Rheumatology expertise in advising immunocompromised healthcare workers: Insights from a survey of Australian rheumatologists

  • Dana Yen Lin Lee
    Central Clinical School, Monash University, Level 5, Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia
    Search for articles by this author
  • Marian Makary
    Department of Rheumatology, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
    Search for articles by this author
  • Anne Powell
    Corresponding author. Central Clinical School, Monash University, Level 5, Alfred Centre, 99 Commercial Road, Melbourne VIC 3004, Australia.
    Central Clinical School, Monash University, Level 5, Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia

    Department of Rheumatology, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Australia
    Search for articles by this author


      • Most rheumatologists manage immunocompromised healthcare workers (HCW).
      • The expectation remains with specialists to advise HCW on managing workplace infection risks.
      • There remains a level of discomfort amongst rheumatologists in providing these recommendations.
      • Colleagues were the most common source of guidance for managing immunocompromised HCW.
      • Frameworks needed to guide clinicians in making recommendations for immunocompromised HCW.



      Healthcare workers (HCW) with an inflammatory disease may be at increased risk of infections and their complications, however there is no evidence to guide specific measures to reduce the risk of immunocompromised HCW acquiring infection in the workplace. This cross-sectional study aimed to define the attitudes of rheumatologists and rheumatology trainees towards counselling immunocompromised healthcare workers about additional workplace precautions to minimise workplace risk of infection.


      A cross-sectional survey was administered via Zoom poll during a webinar held in August 2020. Participants were Victorian and Tasmanian members of the Australian Rheumatology Association, which includes consultant rheumatologists and rheumatology trainees. Descriptive statistics were used to analyse survey responses.


      Of the 52 participants, 41 provided care to at least one immunocompromised healthcare worker. 21 out of 52 participants estimated that the majority of these patients sought their advice about infection risk in the workplace. The most common source of information for counselling patients on workplace infection risks were colleagues (38/50). Participants were most confident in providing information on influenza and hepatitis but less confident in providing information in tuberculosis, shingles and COVID-19. Most participants believed employers of immunocompromised HCW should play a role in providing advice on managing infection risks in the workplace.


      Our study reveals a level of uncertainty and discomfort amongst rheumatologists in providing recommendations to immunocompromised healthcare workers about managing their workplace risk of infection. We recommend the development of a framework to guide the clinician in making individualised recommendations for immunocompromised HCW.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Infection, Disease & Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Singh J.A.
        • Wells G.A.
        • Christensen R.
        • Tanjong Ghogomu E.
        • Maxwell L.J.
        • MacDonald J.K.
        • et al.
        Adverse effects of biologics: a network meta-analysis and Cochrane overview.
        Cochrane Database Syst Rev. 2011;
        • Cohen S.B.
        • Tanaka Y.
        • Mariette X.
        • Curtis J.R.
        • Lee E.B.
        • Nash P.
        • et al.
        Long-term safety of tofacitinib for the treatment of rheumatoid arthritis up to 8.5 years: integrated analysis of data from the global clinical trials.
        Ann Rheum Dis. 2017; 76: 1253-1262
        • Furer V.
        • Rondaan C.
        • Heijstek M.W.
        • Agmon-Levin N.
        • van Assen S.
        • Bijl M.
        • et al.
        2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases.
        Ann Rheum Dis. 2020; 79: 39
        • National Health and Medical Research Council (NHMRC)
        Australian guidelines for the prevention and control of infection in healthcare.
        • Wan T.H.
        • Mok C.C.
        • Fong L.S.
        Prevalence and risk factors of serious infections in rheumatoid arthritis patients receiving the biologic/targeted synthetic DMARDs: a propensity score analysis.
        International Journal of Rheumatic Diseases. 2018; 21: 207-208
        • Mori S.
        • Yoshitama T.
        • Hidaka T.
        • Sakai F.
        • Hasegawa M.
        • Hashiba Y.
        • et al.
        Comparative risk of hospitalized infection between biological agents in rheumatoid arthritis patients: a multicenter retrospective cohort study in Japan.
        PLoS One. 2017; 12e0179179
        • Emery P.
        • Gallo G.
        • Boyd H.
        • Morgan C.L.
        • Currie C.J.
        • Poole C.D.
        • et al.
        Association between disease activity and risk of serious infections in subjects with rheumatoid arthritis treated with etanercept or disease-modifying anti-rheumatic drugs.
        Clin Exp Rheumatol. 2014; 32: 653-660
        • Au K.
        • Reed G.
        • Curtis J.R.
        • Kremer J.M.
        • Greenberg J.D.
        • Strand V.
        • et al.
        High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis.
        Ann Rheum Dis. 2011; 70: 785
        • Mehta B.
        • Pedro S.
        • Ozen G.
        • Kalil A.
        • Wolfe F.
        • Mikuls T.
        • et al.
        Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study.
        RMD Open. 2019; 5e000935
        • Belo C.
        • Naidoo S.
        Prevalence and risk factors for latent tuberculosis infection among healthcare workers in Nampula Central Hospital, Mozambique.
        BMC Infect Dis. 2017; 17: 408
        • Koh D.
        • Lim M.K.
        • Chia S.E.
        SARS: health care work can be hazardous to health.
        Occup Med. 2003; 53: 241-243
        • Bandyopadhyay S.
        • Baticulon R.E.
        • Kadhum M.
        • Alser M.
        • Ojuka D.K.
        • Badereddin Y.
        • et al.
        Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review.
        BMJ Global Health. 2020; 5e003097
        • Bourrier A.
        • Seksik P.
        • Gornet J.M.
        • DeWit O.
        • Nancey S.
        • Altwegg R.
        • et al.
        Risk of serious infection in healthcare workers with inflammatory bowel disease: a case-control study of the Groupe d'Etude Therapeutique des Affections Inflammatoires du tube Digestif (GETAID).
        Aliment Pharmacol Therapeut. 2018; 48: 713-722
        • Noorwali A.S.A.
        • Turkistani A.H.M.
        • Asiri S.I.
        • Trabulsi F.A.
        • Alwafi O.M.
        • Alzahrani S.H.
        • et al.
        Descriptive epidemiology and characteristics of confirmed cases of Middle East respiratory syndrome coronavirus infection in the Makkah Region of Saudi Arabia, March to June 2014.
        Ann Saudi Med. 2015; 35: 203-209
      1. Australian Government Department of Health. Coronavirus (COVID-19) advice for people with chronic health conditions [Available from: