

THE BOTTOM LINE - Health Canada and the Canadian Rheumatology Association recommend vaccination in high risk groups and your family doctor will have the most up to date information to guide your decision