Low vaccination uptake and attitudes towards COVID-19, influenza, and Streptococcus pneumoniae vaccines: a cross-sectional survey of patients with rheumatic diseases

Patients with immune-mediated inflammatory diseases (IMIDs) are at increased risk for vaccine-preventable infections (VPIs), yet vaccination uptake remains suboptimal in European countries. This is the first study that assessed vaccination rates, adverse events, and attitudes toward COVID-19, influenza, and S. pneumoniae vaccines among IMID patients in Croatia. We conducted a cross-sectional survey (May–October 2023) using an adapted and translated version of the COVID-Vaccination Attitude Scale (C-VAS) incorporating Health Belief Model (HBM) constructs. Adult IMID patients under rheumatology follow-up for ≥3 years at a tertiary centre were invited to participate. Data were verified against medical records. Descriptive statistics, Chi-square tests, and Mann–Whitney U tests compared vaccination status with sociodemographic variables and HBM constructs. 71 patients (median age 55 years; 73% female) were analysed. Vaccination rates were 69% for COVID-19, 35.2% for influenza, and 16.9% for S. pneumoniae. COVID-19, influenza, and S. pneumoniae infections were reported in 64.8%, 12.7%, and 4.2% of patients, respectively. Influenza vaccination was significantly associated with employment/retirement, age ≥50 years, and prior influenza infection. Vaccination against S. pneumoniae was more frequent in men. Adverse events were uncommon; serious vaccine-related events occurred only after COVID-19 vaccination (n = 2), whereas more severe complications followed infections. Vaccinated patients showed significantly higher perceived benefits, severity, and risk, and lower perceived barriers, across most HBM domains. In this study, uptake od influenza and S. pneumoniae was low among patients with IMIDs despite a favourable safety profile and more severe outcomes from infection than vaccination. Targeted education addressing perceived barriers and improving risk perception may increase vaccine uptake. Further randomized studies in IMID populations are warranted.